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Sunshine Health Therapy Program

As a result of integration of Sunshine Health and Staywell Health Plan, Sunshine Health has a new therapy program, effective Oct. 1, 2021.

Medicaid, Serious Mental Illness Specialty Plan and Child Welfare Specialty Plan

Therapy Network of Florida (TNFL) will administer therapy services at outpatient free standing facilities for Sunshine Health’s Medicaid (MMA), Serious Mental Illness (SMI) Specialty Plan and Child Welfare (CW) Specialty Plan members ages 3 and above enrolled in Sunshine Health as of Oct. 1, 2021. Member ages 0-2 will be managed by Sunshine Health.

The following services are excluded:

  • Members ages 0-2 (Note: Members will be managed by Therapy Network of Florida (TNFL) on the date of their 3rd birthday)
  • Children’s Medical Services (CMS) Health Plan
  • Long Term Care
  • Medicare
  • Early Intervention Services (EIS)
  • Prescribed Pediatric Extended Care (PPEC) locations
  • Outpatient (Hospital)

During this change period, members can keep getting services that were already approved through the Continuity of Care period, even if the provider is not in the Therapy Network of Florida (TNFL) network.

  • Sunshine Health members can keep going to the same provider for up to 120 days.
  • Transitioning Staywell members can keep going to the same provider for up to 120 days.

After the Continuity of Care period, members will need to get services through a Therapy Network of Florida (TNFL) network provider.

Please be assured that approved and active authorizations for services will be paid according to your existing participating provider agreement during the Continuity of Care period.

Children’s Medical Services Health Plan

eviCore will administer therapy Utilization Management (PT/OT/ST) services in outpatient locations, including speech therapy for members of Children’s Medical Services (CMS) Health Plan, which will be operated by Sunshine Health as of Oct. 1, 2021.

Frequently Asked Questions (FAQ)

We have outlined some Frequently Asked Questions (FAQs) below regarding this change and how it affects you.