STAR Health Trauma-Informed Care Alternative Payment Model
Date: 09/24/20
Note: Please see STAR Health Trauma-Informed Care Alternative Payment Model for the most up-to-date information regarding this alternative payment model.
Superior launched a new Alternative Payment Model (APM) focused on Trauma-Informed Care for behavioral health therapy providers serving STAR Health members on February 1, 2020. 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 mission of continuing to positively impact the care and treatment of STAR Health members, Superior has invested in trauma-informed care training. By completing training and using an approved evidenced-based, trauma-informed care modality to treat trauma-related behavioral health symptoms and issues, providers can receive an additional 10% payment to each submitted claim.
Modalities
As a reminder, there are 5 therapy modalities recognized for this APM:
- Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) – Recognized as evidence-based and 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 ages 2-7.
Requirements
The requirements for participating in this APM are as follows:
1. Submit a training certificate for one or more of the modalities listed above. Certificates can be submitted to Superior’s Account Management Department at: ProviderCertifications@SuperiorHealthPlan.com.
2. A trauma-related diagnosis should be indicated on the claims submission.
3. 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. Complete a baseline screening at the beginning of treatment. Follow-up screenings should be conducted every 90 days, or at the conclusion of treatment (whichever comes first).
- For children and adolescents, use the Child and Adolescent Trauma Screen (CATS). Please reference Please Child and Adolescent Trauma Screen (CATS) - Youth Report (PDF).
- For adults, use the Trauma Screening Questionnaire (TSQ). Please reference Trauma Screening Questionnaire (TSQ).
- Screening assessments must be faxed into Superior’s Health Passport application, 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.
Please note: If all requirements are not present, the additional 10% payment may not be processed or may be recouped.
For any questions or more information on the STAR Health Trauma-Informed Care APM, please contact your local Account Manager.
To view the original article regarding this new APM, please visit Trauma-Informed Care Alternative Payment Model Launching 2/1.