Behavior Analysis Services Information

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. More information, including fact sheets and videos, is located on the Behavior Analyst Certification Board’s page.

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.

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. Who is Acentra?

Acentra, formerly eQHealth Solutions is the company that reviews all requests for BA services covered under Florida Medicaid. A BA provider will submit the service request to Acentra, which will review the service need based on medical necessity. After the determination is made, Acentra will send you a letter.

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?

• 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 a provider (see question 4 above)
• The BA provider will send a BA service request  to Acentra for review.
• Acentra will review the information your provider submits and make a service determination based on the provided information and medical necessity.
• Acentra will notify you and the BA provider of the outcome of the review.

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.”

Provider Resources

Trainings, Presentations, and Resources

Subject	Resource
Agency Rules	Behavior Analysis Coverage Policy [ 235.2 kB ] Behavior Analysis Fee Schedule [ 441.3 kB ] Agency Rules
Behavior analysis coverage policy and fee schedule FAQ	BA FAQ November 2022 [ 193.1 kB ]
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
Acentra Multidisciplinary Trainings	Available on Acentra's website.

BA Prior Authorization Submission Requirements

To obtain approval for Behavior Analysis services, providers must submit all new authorization requests to Acentra, the Agency’s contracted Quality Improvement Organization for this service. For further information, please reference the following:

• Behavior Analysis Services Coverage Policy [ 235.2 kB ]
• Authorization Requirements Rule [ 110.8 kB ]
• Acentra Behavior Analysis Website provides information and training for the below topics:
  • Behavior Analysis eQSuite User Guide
  • Behavior Plan Provider Training
  • Submitting a Modification to a BA Prior Authorization Training

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

Alternative Assessments in Pilot Regions

In the MDT regions, BA services may be initiated for a child during an excessive wait time for their scheduled CDE. When a child is on a waiting list for a scheduled CDE, Acentra may accept the following documentation, in lieu of the CDE:

• Scheduled CDE confirmation
• 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

Authorizations without a CDE are temporary. 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.