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Behavior Analysis Services Information

Service Information

What is Behavior Analysis
Report a Complaint
Report Fraud &Abuse
BA Coverage Policy
BA Fee Schedule
All Adopted Agency Rules
All Agency Rules in Process

Updates and Resources

Summary of Updates
Training Registration
Helpful Information and Presentations

Recipients

Information
Have a BA Question?

Providers

BA Prior Authorization Submission Requirements
Sign up for Provider Alerts
Provider Alert Archive
Have a BA Question?

What is Behavior Analysis?

Behavior analysis services provide a way for a person to reduce unwanted behaviors and increase desired behaviors. More information, including fact sheets and videos, is located on the Behavior Analyst Certification Board’s website.

Summary of Proposed Updates to Behavior Analysis

The Agency has hosted several public meetings to introduce proposed updates to Medicaid-covered behavior analysis services. These updates are intended 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. Here is a summary of the updates:

Topic Information
Behavior Analysis Rates
  • No changes to behavior analysis reimbursement rates will occur during 2019 – July 2020.
Moratorium
  • The Agency is partially lifting the behavior analysis (BA) provider enrollment moratorium in Broward and Miami-Dade counties for individual rendering providers wishing to link to a BA group that is already enrolled in Florida Medicaid. Beginning May 17, 2019, the Agency will be ready to accept new provider enrollment applications for individual rendering providers wishing to link to an existing BA group in these two counties. The provider enrollment moratorium in Miami-Dade and Broward counties will remain in effect for the enrollment of new behavior analysis group providers and individual providers practicing independent of a group.
Health Care Clinic Licensure
  • By July 1, 2020, behavior analysis provider groups must show proof of their health care clinic licensure, as a condition of Medicaid enrollment.
Multidisciplinary Team (MDT)
  • Beginning July 1, 2019, the Agency will implement a multidisciplinary team (MDT) model for authorizing behavior analysis services in Regions 4 and 7 through its vendor, eQHealth Solutions.  
    • Counties: Baker, Clay, Duval, Flagler, Nassau, St. Johns, Volusia, Brevard, Orange, Osceola and Seminole.
  • For more information, please visit the eQHealth Training Resources page.
Electronic Visit Verification
  • EVV Will Now Go Live October 1

    The Agency for Health Care Administration (Agency) has changed the implementation date for behavior analysis (BA) electronic visit verification (EVV) in Regions 9, 10, and 11 to October 1. This is to ensure that providers have additional time to resolve the issue described below.

    Take Action Now to Ensure You Can Receive Payment

    The Agency has identified that 26% of all BA rendering providers do not have unique email addresses or phone numbers listed in the Florida Medicaid Management Information System (FMMIS).  Without this information, those providers cannot be scheduled to deliver services, and group providers will not be able to bill and get paid for services rendered by those providers.

    It is critical that rendering providers without unique information in FMMIS update their email addresses and phone numbers as quickly as possible.  Group providers that do not see their rendering providers in the eVV System, should contact their rendering providers and advise them to add/update a unique email address and phone number in the FMMIS.  Each rendering provider must log in to the secure Florida Medicaid Provider Web Portal at:  https://home.flmmis.com/home/ and add/update the Mail To/Correspondence fields with a unique phone number and email address. The portal displays instructions if a provider has forgotten their login or password.

    Do not delay -- Once updated in the FMMIS, it can take several days before the new information is in the Tellus eVV System to allow visit scheduling.

    Other Information
    To register for training, go to https://4tellus.com/ahca-ba and select the Training & Resources tab.  If you have questions regarding training or system registration you may contact Tellus at:  1.833.622.2422.

    Beginning October 1, 2019, providers must bill through the Tellus eVV System and must no longer bill via the Provider Web Portal Direct Data Entry (DDE).  (The following services:  H0031 Behavioral Assessments and H0032 Behavioral Reassessment, should continue to be billed as they are today.)
  • Services that will require EVV include:
    HCPCS Modifer I Modifier II Description
    H2019 BA   Behavior Analysis - Lead Analyst
    H2012 BA   Behavior Analysis - Assistant Behavior Analyst
    H2014 BA   Behavior Analysis - Technician
    H2019 BA GK Behavior Analysis - Group (up to 6)
  • For more information please visit https://4tellus.com/ahca-ba/
Behavior Analysis Coverage Policy

Training Registration

Upcoming training opportunities for the Multidisciplinary Team (MDT) meetings and Electronic Visit Verification (EVV) are detailed below:
Topic Date and Time Link
eQHealth Solutions' Multidisciplinary Trainings Recurring Register for these trainings on eQHealth Solutions' website: http://fl.eqhs.org/ProviderResources/Registerforawebinar.aspx
Tellus Electronic Visit Verification Trainings Recurring Register for these trainings on Tellus’ website, under the Training & Resources tab: https://4tellus.com/ahca-ba/

Helpful Information and Presentations

Subject Resource
Behavior Analysis Provider Enrollment (May 2019) Presentation: Enrolling as a Florida Medicaid Behavior Analysis Provider
Webinar Recording: Enrolling as a Florida Medicaid Behavior Analysis Provider
Behavior Analysis Provider Enrollment (April 2019) Medicaid Behavior Analysis (Provider Type 39) Enrollment Webinar
Behavior Analysis Updates (April 2019) Presentation: Florida Medicaid Behavior Analysis Updates 2019
Webinar Recording: lorida Medicaid Behavior Analysis Updates 2019
Health Care Clinic Licensure

Health Care Clinic Licensure

Behavior Analysis Frequently Asked Questions

Frequently Asked Questions
Electronic Visit Verification Presentation: Florida Medicaid Behavior Analysis Updates 2019
Webinar Recording: Florida Medicaid Behavior Analysis Updates 2019
Electronic Visit Verification Frequently Asked Questions

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/.

BA Prior Authorization Submission Requirements

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:

Provider Enrollment

To learn more about the provider enrollment process for behavior analysis services, please review the presentation materials on the Agency’s website. For additional assistance, please contact a customer service representative at 1-800-289-7799, Option 4.

Additional information is available on the Agency’s website: