Behavior Analysis Services Information

Public Meeting for Proposed Behavior Analysis Changes

The Agency has hosted several public meetings to introduce proposed changes to Medicaid-covered behavior analysis services. These changes are being proposed to ensure children receive the right service, at the right time, and by the right provider. It is of chief importance to the Agency that children who need behavior analysis services receive the highest quality of care and continue to receive services in a timely manner. Based on public input to date, we are modifying the proposed changes and the schedule for implementation.

No changes to behavior analysis reimbursement rates will occur during 2019.
The Agency will delay the requirement that behavior analysis provider groups show proof of their health care clinic licensure, as a condition of Medicaid enrollment, until July 1, 2020.
The Agency will implement a multidisciplinary team (MDT) model for authorizing behavior analysis services, as a pilot only, effective July 1, 2019. The MDT model will be piloted in Regions 4 and 7 and the Agency will determine its effectiveness before expanding into other regions. We will continue to explore other process improvements with providers, to help expedite the review process, that can be implemented in other parts of the state in the interim. Counties in Regions 4 and 7 include: Baker, Clay, Duval, Flagler, Nassau, St. Johns, Volusia, Brevard, Orange, Osceola and Seminole.
The Agency will implement electronic visit verification (EVV) for behavioral analysis services, as a pilot only, effective September 1, 2019. Electronic visit verification will be piloted in Regions 9, 10, and 11 and will determine its effectiveness before expanding into other regions.

Upcoming training opportunities for the Multidisciplinary Team (MDT) meetings and Electronic Visit Verification (EVV) are detailed below:

Date	Time	Link
eQHealth Solutions' Multidisciplinary Trainings	Recurring	Register for these trainings on eQHealth Solutions' website: http://fl.eqhs.org/ProviderResources/Registerforawebinar.aspx
Introduction to EVV Training: 5/15/19	9:00 am EDT	Register for this training here
Introduction to EVV Training: 5/16/19	3:00 pm EDT	Register for this training here
Introduction to EVV Training: 5/20/19	9:00 am EDT	Register for this training here
Introduction to EVV Training: 5/21/19	4:00 pm EDT	Register for this training here
Introduction to EVV Training: 5/30/19	9:00 am EDT	Register for this training here
Introduction to EVV Training: 5/31/19	12:00 pm EDT	Register for this training here

Presentation Archive

Date	Presentation	Webinar Recording
Wednesday, May 15, 2019	Enrolling as a Florida Medicaid Behavior Analysis Provider	Enrolling as a Florida Medicaid Behavior Analysis Provider
Thursday, April 25, 2019	Medicaid Behavior Analysis (Provider Type 39) Enrollment Webinar
Friday, April 26, 2019	Florida Medicaid Behavior Analysis Updates 2019	Florida Medicaid Behavior Analysis Updates 2019

Recipient Information

eQHealth Solutions now makes all new determinations for Behavior Analysis (BA) services. This is the company that decides if your child needs BA services. When a decision is made, eQHealth will send you a letter. The following questions provide additional information:

1. What are Behavior Analysis (BA) Services?

Behavior analysis services provide a way for a person to reduce unwanted behaviors and increase desired behaviors.

2. Who can receive Behavior Analysis Services?

Behavior Analysis services are provided to all eligible Florida Medicaid recipients under the age of 21 years requiring medically necessary BA services.

3. Who is eQHealth?

eQHealth Solutions is the company that will begin reviewing all requests for BA services covered under Florida Medicaid.

4. How do I find a provider?

A link to BA service providers can be found on the Agency’s Recipient Support webpage under Additional Reference Information.

5. What are the steps I take to get BA services?

Step 1: Go to your doctor and get a written order for BA services.
Step 2: Find a provider (see question 4 above)
Step 3: The BA provider will send a request for BA services to eQHealth for review.
Step 4: eQHealth has professionals that will review the information your provider submits.
Step 5: You will get a letter in the mail letting you know the outcome.

6. Who can I contact if I have more questions?

Please call the Medicaid helpline at 1-877-254-1055, if you have more questions.

7. Who can I contact if I am having issues with receiving BA services?

Please contact the Medicaid helpline at 1-877-254-1055 to report those issues.

8. What is a prior authorization number?

A prior authorization number is a number that is 10 digits long, has no hyphens, and begins with “5.”

Provider Information

To obtain approval for Behavior Analysis services, providers must submit all new authorization requests to eQHealth Solutions, the Agency’s contracted Quality Improvement Organization for this service. For further information, please reference the following FAQs:

1. What documentation should be submitted to eQHealth?

When submitting prior authorization requests to eQHealth, BA providers will need to submit documentation that meets the requirements in section 9.0 of the Behavior Analysis Services Coverage Policy.

2. Is a physician's order required to obtain an assessment, reassessment, or BA Services?

Yes. Providers must submit a written physician's order to receive authorization for assessments, reassessments, and BA services in accordance with the Behavior Analysis Services Coverage Policy.

3. Is a diagnosis code required for submission with documentation?

Yes. Documentation must include an appropriate diagnosis code at the highest level of specificity as required by policy: http://ahca.myflorida.com/medicaid/review/Specific/59G-4.125_BA_Services_Coverage_Policy.pdf

4. Where can I access training documents and information about eQHealth’s BA implementation?

Trainings and information can be located on eQHealth’s website: http://fl.eqhs.org/. Providers will continue to be updated on impending changes through Provider Alerts.

5. Who can I contact if I have more questions?

Please call the Medicaid helpline at 1-877-254-1055 or eQHealth at 1-855-444-3747 and via the web at http://eqhs.org/.

Behavior Analysis Provider Update

On March 1, 2017, Applied Behavior Analysis (ABA) services ended and BA services began. Providers must be enrolled as provider type 39 with the Florida Medicaid to bill for dates of service using the new BA billing procedure codes.

BA Providers must submit prior authorizations request through eQHealth. The Agency has updated the BA provider enrollment process requiring documentation to verify credentials and provider identities (Please see BA Prior Authorization Submission Requirement below).

The Agency has imposed a temporary moratorium on enrollment of new BA providers in Miami-Dade and Broward counties. The moratorium was extended for an additional six months on November 9, 2018, and continues to stay in effect.

As of Jan 1, 2019 all BA providers who want to continue delivering Florida Medicaid services as behavior assistants must be certified RBT’s by the Behavior Analyst Certification Board (BACB).

BA Prior Authorization Submission Requirements

When submitting prior authorization requests for BA services, providers must submit ALL materials to eQHealth as specified in Appendix 9.0 of the Behavior Analysis Services Coverage Policy. If eQHealth determines that the submission is incomplete or contains insufficient documentation to make a decision, it will inform the provider. The provider then has two business days to submit the remaining materials and/or documentation before the request is denied for lack of documentation. The provider can resubmit a complete authorization request at any time.

When requesting prior authorization for BA services, providers must submit one of the following types of comprehensive evaluations:

Individualized Education Program (IEP)
Evaluation by the recipient’s school district that has determined eligibility for special education
Diagnostic evaluation conducted by one of the following:
- Developmental pediatrician licensed in accordance with Chapter 458, F.S. and certified by the American Board of Pediatrics
- Clinical psychologist licensed in accordance with Chapter 490, F.S.
- Child and adolescent psychiatrist licensed in accordance with Chapter 458, F.S. and certified or eligible for certification by the American Board of Psychiatry and Neurology

A complete request must include the recipient’s diagnostic evaluation report that contains clinical findings, recommendations, and a diagnosis. All submitted documentation must meet the requirements in accordance with Appendix 9.0 of the Behavior Analysis Services Coverage Policy (Rule 59G-4.125, F.A.C.).

Questions

If you have additional (non-enrollment) questions, please contact the provider/recipient help line at 1-877-254-1055 or eQHealth at 1-855-444-3747.