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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

ATA-FL 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 ATA-FL 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 ATA-FL 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 an ATA-FL 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.

Provider Webinars

Frequently Asked Questions (FAQ)

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

  • ATA-FL has been selected to continue to 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.
  • eviCore has been selected to continue to administer therapy Utilization Management (PT/OT/ST) services in outpatient locations, including speech therapy for Children’s Medical Services (CMS) Health Plan members, which will be operated by Sunshine Health as of Oct. 1, 2021.
  • Long-Term Care (LTC)
  • Medicare
  • Children’s Medical Services (CMS) Health Plan
  • Members ages 0-2 (Note: Members will be managed by ATA-FL on the date of their 3rd birthday)
  • Early Intervention Services (EIS)
  • Prescribed Pediatric Extended Care (PPEC)
  • Outpatient hospitals 
  • MMA – Medicaid
  • SMI – Serious Mental Illness Specialty Plan
  • CW - Child Welfare Specialty Plan
  • Long-Term Care (LTC)
  • Medicare
  • Network
  • Claims

No. Members will not experience any changes to their therapy benefits.

Please submit your authorization request through Sunshine Health’s Secure Provider Portal.

Participating ATA-FL therapy providers should continue to obtain authorizations via the ATA-FL Provider Web Portal. To reference full guidelines for authorization requests, please reference the Provider Resources page in the online ATA-FL Provider Manual.

Non-participating ATA-FL providers may submit authorization requests via fax at 1-855-410-0121.

Please submit your authorization request through eviCore’s Secure Provider Portal.

Providers wishing to service these members can Join Our Network. Sunshine Health will reach out to you regarding participation after you provide the requested information.

Call ATA-FL at 1-888-550-8800 and enter the extension of the representative below in your area. You may also dial the toll-free number and select Option 2 to speak with an in-house Provider Relations Representative.

  • Regions 1, 2, 3, 5: Rosanna Briggs, Ext: 4215
  • Region 4 and Seminole, Orange, Brevard, Indian River, Okeechobee, St. Lucie and Martin counties: Paula Powell, Ext: 4711
  • Regions 6, 8 and Osceola and Palm Beach Counties: Ana Rios, Ext: 4604
  • Regions 10, 11: Luis Martinez, Ext: 4223

To find the region you are in, you may access a FL Medicaid Regions map (PDF)

MMA and SMI members ages 0-2; non-covered ATA-FL services; Children’s Medical Services (CMS) Health Plan members

No, you do not need to obtain a new authorization. You may continue to treat members through the end of the COC period up to 120 days.

If an authorization expires during the course of the 120 day COC period, providers must request an additional authorization for the remainder of the COC period from Sunshine Health via the Secure Provider Portal.  If the member requires treatment after the COC period, the provider must be contracted with Sunshine Health.

MMA and SMI members ages 3 and above

 

No, you do not need to obtain a new authorization. You may continue to treat members through the end of the COC period up to 120 days.

If you are not a participating ATA-FL therapy provider, you may continue to treat members through the end of the COC period up to 120 days.  If an authorization expires during the course of the 120 day COC period, non-participating providers must request an additional authorization from ATA-FL via fax at 1-855-410-0121 for the remainder of the COC period.  If the member requires treatment after the COC period, the provider must be contracted with ATA-FL.

Ages 0-2

No, you do not need to obtain a new authorization. You may continue to treat members through the end of the COC period up to 120 days.

If an authorization expires during the course of the 120 day COC period, providers must request an additional authorization for the remainder of the COC period from Sunshine Health via the Secure Provider Portal.  If the member requires treatment after the COC period, the provider must be contracted with Sunshine Health.

Ages 3 and above

No, you do not need to obtain a new authorization. You may continue to treat members through the end of the COC period up to 120 days.

If you are not a participating ATA-FL therapy provider, you may continue to treat members through the end of the COC period up to 120 days.  If an authorization expires during the course of the 120 day COC period, non-participating providers must request an additional authorization from ATA-FL via fax at 1-855-410-0121 for the remainder of the COC period.  If the member requires treatment after the COC period, the provider must be contracted with ATA-FL.

MMA, SMI, and CW ages 0-2; non-covered ATA-FL services; Children’s Medical Service (CMS) Health Plan members

Follow the normal claims submission guidelines as documented in the Sunshine Health Provider Manual (PDF). 

MMA, SMI, and CW ages 3 and above

Follow the normal claims submission guidelines as documented in the ATA-FL Provider Manual.

If a member turns age 3 during active treatment with an open authorization with Sunshine Health, claims should be submitted to Sunshine Health until that authorization expires.