Behavior Analysis Services Information
eQHealth Solutions now makes all new determinations for Behavior Analysis (BA) services. This is the company that decides if your child needs BA services. When a decision is made, eQHealth will send you a letter. The following questions provide additional 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 Behavior Analysis Services?
Behavior Analysis services are provided to all eligible Florida Medicaid recipients under the age of 21 years requiring medically necessary BA services.
3. Who is eQHealth?
eQHealth Solutions is the company that will begin reviewing all requests for BA services covered under Florida Medicaid.
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?
Step 1: Go to your doctor and get a written order for BA services.
Step 2: Find a provider (see question 4 above)
Step 3: The BA provider will send a request for BA services to eQHealth for review.
Step 4: eQHealth has professionals that will review the information your provider submits.
Step 5: You will get a letter in the mail letting you know the outcome.
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.”
*****ATTENTION BA PROVIDERS********
To obtain approval for Behavior Analysis services, providers must submit all new authorization requests to eQHealth Solutions, the Agency’s contracted Quality Improvement Organization for this service. For further information, please reference the following FAQs:
1. When will eQHealth begin authorizing services for BA?
Authorizations for BA services began March 26, 2018.
2. What was eQHealth’s first phase of BA implementation?
The first phase began March 26, 2018 and went through April 30, 2018. eQHealth issued administrative authorizations for BA assessments, reassessments, and 20 hours of services per week per recipient. Administrative authorizations did not include a clinical review for medical necessity. If recipients required additional services, providers had to submit documentation demonstrating medical necessity.
3. What is eQHealth’s second phase of BA implementation?
Beginning May 1, 2018, eQHealth will determine prior authorizations based on the medical necessity of a recipient’s request for services. eQHealth will no longer issue automatic administrative approvals of authorizations for BA assessments, reassessments, or BA services.
4. What documentation should be submitted to eQHealth?
When submitting prior authorization requests to eQHealth, BA providers will need to submit documentation that meets the requirements in section 9.0 of the Behavior Analysis Services Coverage Policy.
5. Is a physician’s order required to obtain an assessment, reassessment, or BA Services?
Yes. Providers must submit a written physician’s order to receive authorization for assessments, reassessments, and BA services in accordance with the Behavior Analysis Services Coverage Policy.
6. Is a diagnosis code required for submission with documentation?
Yes. Documentation must include an appropriate diagnosis code at the highest level of specificity as required by policy: http://ahca.myflorida.com/medicaid/review/Specific/59G-4.125_BA_Services_Coverage_Policy.pdf
7. Where can I access training documents and information about eQHealth’s BA implementation?
8. Who can I contact if I have more questions?
Please call the Medicaid helpline at 1-877-254-1055 or eQHealth at 1-855-444-3747 and via the web at http://eqhs.org/.
***Behavior Analysis Provider Update***
On March 1, 2017, Applied Behavior Analysis (ABA) services ended and BA services began. Providers must be enrolled as provider type 39 with Florida Medicaid to bill for dates of service using the new BA billing procedure codes.
Starting March 26, 2018, BA service providers (provider type 39) must begin submitting prior authorization requests through eQHealth.
Beginning June 27, 2018, all BA services delivered under Florida Medicaid must have received prior authorization from eQHealth. Prior authorizations issued by Beacon will not be valid for BA services delivered after June 26th.
BA Prior Authorization Submission Requirements
When submitting prior authorization requests for BA services, providers must submit ALL materials to eQHealth as specified in Appendix 9.0 of the Behavior Analysis Services Coverage Policy. If eQHealth determines that the submission is incomplete or contains insufficient documentation to make a decision, it will inform the provider. The provider then has two business days to submit the remaining materials and/or documentation before the request is denied for lack of documentation. The provider can resubmit a complete authorization request at any time.
When requesting prior authorization for BA services, providers must submit one of the following types of comprehensive evaluations:
- Individualized Education Program (IEP)
- Evaluation by the recipient’s school district that has determined eligibility for special education
- Diagnostic evaluation conducted by one of the following:
- Developmental pediatrician licensed in accordance with Chapter 458, F.S. and certified by the American Board of Pediatrics
- Clinical psychologist licensed in accordance with Chapter 490, F.S.
- Child and adolescent psychiatrist licensed in accordance with Chapter 458, F.S. and certified or eligible for certification by the American Board of Psychiatry and Neurology
A complete request must include the recipient’s diagnostic evaluation report that contains clinical findings, recommendations, and a diagnosis. 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.).
If you have additional (non-enrollment) questions, please contact the provider/recipient help line at 1-877-254-1055 or eQHealth at 1-855-444-3747.