Reminder: No Prior Authorization Required for OT/PT/ST Therapy Services for Children Ages 2 Years and Under
Date: 09/08/23
Fort Lauderdale, Florida
No prior authorization is required for therapy services for children under the age of 3 years for MMA, Child Welfare Specialty Plan (CWSP), Serious Mental Illness (SMI) and Children’s Medical Services (CMS) Health Plan. A member’s care is governed by their Plan of Care (POC).
Please note the differences between CMS Health Plan and all other Medicaid products:
MMA/SMI/CWSP
Occupational Therapy (OT), Physical Therapy (PT) and Speech-Language Therapy (ST) authorizations for children ages 3 years old and up must be submitted to the Therapy Network of Florida (TNFL). Members ages 2 years old and under are managed by Sunshine Health.
If a member has an active POC when they turn 3 years old, Sunshine Health will continue to manage OT/PT/ST services until the expiration date. Once the POC expires, a new authorization request must be submitted to TNFL for additional therapy services.
CMS Health Plan
Sunshine Health manages OT/PT/ST services for CMS Health Plan members. However, please remember that authorizations are not required for members under the age of 3 years old. After a member’s 3rd birthday and their POC has ended, prior authorization should be sent directly to Sunshine Health for review and processing.
For More Information
Visit Sunshine Health Therapy Program for more information, important links and Frequently Asked Questions (FAQ).
Questions?
If you have questions, please contact your Provider Engagement Administrator by selecting the county of your organization’s main office. You can also call Sunshine Health Provider Services at 1-844-477-8313 or visit the Secure Provider Portal. Stay up to date on Sunshine Health provider notices by reviewing and bookmarking Provider News.
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