Provider Requirements and Service Limitations
From The May 2010 Florida Medicaid Provider Handbook
Information highlighted in yellow indicates a change since the July 2007 version of this handbook.
Behavior Analysis- Requirements To Receive
Behavior analysis services are provided to assist a person or persons to learn new behavior that are directly related to existing challenging behaviors or functionally equivalent replacement behaviors for identified challenging behaviors. Services may also be provided to increase existing behavior, to reduce existing behavior, and to emit behavior under precise environmental conditions. The term “behavior analysis services” includes the terms “behavior programming” and “behavioral programs.” Behavior analysis includes the design, implementation and evaluation of systematic environmental modifications for the purposes of producing socially significant improvements in and understanding of human behavior based on the principles of behavior identified through the experimental analysis of behavior. It includes the identification of functional relationships between behavior and environment. It uses direct observation and measurement of behavior and environment. Contextual factors, establishing operations, antecedent stimuli, positive reinforcement and other consequences are used based on identified functional relationships between behavior and environment, in order to produce practical behavior change.
Behavioral services must include procedures to insure generalization and maintenance of behaviors. The services are designed to engineer environmental modifications including ongoing styles of interactions, and contingencies maintained by significant others in the recipient’s life. Training for parents, caregivers and staff is also part of the services when these persons are integral to the implementation or monitoring of a behavior analysis services plan. Services should be provided for a limited time and discontinued as the significant others gain skills and abilities to assist the recipient to function in more independent and less challenging ways.
Delivery of behavioral services is a complex process that includes provision of services directly to the recipient, at times, or others supporting the recipient in his or her presence, as well as services required to assess, plan and train others without the recipient present. Examples of services provided to the recipient to caregivers, staff or other providers while the recipient is present include: analog functional analysis, observation of the recipient for descriptive functional assessment, observations of and feedback regarding interactions of caregivers, staff or other providers with the recipient, modeling procedures with the recipient for caregiver, staff, or other providers, probing new procedures with the recipient, and direct training to the recipient (typically with caregivers, staff, or other providers present). In addition, services required to support behavior analysis services, may include: behavior plan development, graphing and analysis of data, behavior plan revision, training staff, caregivers or other providers (recipient not present), consultation to other professionals, Local Review Committee presentation, and treatment team meeting (with or without recipient present). The latter support services may not be reimbursed in excess of 25 percent of the total units for the cost plan year.
Behavior analysis does not rely on cognitive therapies and expressly excludes psychological testing, neuropsychology, psychotherapy, sex therapy, psychoanalysis, hypnotherapy and long-term counseling as treatment modalities. Provision of behavioral services must comply with rule 65G-4.009, F.A.C. Services provided by behavior analysts with limited experience in the problem area or by behavior analysts who are not Board Certified Behavior Analysts with three years of experience or licensure under Chapter 490 or 491, F.S., should receive oversight and approval of services with a more experienced behavior analyst or with the above described highest level of certification.
A recipient shall receive no more than 16 units of this service per day. A unit is defined as a 15-minute time period or portion thereof. This service may be provided concurrently (at the same time and date) with another service.
Documentation of services must comply with rule 65G-4.009, F.A.C. Reimbursement* and monitoring documentation to be maintained by the provider includes:
- *Copy of claim(s) submitted for payment;
- *Copy of service log;
- *Copy of assessment report, when an assessment has been requested; *Quarterly summary of monitoring including the who, what, when and where of the monitoring events
• A quarterly summary for each quarter of the support plan year;
• A quarterly summary for the third quarter of the support plan year also serves as the annual report and must include:
• a summary of the fourth quarter of the previous support plan year, and a summary of the first three quarters of the current support plan year.
- *Behavior analysis service plan and services provided including graphic display of acquisition and reduction behaviors related to implementation of the service plan; and
- *Dated evidence of LRC reviews and recommendations specific to target behaviors and the behavior plan, when the procedures and behaviors meet criteria for review and approval in accordance with rule 65G-4.010, F.A.C.
Documentation to be submitted to the waiver support coordinator by the provider:
- *Copy of service log, monthly;
- *Copy of assessment report within 30 days of initially providing services, when an assessment has been requested;
- *A copy of the provider’s behavior analysis service plan within 90 days of initially providing services;
- *Updates of the intervention plan as it is modified;
- *Graphic displays of acquisition and reduction behaviors related to implementation of the service updated monthly, with baseline data to allow evaluation of progress; and
- Annual report prior to the annual support plan update.
*Indicates reimbursement documentation.
Place of Service
These services may be provided in the provider's office, the recipient’s place of residence or anywhere in the community. However, in all cases, behavior analysis services must also be provided in the setting(s) relevant to the behavior problems being addressed.
Behavior analysis and assessment services are described more fully in Chapter 65G, F.A.C., which is available through the APD Area Office. As stated in rule 65G-4.010, F.A.C., approval for behavior analysis services for behaviors meeting the characteristics described in the rule must be obtained from certified behavior analysts meeting educational and experience requirements or persons licensed pursuant to Chapter 490 or 491, F.S., prior to implementation of the services.
Note: The F.A.C. is available online at flrules.org.
Behavior Analysis Provider Requirements
Providers of behavior analysis must have licensure or certification on active status at the time services are provided. Providers of this service must have one or more of the following credentials:
- Level 1 Board Certified Behavior Analyst; Florida Certified Behavior Analyst with expanded privileges; or a person licensed under Chapter 490 or 491, F.S., (Psychologist, School Psychologist, Clinical Social Worker, Marriage and Family Therapist or Mental Health Counselor), with more than three years of experience in behavior analysis post certification or licensure.
- Level 2 Board Certified Behavior Analyst; Florida Certified Behavior Analyst with
expanded privileges; or a person licensed under Chapter 490 or 491, F.S.,
(Psychologist, School Psychologist, Clinical Social Worker, Marriage and Family
Therapist or Mental Health Counselor), with less than three years of experience
in behavior analysis post certification or licensure; or a Florida Certified Behavior Analyst
with a Masters or Doctorate, regardless of experience.
- Level 3 Board or Florida Certified Assistant Behavior Analyst or a Florida Certified
Behavior Analyst with bachelors or high school diploma, regardless of
The provider is responsible for all training requirements outlined in the Core Assurances.
Note: Refer to the Core Assurances in Appendix A for the provider training requirements.