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Intermittent Skilled Nursing Code Changes

Date: 09/06/23

Fort Lauderdale, Florida

Sunshine Health is changing the codes and units in the Long Term Care (LTC) Agreement for Intermittent Skilled Nursing services to align with the Statewide Medicaid Managed Care Long-Term Care Program Coverage Policy.

Pursuant to the “Amendment” provision of the Agreement, the code change for Intermittent Skilled Nursing services is set to take effect on October 1, 2023, unless you object in writing within 30 days from the date of this letter. If you do not send a written objection, the code and unit change for specified Intermittent Skilled Nursing services will replace the current Intermittent Skilled Nursing services codes and rates in the Agreement effective October 1, 2023. Please note, this does not change the payment rate but converts it into 15-minute units.

To align with the SMMC-LTC Program, we are moving away from S9123 and S9124 for the LTC population. These codes are being replaced with T1002 and T1003. In addition, we want to ensure you are aware that T1002 and T1003 are configured as “per 15 minutes.” As you report and bill your electronic visits via the HHAeXchange portal, please ensure that your EDI vendor is aware of this update. Both codes are configured as per 15 minutes or 4 units = 1hour.

If you have any questions, please contact the Sunshine Health Contracting Department at SunshineContracting@SunshineHealth.com.

AMENDMENT

This Amendment ‌‪‌ (“Amendment”) is entered into as of October 1, 2023, (the “Amendment Effective Date”), by and between Sunshine State Health Plan, Inc.‌‪‌ (“Health Plan‌‪‌”) and <PROVIDER_NAME> (“Provider”), collectively referred to herein as the “Parties.”

WHEREAS, Health Plan and Contracted Provider are parties to that certain network participation agreement in effect (as amended, the “Agreement”) for the provision of health care services to Health Plan Members; and

 

WHEREAS, the Parties desire to amend the Agreement;

NOW THEREFORE, in consideration of the promises and mutual covenants herein contained, the Parties agree as follows, as applicable to the Agreement:

Skilled Nursing Codes

Service Category

Identifier Codes

Per Unit

Contracted Rate

Intermittent Skilled Nursing-RN

T1002

Per 15 Minutes

$______

Intermittent Skilled Nursing-LPNT1003Per 15 Minutes$______
  1. The existing Intermittent Skilled Nursing codes, S9123 and S9124, are hereby deleted from the Agreement and replaced with the above.
  2. All other terms and conditions of the Agreement and any amendments thereto, if any, shall remain in full force and effect. If the terms of this Amendment conflict with any of the terms of the Agreement, the terms of this Amendment shall prevail.

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