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Behavior Analysis Services Information

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What is Behavior Analysis
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BA Coverage Policy
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Updates and Resources

Summary of Updates
Training Registration
Helpful Information and Presentations
Telemedicine during the Public Health Emergency Period
Updates to Health Care Clinic Licensure for Florida Medicaid Providers

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Information
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BA Prior Authorization Submission Requirements
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Medicaid Behavior Analysis Service Provider listing

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.
Multidisciplinary Team (MDT)

MDT Updates: Provides information to behavior analysis providers in Regions 4 and 7

The Agency directed eQHealth Solutions, Inc. to implement a multidisciplinary team approach to reviewing prior authorization requests for behavior analysis services in Regions 4 and 7, as a pilot, beginning July 1, 2019. As a part of the MDT review process, all requests for more than 20 hours per week must undergo a telephone or face-to-face staffing to ensure the child is receiving all necessary services and supports. While this approach has proven valuable in obtaining additional information about the needs of the child, the Agency has identified opportunities to streamline and expedite the process, while continuing to engage providers and parents.

Effective immediately, the Agency will limit the circumstances in which an MDT meeting is needed, as follows:
  • If the request for BA services can be approved after completion of the desk review, the provider will be notified electronically via eQSuites, and the care coordinator will contact the parent/legal guardian to notify of the final decision.
  • If the request for BA services cannot be approved because information is missing, there are inconsistencies in the record, or the request does not meet medical necessity (in whole or part), eQHealth will schedule a peer- to-peer telephonic review with the provider in lieu of an MDT meeting. If the concerns can be resolved during the peer-to-peer review, the case will be approved.
    • If the request still cannot be approved after the peer-to-peer review, eQHealth will call the parent to discuss the decision and follow with the standard denial letter with appeal rights.
  • If eQHealth believes the child may benefit from additional services or supports, a care coordinator will contact the parent to discuss how to initiate those services. BA services will not be delayed while this is occurring.

eQHealth will only initiate MDT meetings in cases where convening treatment providers may be of benefit in maximizing the treatment outcomes, particularly where progress has stalled or regressed over several review periods.

It is of chief importance to us to solicit input from parents prior to making a service authorization decision, so eQHealth will continue to contact the child’s parent/guardian prior to completing the review to collect information and to discuss any additional needs that may have arisen.

For more information, please visit the eQHealth Training Resources page.
Electronic Visit Verification Electronic Visit Verification (EVV)

EVV Goes Live December 1, 2020
The implementation date for electronic visit verification (EVV) for behavior analysis (BA) services is December 1, 2020, for the pilot Regions 9, 10, and 11.  For dates of service on or after December 1, 2020, providers must bill through the Tellus EVV System and must no longer bill the Florida Medicaid Management Information System (FMMIS) via the Medicaid Provider Web Portal.  Providers should act now to ensure compliance and avoid potential payment delays.  The Agency for Health Care Administration will be enforcing the use of the Tellus EVV Systems as follows.

Enforcement Actions Begin December 7, 2020

Effective December 7, 2020, providers must at least be registered in the Tellus EVV System.  If not, all claims submitted directly to FMMIS will suspend until the Agency confirms the provider has registered and begun using the Tellus EVV System at least for scheduling and visit verification.  Once registration and activity are confirmed, the claims in FMMIS will be released for payment without any further action by the provider.  Providers will not need to resubmit the claims.  If you are currently registered in the Tellus EVV System, this deadline does not apply to you.

Effective December 14, 2020, providers must be using the Tellus EVV System to submit claims.  If not, all claims submitted directly to FMMIS will suspend until the Agency can document the provider has begun using the Tellus EVV System to submit claims.  Once confirmed, the claims in FMMIS will be released for payment without any further action by the provider.  Providers will not need to resubmit the claims.  If you are currently billing claims through the Tellus EVV System, this deadline does not apply to you.

Effective December 28, 2020, claims that are billed directly to FMMIS will be denied.

To allow providers delivering behavior analysis (BA) services to recipients in Regions 9, 10, and 11 additional time to successfully submit claims through the Tellus EVV System, the effective date for denying claims that are billed directly to FMMIS has been changed to December 28, 2020.

For dates of service on or after December 1, 2020, providers must bill through the Tellus EVV System and must no longer bill the Florida Medicaid Management Information System (FMMIS) via the Medicaid Provider Web Portal.  Providers should act now to ensure compliance and avoid potential payment delays. 

February 8, 2020 Update
Additional Enforcement for Mandatory Usage

For dates of service on or after February 1, 2021, providers must bill through the Tellus EVV System and must no longer bill the Florida Medicaid Management Information System (FMMIS) via the Medicaid Provider Web Portal.  Previously, providers that were unable to bill claims using the Tellus system and had open tickets with Tellus regarding their claims-related issue were allowed to submit through the FMMIS.  That option is no longer available.  Claims that are billed directly to FMMIS will be denied even if a provider has an open ticket.

Claims for assessments (H0031) and re-assessments (H0032) should continue to be billed in the same way as it was done prior to the EVV implementation, directly to FMMIS.

To open a Tellus ticket, click on the link below, then click on “Open Support Ticket”. This is the fastest way to receive assistance. Tellus | EVV Software & Claims Processing For Home Health/Long Term Care (4tellus.com)

Take the Following Actions to Ensure Your Success:

Ensure you are using the latest version of the Tellus mobile app

The current app version can be found at https://4tellus.com/electronic-visit-verification. Scroll to the bottom of the page to view the app version number and effective date.

Update Contact and Linking Information

  • Verify that all rendering providers have current and unique contact information in FMMIS and that providers are linked to the appropriate group(s).  This is critical because FMMIS sends the provider information to Tellus.  To update information in FMMIS, providers should access the secure portal at:  https://home.flmmis.com/home.  Providers and their authorized delegates may perform group linking and delinking in real-time, via the secure Web Portal.  Detailed instructions on linking is here:  Group Linking and Delinking.

Known Issues:  To find information about the top currently known technical issues related to the Tellus EVV System, please go to https://4tellus.com/ahca-ba-known-issues/

Training

  • To register for training, listen to pre-recorded trainings on demand, or review training modules, please go to https://4tellus.com/ahca-ba and select the Training & Resources tab. 

Dedicated BA EVV Hotline

  • Call 1-833-622-2422 to speak to a Tellus agent or email at ahcabaevv@4tellus.com if you have any questions or need technical assistance.
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: Florida Medicaid Behavior Analysis Updates 2019
Electronic Visit Verification Presentation: Florida Medicaid Behavior Analysis Updates 2019
Webinar Recording: Florida Medicaid Behavior Analysis Updates 2019
Electronic Visit Verification Frequently Asked Questions
Instructions to BA EVV providers in the pilot program BA services to recipients with home addresses in Regions 9, 10, and 11.

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:

  • Behavior Analysis Services Coverage Policy
  • Authorization Requirements Rule
  • eQHealth’s Website

    Behavior Analysis eQSuite User Guide

    Behavior Plan Provider Training

    Submitting a Modification to a BA Prior Authorization Training

    Clarification of the ComprehensiveDiagnostic Evaluation Requirements

    A Comprehensive Diagnostic Evaluation (CDE) is a thorough review and assessment of the child’s development and behavior using national, evidence-based practice standards, which may include:
    • Parent or guardian interview
    • Teacher assessment
    • Diagnostic testing using tools such as: o   Autism Diagnostic Observation Schedule (ADOS-2)
      o   The Childhood Autism Rating Scale – 2nd edition (CARS2)
      o   Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R)
      o   Communication and Symbolic Behavior Scales (CSBS)
      o   Autism Diagnostic Interview, Revised (ADI-R)
      o   Social Communication Questionnaire
      o   Battelle Developmental Inventory– 2nd edition
    • Hearing and vision testing
    • Genetic testing
    • Neurological and/or other medical testing

    The CDE must be led by licensed practitioners qualified to assess child developmental disorders such as:
    • Developmental Pediatricians
    • Child Neurologists
    • Child Psychologists
    • Child Psychiatrists

    Here are the circumstances in which a CDE is required for authorization of BA services:
    • In order to initiate (for the first time) behavior analysis services, the Agency requires that the provider submit a copy of the child’s Comprehensive Diagnostic Evaluation (CDE), along with all other required documentation to eQHealth Solutions, Inc. The CDE will only be required to be submitted one-time and the child will not have to obtain another CDE to continue services. 
    • If a CDE has never been submitted with a previous authorization request. In these circumstances, the child does not have to get a new CDE if one was completed in their lifetime. The provider can submit the last CDE completed. If a CDE was never completed, eQHealth will extend the authorization to allow time for the child to obtain a CDE.

    Alternative Assessments in Pilot Regions


    Effective immediately, in order to initiate BA services while a child is waiting for his/her scheduled appointment for the CDE, eQHealth will accept the following documentation, in lieu of the CDE:
    • Children 0 – 36 months of age: Early Intervention Services evaluation/Individual and Family Support Plan
    • Children older than 36 months of age:
      • Individual Education Assessment (IEP) or school district assessment for IEP
      • Neurological evaluation
      • History and physical from a licensed physician documenting behaviors and evaluation conducted to ascertain diagnosis

    These alternative assessments do not replace the requirements for a CDE. If parents are having difficulty finding a provider to perform the CDE, their child’s health plan is available to help. Parents can also contact the Agency at 877-254-1055 and we will work with them or their child’s plan to find a provider.

     Additional Resources and Information
    • For assistance with EVV questions, please contact Tellus at 1-833-622-2422.
    • For assistance with obtaining prior authorization for behavior analysis services, please contact eQHealth Solutions at 1-855-444-3747.
    • Additional questions from providers may be directed to the Florida Medicaid Helpline at 1-877-254-1055.

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: