Sunshine Health Therapy Program

• Sunshine Health will administer therapy services for members of all Medicaid products of all ages effective January 1, 2025.

An authorization is not required for MMA, SMI, CW, and CMS member ages 0-2 years.

• An authorization is required for members ages 3 years and older.
• If a member has an active Plan of Care when they turn 3 years old, an authorization request should be submitted to Sunshine Health once the Plan of Care expires.

Therapy providers should continue to obtain authorizations via the Sunshine Health Secure Provider Portal. To reference full guidelines for authorization requests, please reference the Therapy Quick Reference Guide (QRG).

• You may continue to treat members through the end of the Continuity of Care (COC) period up to 60 days, or through the expiration of the authorization, whichever comes first.  
• After the end of the COC period or the end of the authorization (whichever comes first), the provider must contact Sunshine Health via the Secure Provider Portal for additional authorizations. 

• Claims for PT/OT/ST services in a free standing facility prior to January 1, 2025 for members ages 3 years and above should continue to be submitted to HN1/TNFL as documented in the TNFL Provider Manual (PDF).  The following service exclusions would not be submitted to HN1/TNFL:
  • Members ages 0 – 2 years
  • Long-Term Care (LTC)
  • Medicare
  • Children’s Medical Services Health Plan (CMS)
  • Early Intervention Services (EIS)
  • Prescribed Pediatric Extended Care (PPEC)
• Claims for dates of service January 1, 2025, or after should follow the claims submission guidelines as documented in the Sunshine Health Provider Manual.

Providers wishing to service these members can apply to join our network. Sunshine Health will reach out to you regarding participation after you provide the requested information.