Behavior Analysis Services Provider Information

Summary of Key Dates

February 2017:  Provider training on the prior authorization process for Behavior Analysis (BA) services is available by webinar on Beacon Health Options’ website.

March 1, 2017: Applied Behavior Analysis (ABA) services will end and BA services will begin. Providers must be enrolled as Provider Type 39 with Florida Medicaid to bill for dates of service starting March 1 and providers must use the new BA billing procedure codes.

April 3, 2017: Provider Type 39 must have an approved prior authorization for dates of service starting April 3.

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 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 April 3, 2017. All BA assessments and services provided on or after April 3 will require prior authorization in order to be reimbursed.

While providers will not need a prior authorization number to bill for services provided between February 1, 2017 and April 3, 2017, providers will be required to submit requests for prior authorization beginning February 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 April 3, 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.

Questions

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