Child Welfare Value-Based Incentive Program
Behavioral Health Evidence Based Practice
Sunshine Health is committed to supporting your efforts to provide the highest quality of care for our members. We are excited to announce the 2022 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 models: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Brief Strategic Family Therapy (BSFT), and Multi-Systemic Therapy (MST). Based on a healthcare analytics study conducted by Centene, Sunshine Health’s parent company, evidence-based treatment models show 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, BSFT, and MST will qualify for incentivized payment programming.
2022 Child Welfare Value-Based Incentive Program Frequently Asked Questions
Which providers are eligible for the Child Welfare Value-Based Incentive Program?
This program is offered to Behavioral Health providers who are certified in and are using the evidence-based treatment models: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Brief Strategic Family Therapy (BSFT) and Multi-Systemic Therapy (MST).
What products are included in these incentives?
Sunshine Health’s Child Welfare Specialty Plan enrolled population.
How do providers submit a claim showing that Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Brief Strategic Family Therapy (BSFT) or Multi-Systemic Therapy (MST) have been used to be considered for payment?
Providers must bill using the U1 modifier to identify the Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Brief Strategic Family Therapy (BSFT) or Multi-Systemic Therapy (MST) models were used.
Are there specific codes that must be used when submitting a claim?
Yes, refer to the table below.
Claim codes
Procedure Code | Description |
90832 | Psychotherapy, 30 minutes with patient and/or family member |
90834 | Psychotherapy, 45 minutes with patient and/or family member |
90837 | Psychotherapy, 60 minutes with patient and/or family member |
90846 | Family psychotherapy without patient present |
90847 | Family psychotherapy (conjoint psychotherapy) with patient present |
90833 | Psychotherapy, 30 minutes with patient and/or family member when performed with an evaluation and management service (list separately in addition to the code for primary procedure) |
90836 | Psychotherapy, 45 minutes with patient and/or family member when performed with an evaluation and management service (list separately in addition to the code for primary procedure) |
90838 | Psychotherapy, 60 minutes with patient and/or family member when performed with an evaluation and management service (list separately in addition to the code for primary procedure) |
H2019 HO* | Therapeutic Behavioral Onsite Services |
H2019 HR* | Therapeutic Behavioral Onsite Services (Individual and Family Therapy) |
Modifier | Description |
U1 | Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Brief Strategic Family Therapy (BSFT), or Multi-Systemic Therapy (MST) |
*For procedure code H2019 the provider would bill U1 modifier AND one of the two modifiers above (HO or HR). The provider can bill two modifiers, H2019 HO U1 or H2019 HR U1. If service is provided via telehealth, the GT modifier should also be included in the claim.
Are providers able to resubmit a claim?
Providers can resubmit claims that back date to January 1, 2022.
Are there a number of members a provider must see to quality for this incentive program?
No. Any of our participating Behavioral Health providers are eligible to participate.
How will providers be paid?
This is a shared savings program which means the Per Member Per Month (PMPM) cost savings will be shared with the provider and plan. The check will be made out at the TIN level, and the entity will divide the savings based on performance detailed in the scorecard.
When will providers be paid?
A one-time payout will be awarded in Q4 2023.
What are the cost categories?
The cost categories are Emergency Department, Inpatient, Outpatient, Primary Care Provider, Pharmacy and Specialist.
What are the other requirements?
Behavioral Health Providers must be contracted and in good standing with Sunshine Health.
How can I track my progress?
Starting July 2022, you will begin receiving quarterly scorecards to track your performance in the cost categories referenced above.
What is the amount of the incentive?
The amount of incentive will not be known until an annual analysis is completed following 15-24 months after the program start.
What is the payment schedule?
The program began on January 1, 2021, and will be extended again for calendar year 2022, beginning January 1, 2022. It is effective for all dates of service from January 1, 2022, to December 31, 2022. Following the measurement period, there will be a six-month trend period, plus three months of claims runout with payment occurring approximately the end of the Q4 2023.