Behavior Analysis Services Information
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 |
|
| Moratorium |
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| 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:
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
The Agency for Health Care Administration (Agency) is cognizant of the impact that the 2019 novel coronavirus (COVID-19) is having on providers in their efforts to ensure that recipients continue to receive timely care. The Agency will be postponing implementation of the electronic visit verification (EVV) requirements for behavior analysis services provided in Regions 9, 10, and 11 until further notice. We will continue to evaluate the situation to determine the best time to resume implementation activities and will provide ample notification of the new mandatory implementation/launch date. As a reminder, during this postponement, the TELLUS EVV System will still be available to providers. We encourage providers to take advantage of this additional time to practice using the system so we can have a smooth transition in the future. Providers may continue to use the system and all functionality (e.g., scheduling visits, checking in/out, handling exceptions, etc.), while submitting claims via the Provider Web Portal Direct Data Entry (DDE). This means that providers will have the option of submitting claims through Tellus’ EVV system but are not required to do so. The Agency encourages providers to become proficient in using all functions within the system (including claims payment) during this time in anticipation of a future launch date. |
| Behavior Analysis Coverage Policy |
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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 |
| 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: