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:
|Behavior Analysis Rates
- No changes to behavior analysis reimbursement rates will occur during 2019 – July 2020.
- 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 December 1, 2020, behavior analysis provider groups must show proof of their health care clinic licensure, as a condition of Medicaid enrollment.
|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) Pilot – Implementation Date Change
In order to give behavior analysis providers that provide services to recipients with home addresses in Regions 9, 10, and 11 more time to complete any required training and to ensure the group’s rendering providers’ contact information is up-to-date in the Florida Medicaid Management Information System or Tellus’ EVV system, the Agency will postpone implementation of the EVV requirement as follows:
Beginning December 1, 2019 through March 1, 2020, the Agency will initiate a soft-launch of the EVV system, where providers may begin to use the system and all functionality (e.g., scheduling visits, checking in/out, handling exceptions, etc.), while continuing to submit 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 the mandatory launch date which will be no earlier than August 1, 2020. After this date, all BA providers in Regions 9, 10, and 11 will be required to bill through the Tellus EVV system and no longer bill via the DDE.
Take Action Now to Ensure You Can Receive Payment
Provider Action Required by January 15, 2020
Update Rendering Providers’ Contact Information
This is only applicable for Fee-For-Service and not the Statewide Medicaid Managed Care program.
The Agency for Health Care Administration (Agency) is directing behavior analysis (BA) group providers that deliver services to recipients residing in Regions 9, 10, and 11 to update their rendering providers’ email and phone number with unique contact information in the TELLUS electronic Visit Verification (eVV) System by January 15, 2020. Without this information, BA services cannot be properly verified through the EVV system and providers cannot get paid.
Group providers will know that a rendering provider has non-unique contact information if that rendering provider is not visible to them in the Tellus eVV System.
Detailed instructions on how to update provider contact information via the Tellus eVV System are available by using the following link: AHCA BA • Updated Instructions to Resolve Provider Contact Information.
Rendering providers should also ensure that the Florida Medicaid Management Information System (FMMIS) has their most current and unique contact information. To update the FMMIS, providers should access the secure Portal at: https://home.flmmis.com/home. Detailed instructions can be found at: https://4tellus.com/ahca-ba-•-instructions-to-update-provider-contact-information.
Do not delay in using one of these methods to update individual rendering provider information by January 15, 2020.
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.
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.
- Services that will require EVV include:
||Behavior Analysis - Lead Analyst
||Behavior Analysis - Assistant Behavior Analyst
||Behavior Analysis - Technician
||Behavior Analysis - Group (up to 6)
- For more information please visit https://4tellus.com/ahca-ba/
|Behavior Analysis Coverage Policy
Upcoming training opportunities for the Multidisciplinary Team (MDT) meetings and Electronic Visit Verification (EVV) are detailed below:
Helpful Information and Presentations
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.”
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.
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: