Behavior Analysis Services Information

• 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.

• By December 1, 2020, behavior analysis provider groups must show proof of their health care clinic licensure, as a condition of Medicaid enrollment.

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.

• 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.

• 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.

  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.

• 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/

• When available, the draft will be posted on the Agency’s Rules in Process website. 
• Providers may submit comments anytime to the Agency by email: BAComments@ahca.myflorida.com.
• Future rule meetings will be scheduled and noticed to providers through provider alerts. To sign up for provider alerts, visit the Agency’s Medicaid Health Care Alerts website.

Health Care Clinic Licensure

Behavior Analysis Frequently Asked Questions