STAR Health Trauma-Informed Care Alternative Payment Model
Date: 11/08/21
Superior HealthPlan recognizes that trauma is a driving force for many children and adolescents in foster care. With effective treatment, however, healing can occur and lead to a better quality of life for those who have experienced trauma. With a goal of continuing to positively impact the care and treatment of STAR Health members, Superior has invested in trauma-informed care training.
As a reminder, Superior launched a new Alternative Payment Model (APM) for behavioral health therapy providers serving STAR Health members in 2020. When a provider uses an approved evidenced-based, trauma-informed care modality to treat trauma-related behavioral health symptoms and issues, they can receive an additional 10% payment to their submitted claim.
There are 5 therapy modalities that will be recognized for this APM:
- Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) – Recognized as evidence-based, validated for use with children and adolescents.
- Eye Movement Desensitization and Reprocessing (EMDR) – Recognized as evidence-based, validated for use with adults.
- Cognitive Processing Therapy (CPT) – Evidence-based, primarily focused on adults.
- Prolonged Exposure (PE) – Evidence-based, validated for adolescents (PE-A) and adults.
- Parent Child Interaction Therapy (PCIT) – Evidenced-based, validated for children two to seven years of age.
The requirements for participating in this APM are as follows:
- Providers must submit a modality certification for one or more of the modalities listed above. Certificates can be submitted to Superior’s Account Management Department at ProviderCertifications@SuperiorHealthPlan.com.
Please note: Effective May 15, 2021, Superior now accepts a trauma assessment completion in place of a full certificate (for TF-CBT only). See accepted assessments below.
- A trauma-related diagnosis should be indicated on the claims submission.
- When submitting claims to Superior for the therapy modalities, use the identified billing modifier to indicate which modality was used, based on the chart below:
MODIFIER | MODALITY |
|---|---|
U1 | Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) |
U2 | Eye Movement Desensitization and Reprocessing (EMDR) |
U3 | Cognitive Processing Therapy (CPT) |
U4 | Prolonged Exposure (PE) |
U5 | Parent Child Interaction Therapy (PCIT) |
4. Effective May 15, 2021, a trauma assessment is not required in order to receive the additional payment,
however, Superior encourages the use of these assessments.
- For children and adolescents, use the Child and Adolescent Trauma Screen (CATS) (PDF).
- For adults, use the Trauma Screening Questionnaire (TSQ).
- The CATS and/or TSQ assessments should be faxed in to the Health Passport system, selecting the “other” checkbox on Superior's Health Passport Form Coversheet (PDF).
- Note: For future use, this coversheet can also be found on the Foster Care Texas Important Forms webpage. Superior is working to have these assessments loaded into Health Passport, where they will be available to populate within the system. Until that functionality is available, please continue to fax in the assessments and document in the patient’s medical chart that an evidenced-based approach to trauma is being used.
5. If modality certification is not present, the additional 10% payment may not be processed or may be recouped.
For TF-CBT, please send in documentation of training.
For any questions or more information on the STAR Health Trauma-Informed Care APM, please contact your local Account Manager.