Below is official communication from Sunflower Health sent on September 9 to service providers.
“Sunflower Health Plan has received requests from Targeted Case Management providers for units above the TCM benefit limit. Sunflower intends to enforce the state-established limit of 240 units per year but will review exception requests for consumers with the most complex needs. Sunflower will note denial reasons in the TCM PA system.
TCMs are encouraged to contact the member’s care coordinator in advance of exceeding unit limits. Regardless of the TCM unit level, all medically necessary services remain available to Sunflower members. Sunflower assures members that they will maintain their TCM and case management services.
Sunflower Resources for Members and TCMs, other providers
Sunflower Health Plan provides care coordination for its members with I/DD and provides services to members, providers and caregivers through LifeShare’s Rapid Crisis Response System (RCRS) and Pathways program. These services are not intended to duplicate or replace the services that TCMs provide.
Additionally, persons with I/DD who participate in the Health Home Program receive case management through Sunflower’s Health Home Partners network and their TCM partners.
Please do not hesitate to call Sunflower Health Plan, or specifically your Sunflower provider relations representative, if you would like to know more about these resources.”
If you have questions about this bulletin or other provider resources, please contact our Customer Service Center in Lenexa, Kansas, at 1-877-644-4623.