AHCA Updates Proposed Behavior Analysis Changes

Agency implements two pilot programs for these services

The Agency for Health Care Administration (Agency) today announced modifications and a new schedule for the proposed changes for behavior analysis services covered under the Florida Medicaid program.

Secretary Mary Mayhew said, “After hearing and carefully considering a large amount of public feedback, we have decided to modify our implementation schedule to address the concerns over the changes in behavior analysis services. The Agency is fully committed to getting this right, and we look forward to continue working with families and providers toward our ultimate goal of ensuring children receive the right service, at the right time, by an appropriately credentialed and qualified provider.”

The modified changes and schedule will include the following:

• No changes to behavior analysis reimbursement rates will occur during 2019.
• The Agency will delay the requirement that behavior analysis provider groups show proof of their health care clinic licensure, as a condition of Medicaid enrollment, until July 1, 2020.
• The Agency will implement a multidisciplinary team (MDT) model for authorizing behavior analysis services, as a pilot only, effective July 1, 2019. The MDT model will be piloted in Regions 4 and 7, and its effectiveness will be evaluated before expanding into other regions. The Agency will continue to explore other process improvements with providers, to help expedite the review process, that can be implemented in other parts of the state in the interim. Counties in Regions 4 and 7 include Baker, Clay, Duval, Flagler, Nassau, St. Johns, Volusia, Brevard, Orange, Osceola and Seminole.
• The Agency will implement electronic visit verification (EVV) for behavioral analysis services, as a pilot only, effective September 1, 2019. The EVV program will be piloted in Regions 9, 10 and 11, and its effectiveness will be evaluated before expanding into other regions. Counties in Regions 9, 10 and 11 include Indian River, Martin, Okeechobee, Palm Beach, St. Lucie, Broward, Miami-Dade and Monroe.

In addition to these changes, the Agency will transition future public meetings on behavior analysis services in Miami, Fort Lauderdale and Pensacola to online webinars to accommodate a larger number of participants. The webinar format will present the same information and accommodate up to 1,000 participants. If demand exceeds the available slots, the Agency will schedule additional webinars.

See webinar information below:

It is of chief importance to the Agency that children who need behavior analysis services receive the highest quality of care and continue to receive services in a timely manner.

In March, the Agency notified providers, individuals and families involved in behavior analysis services of upcoming changes to provider enrollment, service authorization and electronic visit verification. The changes are part of an effort to improve the distribution of services and ensure children enrolled in the program receive the highest quality of care.

Since the announcement, the Agency has hosted a series of meetings to introduce the proposed changes to behavior analysis services and receive public input. Despite moving recent public meetings to larger venues, the spaces have not been able to accommodate the high volume of interested parties. To date, 535 individuals have attended the meetings, and 130 have been waitlisted due to high demand for participation slots.

Florida Medicaid offers coverage of behavior analysis services for eligible recipients ages birth through 20 years old, when medically necessary. Recipients are not required to have a specific diagnosis but must exhibit maladaptive behaviors. Over 90 percent of the population that receives behavior analysis services are diagnosed with Autism Spectrum Disorder (ASD).

See link for more information on behavior analysis services.

The Agency for Health Care Administration is committed to better health care for all Floridians. The Agency administers Florida’s Medicaid program, licenses and regulates more than 48,000 health care facilities and 47 health plans, and publishes health care data and statistics at FloridaHealthFinder.gov.  Additional information about Agency initiatives is available via Facebook (AHCAFlorida), Twitter (@AHCA_FL) and YouTube (/AHCAFlorida).