Incidental Pre-Authorization Requests

Incidental expenses are temporary expenses incurred to facilitate the continuation of treatment and stabilization in the community when no other resources are available. All incidental expenses higher than $500 shall be authorized by CFCHS only to the extent that they are reasonable, allowable, and necessary as determined through the individual’s treatment plan. CFCHS will only authorize expenses for individuals admitted under CFCHS funded programs. This does not include outreach specific programs; these must be programs where the individual is receiving person specific services. Please complete and submit all requests using the following form:


Incidental/Residential Pre-Authorization Request Form

The following links are form field descriptions and the incidental procedure codes when completing the form above:

 Descriptions of Required Fields in Pre-Authorization Request Form

 Incidental Procedure Codes

For any questions or concerns on the pre-authorization process, you may contact:

Incidental Expenses, Transitional Vouchers – Miralys Martinez, Risk Management Specialist, email:

Forensic Residential – Michelle Arroyo, Forensic Coordinator, email:

Civil State Hospital – Stephanie Smith, System of Care Manager, email:

PRTS – Elisa Bustamante, Children’s Behavioral Specialist, email:

Incidental Expense Pre-Authorization Policy