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New Child Welfare Value-Based Incentive Program: Trauma-Focused Evidence Based Practice

Date: 04/12/21

Fort Lauderdale, Florida

Sunshine Health is committed to supporting your efforts to provide the highest quality of care for our members. We are excited to announce the 2021 Incentive Model for Foster Care Providers Trained in Evidence-Based Treatment Models for the foster care-enrolled population.

This shared savings program incentivizes therapists who are certified in and are using the evidence-based treatment model, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). Based on a healthcare analytics study conducted by Centene, Sunshine Health’s parent company, this treatment model showed improvement in quality outcomes for members treated by these skilled clinicians.

To encourage continued use of evidence-based treatment models, Sunshine Health has determined that TF-CBT will qualify for incentivized payment programming.

TF-CBT Incentive Program Details:

  • Providers must use the evidence-based model with foster care members and bill with the specific claims modifiers below:

TF-CBT Incentive Program

Billing Code

Modifier

90832

U1

90834

U1

90837

U1

90846

U1

90847

U1

90833

U1

90836

U1

90838

U1

H2019 HO*

U1

H2019 HR*

U1

*For H2019, bill U1 modifier AND one of the two modifiers above (HO or HR).

  • You will receive a quarterly scorecard outlining your performance based on member outcomes in the cost categories listed below.
  • In year two, Centene will repeat its healthcare analytics study and determine if there are marked improvements for members treated with this evidence-based model versus comparable members who are not treated with this model. This study will look at the following cost categories:
    • Emergency department
    • Inpatient
    • Outpatient
    • Pharmacy
    • Primary Care Physician
    • Specialist
  • A one-time payout will be awarded in Q4 of the following measurement year.
  • Since this is a self-funded program, the amount of the incentive will be calculated when the annual analysis is completed following the specified measurement period.
  • Sunshine Health will share a percentage of the generated savings back to the participating provider as long as the provider is in good standing with the plan.

Note: Participation in the program for foster care providers certified in TF-CBT may result in a request for medical records. The requests may be part of an internal health plan, state, or federal audit.   

Thank you for being our partner in improving our members’ health outcomes. If you have additional questions, please call Provider Services at 1-844-477-8313.