Early Intervention Services
- Sunshine Health covers Early Intervention Services and Child Health Services Targeted Case Management for members receiving services through the Early Steps program.
- Beginning April 1, 2020, Sunshine Health will also cover Physical, Occupational and Speech Therapy provided through the Early Steps program without authorization.
Sunshine Health covers the following services when listed on a member’s Individualized Family Service Plan (IFSP) and rendered through an Early Steps program-approved provider:
- All services listed in the Florida Medicaid Early Intervention Services Coverage Policy
- Targeted Case Management for Early Steps Providers as specified in the Florida Medicaid Child Health Services Targeted Case Management Coverage and Limitations Handbook (T1017TL)
- Therapy services listed in the Florida Medicaid Physical, Occupational and Speech Language Pathology coverage policies when billed with the TL
At this time, Sunshine Health will not require prior authorization for Early Intervention Services and Targeted Case Management for Early Steps Providers (T1017 TL), or Physical, Occupational, or Speech Therapy services when rendered by a provider on the EIS Provider Master List and billed with the TL modifier. Instead, Sunshine Health will perform a post payment review of services using the IFSP.
Yes, Sunshine Health reimburses for EIS, EIS TCM and EIS Therapy services to be provided in the natural environment. We will pay these providers at 100% of the applicable Florida Medicaid Fee Schedule for these services.
Providers who are still in the contracting process can submit a claim through any available mode except the provider portal. Providers who have completed the contracting process and are part of the Sunshine Health network can submit claims through any available mode. Please reference Provider Resources. Sunshine Health’s current average payment timeframe is 7 days.
Providers must use the codes specified in the applicable EIS, TCM or Therapy Florida Medicaid Fee Schedule. For EIS Therapy Services, providers must include the TL modifier on the claim in the first position.
NOTE: Therapy services that are billed without the TL modifier in the first position will not be treated as an EIS-related claim. This may result in the claim being denied or paid incorrectly.
Providers must ensure their claim reflects the accurate rendering provider to avoid the claim being denied as a duplicate service. The claim should include the provider who participated in the service, and not their group affiliation (if applicable).
Providers should follow their normal authorization and claims processes for services rendered to members outside of the Early Steps program.
Providers should follow the authorization and claim information provided in this guide for services rendered to members through the Early Steps program when specified on the IFSP.
The Sunshine Health and Provider Relations teams will help providers who render both EIS and non-EIS related services with contracting and re-credentialing requirements.
Our Network Development team will continue to work with you to ensure you complete the credentialing and contracting process as quickly as possible.