The Agency for Health Care Administration (Agency) released the following updates on Behavioral Analysis (BA) services.
- Since May 1, 2018, 13,687 requests for authorization of BA services have been approved, which equates to 11,564 recipients with approvals by eQHealth.
- From May 15, 2018 to July 13, 2018 253 new BA providers have been enrolled in Medicaid.
- The Agency has paid out more than $100 million for services that have occurred since the eQHealth contract was implemented.
The Agency actions taken against BA providers are below. There are ongoing investigations, and the state will continue to announce sanctions against BA providers as the information becomes available.
Terminations from Medicaid
o Enys Garcia – final order here.
- From March 5, 2018 to March 23, 2018, DRA Behavioral Health billed for Garcia as a renderer for impossible days, an average of 28.21 hours in a day, ranging from 26.5 to 31.5 hours.
o Betty Reynolds – final order here.
- From June 12, 2017 to March 21, 2018, DRA Behavioral Health billed for Reynolds as a renderer for impossible days, an average of 36.71 hours in a day, ranging from 26 to 67 hours.
o Daisy Ravelo – final order here.
- From July 18, 2017 to March 22, 2018, DRA Behavioral Health billed for Ravelo as a renderer for impossible days, an average of 34.53 hours in a day, ranging from 25 to 74.5 hours.
o Aleida Carballo – final order here.
- From February 19, 2018 to February 24, 2018, DRA Behavioral Health billed for Carballo as a renderer for impossible days, an average of 27 hours in a day.
o Jorge Coronado – final order here.
- From March 12, 2018 to March 17, 2018, DRA Behavioral Health billed for Coronado as a renderer for impossible days, an average of 28.67 hours in a day, ranging from 25 to 32 hours.
o Mario Kok Sanchez – final order here.
- On September 3, 2017 DRA Behavioral Health billed for Sanchez as a renderer for 5 claims. Specifically, the claims data shows Sanchez as working a total of 36 hours.
Medicaid Overpayments
o MGM Behavioral – final order here.
- MGM Behavioral used unqualified rendering providers for BA services, and has agreed to refund a Medicaid overpayment totaling $1,047,839.51.
Suspensions from Medicaid
o Harmony Mental Health and Behavioral Services – final order here.
- Harmony Mental Health and Behavioral Services failed to pay the required fine and failed to timely provide required Medicaid records on employees such as: a list of group members, employee resumes, required AHCA training certificates, required certifications, and background checks.
o Meli Medical Center, Inc. – final order here.
- Meli Medical Center, Inc. submitted false information on the Medicaid provider enrollment application. Specifically that owner Orlando Chillon submitted false information on the Medicaid provider enrollment information.
BA is a service provided to children enrolled in Medicaid with significant behavioral issues (e.g., children with autism who are injuring themselves or others). It is usually provided in the child’s home. It is critical that the Agency ensure the health, safety, and welfare of the children receiving this service.
Under the Florida Medicaid program children have access to all medically necessary services, including applied behavioral analysis services. If any recipient is having difficulty accessing services, please encourage them to contact the Florida Medicaid Helpline at 1-877-254-1055 or file a complaint using this online form. To be clear, there have been no cuts to funding or coverage for behavioral analysis services, and this service is still available.
