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Clarification: No Change to Existing Expressive Therapy (ET) Authorizations

Date: 07/09/25

HCBS Therapy Providers,

We wanted to provide additional clarification on the communication below. There won’t be any changes applied to existing authorizations. The limit of one expressive therapy session per week per therapy type will apply only to new authorizations and recertifications created July 1, 2025, or beyond to align with standard of care and general clinical practice guidelines.  More intensive needs for expressive therapy will be reviewed for clinical necessity as needed.

Previous Communication:

Expressive Therapy (ET) Services: 1 Unit = 1 Session/Visit

When seeking authorization to treat Sunshine Health members, providers must request authorization in units.

Thus, 1 unit = 1 session/visit. This session is not time-based.

For example: A provider requesting 100 units over three months correlates to 100 sessions or visits over that three-month period.

The standard of care for ET sessions typically involves weekly sessions/visits per therapeutic modality. However, the frequency can vary based on individual needs and the specific therapy approach used.

To ensure authorization requests are completed per Medicaid guidelines, please submit the correct code per session/visit. Submitting incorrect requests could delay ET services or result in denial of services.

Following this guidance will help Sunshine Health better serve art, equine and pet therapy providers so they can better serve our members.

What products does this apply to?

  • Sunshine Health Medicaid (MMA)
  • Comprehensive Long Term Care (LTC)
  • Sunshine Health Pathway to Shine Child Welfare Specialty Plan (CWSP)
  • Sunshine Health Mindful Pathways Serious Mental Illness Specialty Plan (SMI)
  • Sunshine Health Power to Thrive HIV/AIDS Specialty Plan (HIV)
  • Children’s Medical Services (CMS) Health Plan

Questions?

Sunshine Health has a wealth of resources available to help answer your questions and address your concerns:

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