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Does sunshine health cover therapy

Sunshine Health offers multiple therapy benefits (PT/OT/ST) to its members. Read more about the team of vendors and authorization requirements.

Medicaid, Serious Mental Illness Specialty Plan and Child Welfare Specialty Plan

Sunshine Health contracts with Health Network One (HN1) to manage its therapy program. HN1 contracts providers under Therapy Network of Florida (TNFL).

TNFL administers therapy services at outpatient free standing facilities for Sunshine Health’s Medicaid (MMA), Serious Mental Illness (SMI) Specialty Plan and Child Welfare (CW) Specialty Plan members ages 3 years and above enrolled in Sunshine Health. Members ages 0-2 years old are managed by Sunshine Health.

The following services are excluded:

  • Members ages 0-2 years*
  • Children’s Medical Services (CMS) Health Plan
  • Long Term Care
  • Medicare
  • Early Intervention Services (EIS)
  • Prescribed Pediatric Extended Care (PPEC) locations
  • Outpatient (Hospital)

*Note: Members are managed by TNFL on the date of their 3rd birthday. Existing plans of care that extend past a member’s 3rd birthday will continue to be managed by Sunshine Health until completion.

Children’s Medical Services Health Plan

Sunshine Health will handle therapy services for members of CMS Health Plan as of October 3, 2022.

Frequently Asked Questions (FAQ)

We have outlined some Frequently Asked Questions (FAQs) below. 

Forms

In Lieu of Services Resource Guide

The Medicaid In Lieu of Services Resource Guide describes the ILOS benefits, eligibility requirements, limits and prescribing rules.

Housing Assistance Pilot Program

Sunshine Health was selected by the Agency for Health Care Administration (AHCA) to participate in the SMMC Housing Assistance Pilot Program (PDF) for Region 5 and Region 7. This program helps our adult Medicaid members who are homeless or at risk of being homeless keep a stable living arrangement. Members must have a Serious Mental Illness or Substance Use Disorder diagnosis to qualify. The services provided to members in this program are in addition to their current Sunshine Health benefits.

Florida Medicaid Drug Therapy Management Program for Behavioral Health (MDTMP) 

The Florida Medicaid Drug Therapy Management Program for Behavioral Health (MDTMP) was created in 2006 through a directive from the Florida legislature and is managed by the Florida Mental Health Institute in the College of Behavioral and Community Sciences at the University of South Florida.

MDTMP formulates and disseminates best practice psychotherapeutic medication recommendations for the management of serious behavioral health conditions in adults, adolescents and children based on the most current available evidence and clinical consensus. The guidelines are updated biannually by a panel of Florida and national experts and are available in print and electronic versions. Visit the Florida Center for Behavioral Health Improvements and Solutions (FCBHIS) for more information and to access electronic copies of the best practice psychotherapeutic medication guidelines.

ADHD Toolkit

Attention Deficit Hyperactivity Disorder Facts

Best-Practice Intervention Strategies

  • Educate parents on ADHD management
  • Increase parent/child symptom awareness
  • Parental tracking of assignments, chores, and home responsibilities
  • Rule out comorbid disorders
  • Assess for possible presence of parental psychopathology interfering with treatment
  • Take prescribed medications consistently and monitor for side effects
  • Maintain communication with school to increase compliance on assignments
  • Develop and utilize effective study skills
  • Delay instant gratification in pursuit of long-term goals
  • Develop increased anxiety management skills and self-confidence
  • Develop effective problem-solving skills
  • Increase verbalization of acceptance of responsibility for behaviors
  • Identify stressors and emotions that trigger hyperactivity and impulsivity
  • Identify constructive outlets for energy

Citations: Journal of the American Academy of Child & Adolescent Psychiatry 2007 Jul; 46(7):894- 921. The Child Psychotherapy Treatment Planner, 4th Edition, 2006, Arthur E. Jongsma, Jr., L. Mark Peterson, William P. McInnis, Timothy J. Bruce, Ph.D. (Contributing Editor) Websites Children Youth and Families Mental Health Evidence Based Practice Project. SUNY: University at Buffalo, School of Social Work. http://www.socialwork.buffalo.edu/ebp/diagnosis/adhd.htm Clinical Practice Guideline: Treatment of the school-aged child with attention-deficit hyperactivity disorder: http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/4/1033 Therapy Advisor: http://www.therapyadvisor.org/taDisorder.aspx?disID=27&sm=cc27

Anxiety Toolkit

Anxiety and OCD Best Practice Intervention Strategies

Anxiety

  • Participate in a medical evaluation to rule out any medical conditions that may be causing or contributing to anxiety
  • Participate in a psychiatric evaluation and take all medications as prescribed
  • Develop and practice positive coping skills to manage stress and anxiety (Such as adequate rest, proper nutrition, physical exercise and recreational activities/hobbies)
  • Practice relaxation techniques such as deep breathing and guided imagery
  • Learn to recognize the difference between emotional and physical reactions to anxiety
  • Participate in systematic desensitization of feared stimuli while practicing relaxation strategies
  • Identify a social support team and increase participation in social activities
  • Identify negative self-talk and replace with positive statements
  • Involve family members in psycho-education about anxiety to increase understanding and support
  • Recognize, verbalize and address unresolved emotional issues

Obsessive Compulsive Disorder

  • Participate in a psychiatric evaluation and take all medications as prescribed
  • Use a thought stopping strategy to interrupt cognitive obsessions
  • Practice relaxation techniques such as deep breathing
  • Consider learning and practicing the Exposure and Response Prevention (ERP) technique by confronting feared situations and objects (exposure) and resist performing compulsive rituals (response prevention)
  • Recognize, discuss, and refute dysfunctional beliefs (e.g., magical or catastrophic thinking patterns)
  • Develop and practice a daily ritual to interfere with the current compulsive pattern
  • Identify, verbalize and address unresolved life issues
  • Provide psycho-education for family members and encourage their support for the patient during treatment
  • Develop and practice positive self-talk
  • Anxiety ToolkitOverview (PDF)
  • GAD7 Anxiety Screening tool (PDF)
  • Med Guide Anxiety (PDF)
  • PC-PTSD (PDF)

Substance Use Disorder Toolkit

Alcohol and Other Drug Facts

Assessment Components

ASAM is a professional society representing close to 3,000 physicians dedicated to increasing access and improving quality of addiction treatment, educating physicians and the public, supporting research and prevention, and promoting the appropriate role of physicians in the care of patients with addictions.

Enhance your professional development and clinical practice with ASAM CME programs such as the Annual Medical-Scientific Conference, State of the Art Course in Addiction Medicine, Review Course in Addiction Medicine, Medical Review Officer (MRO) Training Course, Buprenorphine Training, SBIRT Training, Tobacco Treatment Training, Alcohol Dependence Training and Best Practices in Buprenorphine Treatment for Opioid Dependence. http://www.asam.org/education

The six ASAM Placement Criteria dimensions:

  • transmissible infectious diseases and other bio-medical history (provide targeted risk-reduction counseling as indicated)
  • co-occurring mental health or behavioral problems (ensure concurrent AOD and mental health treatment, as indicated)
  • potential for withdrawal symptom severity and the need for medications
  • motivation for change (using the Prochaska Stages Of Change model)
  • protective factors and risk factors in the recovery environment
  • potential for relapse

Alcohol and Other Drug Best-Practice Intervention Strategies

  • Participate in a medical evaluation to rule out any medical conditions that may be causing or contributing to anxiety
  • Transmissible infectious diseases and other bio-medical history (provide targeted riskreduction counseling as indicated)
  • Co-occurring mental health or behaviora problems (ensure concurrent AOD and mental health treatment, as indicated)
  • Potential for withdrawal symptom severity and the need for medications
  • Motivation for change (using the Prochaska Stages Of Change model)
  • Protective factors and risk factors in the recovery environment
  • Potential for relapse

Treatment Components

  • Drug testing during treatment to provide incentive for, and monitor, abstinence
  • Utilize Motivational Interviewing as part of a non-confrontational, solution focused approach to treatment engagement and retention in order to facilitate optimum outcomes 
  • Consider age, gender, maturity/developmental level, and culture in all phases of assessment, treatment and service delivery
  • Education regarding the effects of substance use, what to expect in the course of treatment, and the expected effects of treatment
  • Open-ended questions and exploration of values, past successes, and empathic reflection of thoughts and feelings to support self-realization of the need for change
  • Identification of routine triggers for substance use and understanding relapse as a process
  • Identification and modification of social and other barriers to abstinence
  • Support for self-efficacy, effective coping and problem-solving skill sets for current and future stressors
  • Inclusion of the relevant support system (e.g., family members) in both
  • Substance Use Disorder Toolkit Overview (PDF)
  • AUDIT Screener for Alcohol (PDF)
  • CAGE-AID Screening Tool (PDF)

Deciding to see a therapist may have been difficult, but finding one who accepts your insurance may be even more challenging. And while you’re trying to cope with your own mental and emotional issues, dealing with insurance issues may be the last thing you want to do.

At Mental Health Match, we specialize in matching people to therapists near you who accept or are in-network with Sunshine Health.

Wherever you are located in Florida from Altamonte Springs to Winter Garden or evenMiami, or anywhere else nearby, Mental Health Match can help you easily find an experienced therapist or counselor who best meets your needs.

Does Your Insurance Cover Therapy?

Before you start therapy, the first thing you should do is verify your outpatient Sunshine Health therapy coverage. If your plan doesn’t cover behavioral health therapy, they won’t pay; it may surprise you how many plans don’t include therapist insurance coverage.

To determine what your plan covers, you can call the customer service number on your insurance card. Once you know for sure that your insurance will cover outpatient behavioral health, leave it to us to help you find a therapist who accepts Sunshine Health plans.

If you would like to learn more about how to use insurance to cover therapy, check out our FAQ about how to pay for therapy.

Find a Therapist Near You Who Accepts Sunshine Health Therapy Coverage

Instead of Googling “therapists that take my insurance” and sifting through tons of results to no avail, allow us to help. After all, the longer you spend trying to figure out how to pay for therapy, the longer your treatment may be delayed.

With Mental Health Match, finding a qualified therapist near you who takes Sunshine Health therapy coverage is easy! Start by browsing in-network experts below or by using our free therapist matching tool.

Florida Therapists In-Network with Sunshine Health – List Your Practice on Mental Health Match

Looking to expand your network? At Mental Health Match, we quickly match clients to licensed therapists and counselors who accept Sunshine Health insurance. Get set up for new referrals in 10 minutes or less. 60 day free trial, with no credit cards required to start. Join now.

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