florida medicaid behavior analysis services coverage policy october 2017

 

General meetings will be held on the last Friday of the month from 10:00-11:00am, as before. F.S. Behavior analysis (BA) services are highly structured interventions, strategies, and approaches provided to decrease maladaptive behaviors and increase or reinforce appropriate behaviors. (2) All providers must be in compliance with the provisions of the Florida Medicaid Behavior Analysis Services Coverage Policy, October 2017, incorporated by reference. About 41,000 children statewide receive applied behavior analysis therapy, commonly called ABA therapy, through the Florida Medicaid system. Provider training on “Medicaid Coverage & Prior Authorization for Applied Behavior Analysis Services ... We will provide guidance about Florida Medicaid policy for Applied Behavior Analysis services, the prior authorization request process, and information about service codes, reimbursement rates, and billing process. The Florida Agency for Health Care Administration (Agency), Medicaid Program Integrity (MPI) has and is undergoing review of several Behavior Analysis Services providers regarding their Medicaid reimbursement claims for services rendered. Details: Florida Medicaid Therapeutic Behavioral On-Site Services UM Guideline Subject: Therapeutic Behavioral On-Site Services for Recipients Under the Age of 21 Years Current Effective Date: 11/14/18 Status: Approved Last Review Date: 11/14/18 Medicaid UM Guideline Form Creation: 2/10/2016 Revised: 2/17/2017 Page 4 of 21 2) A Bio-psychosocial assessment; OR INDIVIDUAL BUDGETING WAIVER SERVICES . The Florida Agency for Health Care Administration (Agency), Medicaid Program Integrity (MPI) has and is undergoing review of several Behavior Analysis Services providers regarding their Medicaid reimbursement claims for services rendered. 3.0 Eligible Provider 3.1 General Criteria Providers must meet the qualifications specified in this policy in order to be reimbursed for Florida Medicaid behavioral health therapy services. Under the proposed House plan, Florida would be on the short end of the one of the biggest costs shifts from the federal government to the state. Attention Behavior Analysis Service Providers: In accordance with the Florida Medicaid Authorization Requirements Policy, eQHealth Solutions may request additional information … Coverage of Medicaid services during the state of emergency. June 25. How to Use the Update Log Introduction . Florida providers must be enrolled as Provider Type 39 with Florida Medicaid to bill for dates of service starting February 1 and providers must use the new BA billing procedure codes. August 27. Coverage is limited to $36,000 … Special meetings may be announced. COVERAGE AND LIMITATIONS HANDBOOK . DEVELOPMENTAL DISABILITIES INDIVIDUAL BUDGETING WAIVER SERVICES . Law Implemented 409.906 FS. The Informational Bulletin outlines the Medicaid coverage categories that are available to cover services to treat ASD. Florida Medicaid’s General Policies on copayment and coinsurance. Jun 10, 2018 — We want to provide the best quality Behavior Analysis services based on best practice but Florida's Medicaid / ACHA are not listening and this endangers many children in Florida, as well as businesses. Applies to all health insurance plans and health maintenance contracts, and includes coverage for autism spectrum disorders as well as Down Syndrome. Provider training on “Medicaid Coverage & Prior Authorization for ... We will provide guidance about Florida Medicaid policy for Applied Behavior Analysis services, the prior authorization request process, and information about service codes, reimbursement rates, and billing process. COVERAGE AND LIMITATIONS HANDBOOK. The legislation applies to behavior analysis service providers in AHCA Regions 9, 10 and 11, and they can no longer bill through the Florida Medicaid Management Information System (FMMIS). Provider training on “Medicaid Coverage & Prior Authorization for Applied Behavior Analysis Services ... We will provide guidance about Florida Medicaid policy for Applied Behavior Analysis services, the prior authorization request process, and information about service codes, reimbursement rates, and billing process. Agency for Health Care Administration July 2017 . Obtaining the Handbook Update When a handbook is updated, the Medicaid … Florida Medicaid . (1) This rule applies to all providers rendering Florida Medicaid behavior analysis services to recipients. 59G-4.125 Behavior Analysis Services. The blanket of Medicaid coverage for Floridians is wide and crucial for their health and safety. 627.6686. All submitted documentation must meet the requirements in accordance with Appendix 9.0 of the Behavior Analysis Services Coverage Policy (Rule 59G-4.125, F.A.C.). The agency was correct about the spending growth. December 26 (subject to change) Behavior analysis services for children in need of such services when: (i) services cannot be delivered because the center is closed and home-based care is not an option; or (ii) the provider and/or recipient meets one or more of the screening criteria for COVID-19 in accordance with the Department of Health guidelines and services cannot be delivered in the home. Rule: 59G-4.125, F.A.C. A federal judge recently ordered Florida Medicaid to cover Applied Behavior Analysis (ABA) for the treatment of autism spectrum disorders for children under the age of 21, effective April 2, 2012. However, meetings will be every-other month. Applied behavior analysis involves the use of behavioral principles (such as positive reinforcement, or the use of rewards) to encourage the development of the desired behaviors in place of the less adaptive, self-defeating or even harmful behaviors the child may be using. References in this version: Ref-08679 Florida Medicaid Behavior Analysis Services Coverage Policy, October 2017 History–New 2-19-17, Amended 10-29-17. If an assessment takes 90 minutes, then two 0361T codes are used. July 2017 . General meeting dates: April 30. Florida Medicaid Behavior Analysis Services Coverage Policy Appendix Page 1 - Please explain why the policy references the materials The behavior analysis coverage policy will be combined into one policy with other Medicaid-covered behavior modification and intervention services. The AHCA says it intends to appeal this ruling. NH Healthy Families would like to notify providers that there has been no change to the Applied Behavioral Analysis (ABA) codes for NH Healthy Families Medicaid ABA services. 10/29/2017 : History Notes: Rulemaking Authority 409.919 FS. 3.2 Who Can Provide Services must be rendered by one of the following: The Bureau of Policy is responsible for the development, coordination and implementation of Florida Medicaid program policy including: all Medicaid federal authorities (e.g., the Florida State Plan, 1115 waivers and home and community based service waivers, administrative rules, coverage policies and managed care plan contracts) related to services covered by Florida Medicaid. The update log provides a history of the handbook updates. 2017 Medicaid is the state’s number one source of federal funding. (2) All providers must be in compliance with the provisions of the Florida Medicaid Behavior Analysis Services Coverage Policy, October 2017, incorporated by reference. UPDATE LOG. The policy or contract may limit coverage for applied behavior analysis to $36,000 per year, and the insurance policy or contract may not include any limits on the number of visits. Florida Medicaid. 627.6686 Coverage for individuals with autism spectrum disorder required; exception.—. Each Florida Medicaid handbook contains an update log. (1) This rule applies to all providers rendering Florida Medicaid behavior analysis services to recipients. The state says while recipients are not required to have a specific diagnosis, they must exhibit maladaptive behaviors – … February 1, 2017: Applied Behavior Analysis (ABA) services will end and BA services will begin. Coverage of all medically necessary services to COVID-19 testing and treatment. CONSUMER-DIRECTED CARE PLUS PROGRAM COVERAGE, LIMITATIONS, AND REIMBURSEMENT HANDBOOK UPDATE LOG How to Use the Update Log Introduction The update log provides a history of the handbook updates. Florida Medicaid . 59G-4.125 Behavior Analysis Services. • 59G-1.010 AHCA Definitions Policy August 2017 ... field of applied behavior analysis (see Cooper, Heron, & Heward, 2007 for specifics) (this is a big problem in many treatment plans) • Narrative summary of progress during the last observation in relation to long term goals for each behavior targeted for treatment. These changes are all in an effort to reduce the rate of Medicaid Fraud throughout the industry. By 2017… In 2012, AHCA spent $3.1 million on behavior analysis services for children with Medicaid. October 2015 . Florida— Florida Laws, Chapter 30: SB 2654 of 2008; 2016 Florida Bill 0221. However, the Agency did not address one of FABA’s top priorities regarding a requirement that treatment programs be administered by a lead analyst who is a Board Certified Behavior Analyst. Rule Title: Behavior Analysis Services Dear Ms. Oates: I am submitting the following response to your comments in the letter dated June 27, 2017, regarding the above-referenced rule. Children (nc): Added coverage for Behavior Modification/Applied Behavioral Analysis services for children with autism spectrum disorder to meet federal requirements (October 1, 2015).