Behavior Analysis Services Information
What is Behavior Analysis?
Behavior Analysis (BA) services are highly structured interventions, strategies, and approaches provided to decrease maladaptive behaviors and increase or reinforce appropriate behaviors. Florida Medicaid covers behavior analysis services through the Statewide Medicaid Managed Care (SMMC) program and the fee-for-service delivery system.
Updates to Behavior Analysis
Up-to-date information regarding Florida Medicaid behavior analysis service can be found here. Providers can also sign up receive to provider alerts by registering at Florida Medicaid Health Care Alerts.
| Topic | Information |
|---|---|
| Agency Contacts | Report a Complaint Report Fraud & Abuse Ask a behavior analysis question |
| Behavior Analysis will be covered by the Florida Statewide Medicaid Managed Care (SMMC) program | Beginning February 1, 2025, behavior analysis services will be reimbursed by Florida SMMC plans. All claims for BA services delivered on and after February 1, 2025, must be submitted to the recipient’s SMMC plan. Services delivered to recipients who are not enrolled in a SMMC plan will continue to be reimbursed through the fee-for-service delivery system. |
| SMMC transition information | The Agency has published a webpage highlighting the new SMMC program, which will be updated during the transition period. The Agency has also published a BA information sheet [ 
212.9 kB
]
for BA providers, recipients, and parents of recipients who receive Florida Medicaid BA services. |
| Continuity of Care | The Agency has required plans to offer a continuity of care (COC) period, during which non-network providers can be reimbursed for delivered BA services. The purpose of the COC is to ensure that no recipient misses a medically necessary service and providers are paid for services delivered in good faith. See the
COC information document
[
193.9 kB
]
on the SMMC page for more information. |
| Behavior Analysis Coverage Policy | Effective February 10, 2025, The Agency adopted
Rule 59G-4.125, the Behavior Analysis Coverage Policy
[
273.5 kB
]
, according to Chapter 120, Florida Statutes. |
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 BA Services?
Florida Medicaid covers BA services for eligible Florida Medicaid recipients under the age of 21 years requiring medically necessary BA services. BA services for eligible individuals 21 years and older are available through the iBudget Waiver.
3. How do I find a provider?
Your child’s managed care plan can help you find a BA service provider in your child’s plan network. See the SMMC plan contact list if you do not know who to contact in your child’s plan. If your child is not enrolled in a SMMMC plan, a link to BA service providers can be found on the Agency’s Recipient Support webpage under Additional Reference Information.
4. What are the steps I take to get BA services?
- Go to your doctor and get a written order for BA services.
- Have a comprehensive diagnostic evaluation completed by a qualified licensed practitioner
- Choose a BA provider (see question 3 above)
- The BA provider will send a BA service request to your child's plan or Acentra for prior authorization.
- The information your provider submits will be reviewed and the plan or Acentra will make a service determination based on the provided information and medical necessity.
- You and the BA provider will be notified of the outcome of the review.
5. Who can I contact if I have more questions?
Please call the Medicaid helpline at 1-877-254-1055, if you have more questions.
6. 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.
Provider Resources
Trainings, Presentations, and Resources
| Subject | Resource |
|---|---|
| Agency Rules |
Behavior Analysis Coverage Policy
[
273.5 kB
]
Behavior Analysis Fee Schedule [
441.3 kB
]
Agency Rules |
| Agency July 29, 2022 BA Fee Schedule Training |
Fee Schedule Webinar Recording
[
31.9 MB
]
|
| Provider Enrollment |
Agency Provider Enrollment Policy
[
4.7 MB
]
Provider Enrollment website Provider Enrollment helpline: 1-800-289-7799 option 4 Provider Enrollment References and Trainings |
BA Prior Authorization Submission Requirements
All BA services must have prior authorization to be reimbursed by Florida Medicaid. To obtain approval for Behavior Analysis services, providers must:
- Submit new authorization requests to the recipient's SMMC plan according to plan direction, or
- Submit new authorization requests to Acentra, the Agency’s contracted Quality Improvement Organization, for recipients who are not enrolled in an SMMC plan
Comprehensive Diagnostic Evaluation Requirements
To initiate 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 when submitting prior authorization requests.
The Comprehensive Diagnostic Evaluation (CDE) is the national practice standard necessary to diagnose autism as well as other developmental or behavioral disorders and indicate the most appropriate treatment(s) to address the child’s needs. A CDE is a thorough review and assessment of the child’s development and behavior. A CDE may be performed by a multidisciplinary team or individual practitioner. In either case, the CDE must be led by a licensed practitioner working within their scope of practice. The CDE must use evidence-based practice standards, methods and instruments, and the report must include assessment findings and treatment recommendations appropriate to the recipient. For example, CDE testing may include:
- Parent or guardian interview
- Teacher assessment
- Diagnostic testing using tools such as:
- Autism Diagnostic Observation Schedule (ADOS-2)
- The Childhood Autism Rating Scale – 2nd edition (CARS2)
- Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R)
- Communication and Symbolic Behavior Scales (CSBS)
- Autism Diagnostic Interview, Revised (ADI-R)
- Social Communication Questionnaire
- Battelle Developmental Inventory– 2nd edition
- Hearing and vision testing
- Genetic testing
- Neurological and/or other medical testing
