Sunshine Health Therapy Program
Sunshine Health offers multiple therapy benefits (PT/OT/ST) to its members. Read more about the team of vendors and authorization requirements.
Medicaid, Serious Mental Illness Specialty Plan and Child Welfare Specialty Plan
Sunshine Health contracts with Health Network One (HN1) to manage its therapy program. HN1 contracts providers under Therapy Network of Florida (TNFL).
TNFL administers 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 years and above enrolled in Sunshine Health. Members ages 0-2 years old are managed by Sunshine Health.
The following services are excluded:
- Members ages 0-2 years*
- Children's Medical Services (CMS) Health Plan
- Long Term Care
- Early Intervention Services (EIS)
- Prescribed Pediatric Extended Care (PPEC) locations
- Outpatient (Hospital)
*Note: Members are managed by TNFL on the date of their 3rd birthday. Existing plans of care that extend past a member’s 3rd birthday will continue to be managed by Sunshine Health until completion.
Children’s Medical Services Health Plan
Sunshine Health handles authorizations for therapy services for CMS Health Plan members. An authorization is required for members 3 and older.
Frequently Asked Questions (FAQ)
We have outlined some Frequently Asked Questions (FAQs) below.
An authorization is not required for MMA, SMI, CW, and CMS member ages 0-2.
- An authorization is required for members 3 and older.
- If an MMA, SMI, or CW member has an active Plan of Care when they turn 3 years old, Sunshine Health will continue to manage PT/OT/ST services. Once the Plan of Care expires, a new authorization request should be submitted to TNFL for these members.
- Participating TNFL therapy providers should continue to obtain authorizations via the TNFL Provider Web Portal. To reference full guidelines for authorization requests, please reference the Provider Resources page in the TNFL Provider Manual (PDF).
- Non-participating TNFL providers may submit authorization requests via fax at 1-855-410-0121.