Community Success Co-Stars Incentive Program Frequently Asked Questions (FAQ)
This program is effective October 1 through September 30.
The Community Success Co-Stars Program provides an incentive payment of $300 per qualified transition member, per month to Assisted Living Facilities (ALF) for helping our members live in a community setting after they transition from a custodial nursing home.
The ALF must maintain credentialing and site visit compliance as required by Sunshine Health. The member must have transitioned during the fiscal year from a custodial nursing home and remained in the ALF for a minimum of 16 days per month. Incentive payments are paid January, April, July and October.
Incentive Calculation Examples
- If a qualified member remained in an ALF for a minimum of 16 days each month for the period of October 1 through September 30, four quarterly payments of $900 will be made for a total of $3,600.
- If a qualified member transitioned to the ALF from a nursing home on Jan. 1 and remained in the ALF for a minimum of 16 days each month until September 30, three quarterly payments of $900 will be made for a total of $2,700.
- If a qualified member transitioned to an ALF on November 1 and remained in the ALF for a minimum of 16 days each month until the member passed away on March 12, two quarterly payments, one payment for $600 (November-December) will be made in January and a second quarterly payment of $900 (January-March) will be made on the next quarterly payment cycle, which would be April, for a total of $1,500.
On a quarterly basis, Sunshine Health will determine if an ALF provider has a qualified member who has remained in the ALF as described in this FAQ and is eligible for the incentive. Providers will be sent a separate quarterly check for incentives earned. The memo line in the check will note “Community Co-Stars incentive.” Providers can find details on members who qualified and for which the payment is made through our Secure Provider Portal. Once logged in, click Reports. Providers will need to select the applicable TIN and Medicaid Plan type for their account and the report will populate (see illustration).
If a qualified member transitions from a nursing home to an ALF on a date that is not the first of the month, the member must be in the ALF for a minimum of 16 days each month to be considered for the incentive payment. For example:
A qualified member transitioned to an ALF on October 20. Member resided in the facility for 12 days in the month of October, therefore the month of October would not be eligible for the incentive payment. The first eligible month would be November if the member remains in the ALF for a minimum of 16 days.
If a qualified member is disenrolled from Sunshine Health, the member must remain in the ALF for a minimum of 16 days the month prior to disenrollment to qualify for the incentive. For example:
- A qualified member transitioned from a nursing facility to an ALF on October 15, On December 31, the member was disenrolled from Sunshine Health. In this example, the ALF would receive one payment for $900 (October-December) in January.
If the member passes away during the quarter, the period that the member remained in the ALF will be considered. The ALF will receive $300 for each month within the quarter that payment criteria was met including payment for the month the member passed away. For example:
- A qualified member transitioned from a nursing facility to an ALF January 2. On February 5, the member passed away. In this example, the ALF would receive one payment for $600 (January-February) in April.
The Agency for Health Care Administration (AHCA) manages the ongoing eligibility of Medicaid members. AHCA may determine that the member is eligible and retrospectively re-enroll the member in Sunshine Health’s Long Term Care product. In this case, the ALF provider will be paid for that period if the member has remained in the ALF for a minimum of 16 days each month.
If a qualified member is transitioned from one ALF to another that is not under the same tax identification number (TIN), the new ALF would not be eligible for this incentive. The original ALF will be paid an incentive based on the stay in that facility according to the guidelines set forth in this FAQ.