New for 2022 Community Success Co-Stars Incentive Program
Date: 04/04/22
Fort Lauderdale, Florida
We are pleased to announce a revision to our Community Success Co-Stars incentive program. Please review the details below to learn about the program.
What is Community Success Co-Stars?
The Community Success Co-Stars Program provides an incentive payment to Assisted Living Facilities (ALF) for helping our members to continue to live in a community setting after they transition from a custodial nursing home stay.
What is the incentive payment?
From October 1, 2021, through September 30, 2022, Assisted Living Facility providers will receive $200 per month for each member that remains in the ALF for a minimum of 16 days each month post nursing home transition.
How does the program work?
Providers are eligible for an incentive payment when qualified members stay in their facility post nursing home transition for a minimum of 16 days each month. ALF providers will receive an authorization for each member who qualifies.
If the member expires during the quarter, the time that the member remained in the ALF will be considered. The ALF will receive $200 for each month within the quarter that payment criteria was met, including payment for the month the member passed away.
When will providers be paid?
Incentive payments will be made in January, April, July and October.
Action required to get paid: Providers need to email a current W-9 to Sunshine Health LTC_Resolutions_Team@Centene.com.
Please see the Frequently Asked Questions (FAQ) below or more information.
If you have questions, please call Provider Services at 1-844-477-8313, Monday -Friday, 8 a.m. to 8 p.m. Eastern. You can also use the Find Your Rep Tool to locate your assigned representative.
Community Success Co-Stars Program Frequently Asked Questions
When is the program effective?
This program is effective October 1 through September 30.
How does the program work?
The Community Success Co-Stars Program provides an incentive payment of $200 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 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.
How are incentives calculated?
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 $600 will be made for a total of $2,400.
- 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 $600 will be made for a total of $1,800.
- 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 $400 (November-December) will be made in January and a second quarterly payment of $600 (January-March) will be made on the next quarterly payment cycle, which would be April, for a total of $1,000.
How will providers be paid?
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 at SunshineHealth.com/login. 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 at right.
How do I register for the Sunshine Health Secure Provider Portal?
Go to SunshineHealth.com/login and select “Provider” from the “I am a” field and click Submit. Select Create New Account. See additional guidance (PDF).
How can the Secure Provider Portal help me?
The Secure Provider Portal provides tools and functions to help you verify coverage eligibility, track your incentive payments and identify member care gaps.
Do providers need to take any additional steps to get paid?
Yes. To ensure checks are sent to the correct address, email a current W-9 to Sunshine Health at LTC_Resolutions_Team@Centene.com.
How will payment be made if a qualified member moved from a nursing home to an ALF for a partial month?
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 Oct. 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 as long as the member remains in the ALF for a minimum of 16 days.
How does voluntary disenrollment impact the incentive payment?
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, 2021. On December 31, 2021, the member was disenrolled from Sunshine Health. In this example, the ALF would receive one payment for $600 (October-December) in January 2022.
How does the death of a member impact the incentive payment?
If the member passes away during the quarter, the time period that the member remained in the ALF will be considered. The ALF will receive $200 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, 2022. On February 5, 2022, the member passed away. In this example, the ALF would receive one payment for $400 (January-February) in April 2022.
What happens if a member loses their Medicaid eligibility, then is retrospectively enrolled back in Sunshine Health Long Term Care?
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 time period as long as the member has remained in the ALF for a minimum of 16 days each month.
What if the member is transitioned to another ALF that is not under the same tax identification number?
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.
Where can I call if I have more questions?
If you have questions or want information, please call Provider Services at 1-844-477-8313, Monday-Friday, 8 a.m. to 8 p.m. Eastern. Or use our Find Your Rep Tool to find assigned your assigned representative.
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