Behavior Analysis Services Information

Recipient 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 Beacon?

Beacon Health Options 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 Beacon for review.                                     
Step 4: Beacon 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.

*****ATTENTION BA PROVIDERS********

Behavior Analysis Services Coverage Policy Webinar Trainings

When: 

Wednesday, April 5, 2017
2:00 – 4:00 pm

Wednesday, April 12, 2017
2:00 – 4:00 pm

The Behavior Analysis (BA) services coverage policy webinar trainings will be held on the listed dates to provide an overview of the newly developed BA Services Coverage Policy.  Focus topics will include provider requirements, accessing general policies, and seeking authorization.  To register for a webinar, please click the appropriate link below.

April 5th - https://attendee.gotowebinar.com/register/503816400394102786
April 12th - https://attendee.gotowebinar.com/register/6252561269479502851

BA Services Coverage Policy Training presentation: BA Rule Training for Attendees [2.9MB PDF]

BA Services Coverage Policy Webinar Training Video: To access the webinar training video, please register at the following link: https://attendee.gotowebinar.com/recording/4631639238512503553

***Behavior Analysis Provider Update***

Summary of Key Dates

Since February 2017, provider training on the prior authorization process for Behavior Analysis (BA) services has been available by webinar on Beacon Health Options’ website.

On March 1, 2017, Applied Behavior Analysis (ABA) services ended and BA services began. Providers must be enrolled as provider type 39 with Florida Medicaid to bill for dates of service starting March 1 using the new BA billing procedure codes.

Starting May 15, 2017, provider type 39 must have an approved prior authorization for dates of service starting May 15.

Explanation of Policy Changes and Requirements

The Agency for Health Care Administration (Agency) has developed the Behavior Analysis (BA) service for Medicaid recipients under 21 years of age (herein referred to as “children”). The new service will be delivered by a specific provider type created for BA services (Provider Type 39). This new service will replace coverage of Applied Behavior Analysis (ABA) services that is currently reimbursed under the following policies: Community Behavioral Health, Early Intervention Services, and the Individual Budgeting Home and Community-Based Services Waiver. To review a copy of the Behavior Analysis coverage policy, please visit the Rules Page.

Medicaid providers who have been furnishing ABA services to children will need to re-enroll with Florida Medicaid as a Provider Type 39 if they wish to continue to provide services. Providers who do not complete the Provider Type 39 application process prior to March 1, 2017 will not be able to be reimbursed for BA services until their application is complete. Online provider enrollment application information is located at http://portal.flmmis.com/flpublic/default.aspx. The enrollment presentation materials can be found on the Agency’s website at this link:
http://portal.flmmis.com/FLPublic/Provider_ProviderServices/Provider_Training/Provider_Training_Presentations/tabId/84/Default.aspx

In addition, Behavior Analysis services will require prior authorization through a vendor contracted with the Agency, Beacon Health Options. The Agency will activate the prior authorization requirement for Behavior Analysis assessments and services on May 15, 2017. All BA assessments and services provided on or after May 15 will require prior authorization in order to be reimbursed.

While providers will not need a prior authorization number to bill for services provided between March 1, 2017 and May 15, 2017, providers will be required to submit requests for prior authorization beginning March 1, 2017. The purpose of this requirement is to enable providers to receive technical assistance from Beacon regarding the prior authorization process, ensure prior authorization requests are processed by May 15, 2017, and to ensure continuity of care.

Provider training on the prior authorization process via webinar is posted on Beacon Health Options’ website. For information regarding the prior authorization process and webinar-based provider training contact Beacon customer service at 1-866-827-7737. Hours of Operation: 8 a.m. – 5 p.m. ET, Monday through Friday.

Enrollment Begins Now

All current Medicaid providers of ABA services and prospective providers wishing to furnish Behavior Analysis services must complete the online provider enrollment application located on the Florida Medicaid Web Portal. Both group providers and independent practitioners should begin submitting their Medicaid enrollment applications now. 

Each practitioner (e.g., lead analysts, registered behavior technicians, unlicensed behavior assistants, etc.) rendering behavior analysis services will need to be independently enrolled in the Florida Medicaid program, even if the practitioner is employed by or operating under an agency. During the enrollment process, if practitioners are operating as a part of an agency, he or she will be prompted on how to link their Medicaid number to the group’s (i.e., agency) Medicaid provider number to allow for billing.

To ensure that your application is completed accurately, please follow the instructions and checklist provided in the online Florida Medicaid Provider Enrollment Application Guide.

In addition to the information in the Florida Medicaid Provider Enrollment Application Guide, here is additional information that will be useful in completing the enrollment application.

390 Registered Behavior Technician/Behavior Assistant
Application Type Sole Proprietor Enrolling as a Member of a Group
Proof of certification must include one of the following:
  • Behavior Analyst Certification Board designation as a Registered Behavior Technician (RBT), or
  • Self-attestation of appropriate training as a Behavior Assistant
Must link to a Medicaid-enrolled Behavior Analysis Group
391 Assistant Behavior Analyst
Application Type Sole Proprietor Enrolling as a Member of a Group
Proof of certification must include:
  • Behavior Analyst Certification Board designation as a Board Certified Assistant Behavior Analyst (BCaBA)
Must link to a Medicaid-enrolled Behavior Analysis Group
392 Lead Analyst
Application Type Sole Proprietor, or
Sole Proprietor Enrolling as a Member of a Group
Proof of certification or licensure must include one of the following:
  • Behavior Analyst Certification Board designation as a Board Certified Behavior Analyst (BCBA)
  • Behavior Analyst Certification Board designation as a Board Certified Behavior Analyst Doctoral (BCBA-D)
  • Florida Certified Behavior Analyst (FL-CBA)
  • Florida Licensed Clinical Social Worker
  • Florida Licensed Mental Health Counselor
  • Florida Licensed Marriage and Family Therapist
  • Florida Licensed Psychologist
  • Florida Licensed School Psychologist
Can either direct bill Medicaid as a Sole Proprietor or link to a Medicaid-enrolled Behavior Analysis Group
393 Behavior Analysis Group
Application Type Group
Group Members must be enrolled in Medicaid as a Registered Behavior Technician/Behavior Assistant, Assistant Behavior Analyst, or Lead Analyst.  For billing purposes, each Behavior Analysis group must submit a list of treating providers within the group.  Each of the group’s treating providers must be individually enrolled in the Florida Medicaid program by provider type in order to be linked to the group in the Medicaid system.

The enrollment process can take several weeks to complete. The Agency strongly encourages impacted providers to submit their enrollment applications as soon as possible.

If you need assistance or have questions about the Medicaid Provider Enrollment Application, enrollment forms, supporting documentation, or background screening, please contact the Medicaid Provider Enrollment Call Center at 1-800-289-7799, Option 4.

Frequently Asked Questions

Questions

If you have additional (non-enrollment) questions, please contact the provider/recipient help line at 1-877-254-1055.