FABA EVV Action Committee Update - January 7, 2021

FABA EVV Action Committee – December 4, 2020

The FABA EVV Action Committee continues to meet regularly with AHCA. If you did not read the AHCA Alert from 11/25/20 you should know that as of Monday, December 7th, the Agency for Health Care Administration will be enforcing the use of the Tellus EVV System. This means that all Behavior Analysis Fee-for-Service providers funded through Medicaid must be registered in the Tellus system. If you are not registered in the Tellus system as of Monday you will no longer be able to bill through FMMIS. If you are NOT REGISTERED all claims submitted directly to FMMIS will suspend until the Agency confirms that you have registered and begun using the Tellus EVV System at least for scheduling and visit verification.

So, PLEASE REGISTER as soon as possible, if you have not done so already. If you are having PROBLEMS REGISTERING please contact Damon Rich at AHCA. His email is [email protected]. Please use the Subject line, FABA Referral and avoid bombarding a variety of AHCA staff, so that your concerns are directly seen by Damon Rich.

Also, if you are not providing PHI, please copy the FABA PAC, [email protected], so we can assist you and work with AHCA to assure you get registered.

Click below to view a job aid, “AHCA BA Registration Process” that should help walk you through the registration process.

AHCA - Registering Your Agency with Tellus EVV

November 25, 2020  – Legislative Update – EVV Action Committee

The FABA EVV Action Committee met with AHCA this morning and we believe that some additional flexibility with the December 1^st “go live” implementation of the EVV system has been achieved.  These flexibilities will help to ease providers into full implementation over the month of December.  This will mean that providers in the pilot areas (Area 9, 10 and 11) in South Florida will need to demonstrate a good faith effort to attempt implementation of all aspects of the EVV system.

The demonstration of participation will be monitored for all providers in these areas and FABA will be meeting weekly with AHCA to review this progress and update membership.  In the first phase this will mean that ALL providers must register and create an account in the system.  Currently, it appears that only 40% of providers in the Region are registered, while the data is showing that 98% of registered providers have a least 1 recipient listed.  In addition, providers need to attempt scheduling in the system, as only 72% of those currently registered are actually using the system to do this.  Lastly, attempts should be made to bill.  Currently, only 39% of those registered in the system have attempted billing.

To move this system forward, FABA strongly encourages providers to register into the system immediately.  If problems are encountered with registering, AHCA wants to know that so they can address the problem.  The same is true for scheduling and conducting sessions.  Similarly, as providers begin the transition of billing from FLEMMIS to Tellus, AHCA will need to know of any problems with this process.  Part of the agreement is to allow use of FLMMIS, if needed, until December 21st.

Any problems that you encounter should be sent to AHCA through encrypted mail or with a password protected Word document, followed by the emailed password.  AHCA has advised that you are more than welcome to continue copying Tellus, but AHCA will take lead on any direct referrals sent to them.  This means they will either resolve the issue directly without Tellus involvement, or specifically direct Tellus actions for prompt intervention and resolution.  

• You can email the following individuals:
• [email protected]
• [email protected]
• [email protected]
• [email protected]
• [email protected]
• Subject Line: FABA Referral – <Insert Provider Specific Title>
• Specific Example when available
• Include at a minimum, when applicable:
• Date of issue
• Provider ID
• Recipient ID
• Address/Service Location
• Tellus Ticket number if one has been opened
• If you are not providing PHI, please copy the FABA PAC, [email protected], so we can continue to aggregate the data and conduct follow-up with AHCA during our weekly reviews.

OCTOBER 5, 2020 - Legislative Update – Updates to Health Care Clinic Licensure for Florida Medicaid Providers 

During the 2020 Florida legislative session, an exemption to health care clinic licensure for Florida Medicaid providers was added to Section 400.9905, Florida Statutes. As a result of this legislative change, Florida Medicaid providers are not required to seek health care clinic licensure.  

Effective July 1, 2020, Florida Medicaid does not require any provider to show proof of licensure as a health care clinic nor proof of exemption from licensure as a health care clinic. Current, reenrolling, or new Florida Medicaid providers do not need to show proof of licensure as a health care clinic nor proof of exemption from licensure as a health care clinic.

Florida Medicaid is working to update the Enrollment Policy (Appendix E) to remove these requirements to align with Section 400.9905, Florida Statutes for all of the below providers: 

Florida Medicaid providers may voluntarily apply for a certificate of exemption from licensure as a health care clinic. Most health care providers who apply for an exemption certificate do so because Medicare or private insurance companies require documentation of licensure or exemption from licensure prior to authorizing reimbursement for services. If you choose to apply, application forms and information are online at http://ahca.myflorida.com/MCHQ/Health_Facility_Regulation/Hospital_Outpatient/HealthCareClinic/hcc_exemption.shtml. Please note: The health care clinic rules and application forms have not yet been updated to reflect the recent statutory changes. If an entity is attempting to qualify under a newly added exemption, they can submit an application along with appropriate fees, a cover letter stating the exemption sought and appropriate supporting documentation.

For additional assistance please contact the Florida Medicaid Helpline at 1-877-254-1055.

SEPTEMBER 15, 2020 – Legislative Update – HB 731, Agency for Health Care Administration

Governor DeSantis did sign HB 731 – Agency for Health Care Administration on June 30, 2020, that contains an exemption from the health care clinic licensure for Medicaid providers. Now that the exemption is law, it is our understanding, after speaking with the Medicaid Policy Office at AHCA that the exemption will be automatic for behavior analysts enrolled as Medicaid providers and no further action will be needed to be taken by Medicaid providers. We also expect the Agency to announce that the December 1, 2020, health care clinic licensure requirement deadline for behavior analysis groups will be repealed from the Medicaid Enrollment Handbook and that administrative rulemaking will be necessary to effectuate the change. We are anticipating a Provider Alert soon from AHCA on this matter. Please stay tuned and attend the September  17, 2020, panel discussion with AHCA, APD, and CASP at 4pm during the 2020 FABA Conference for further information.

March 6, 2020 - SB 1206

Members,
We are continuing our advocacy to move SB 1206 to the Senate Floor but wanted you to know that HB 731, the AHCA bill that contains a health clinic licensure exemption for all Medicaid providers, moved forward again today and will be ready for a vote on the House Floor early next week.

Take Action Now!

Let Senate President Bill Galvano know that SB 1206 – Applied Behavior Analysis is critical to making sure children with special needs receive medically necessary services. One more time! We are asking each of you to contact Senate President Bill Galvano to make sure that Senate Bill 1206 – Applied Behavior Analysis is either withdrawn from the Senate Appropriations Committee or heard by the Senate Appropriations Committee. As of today, SB 1206 is still stuck in Senate Appropriations and cannot advance. If the bill is withdrawn or heard in Senate Appropriations the bill can move to the Senate Calendar and be matched up with its companion bill, HB 575, that has already passed the House and is awaiting action by the Senate. Please feel free to customize the draft e-mail so that it applies to your unique personal situation.

Go the Action Center now to send your e-mail: 

https://www.votervoice.net/FABA/campaigns/72144/respond

May 4, 2019 - AHCA Announces New Proposed Changes to Florida Medicaid Behavior Analysis

The Agency for Health Care Administration (AHCA) hosted a packed meeting in Tallahassee on March 29, 2019, to announce updates regarding the delivery of Florida Medicaid Behavior Analysis services. The meeting featured a presentation by representatives from the Agency where they announced a number of updates, which are summarized below. 

A number of these updates may be positive developments that will hopefully increase access to service and efficiency in the near future. However, the proposed rate reductions are concerning and have the potential to dramatically limit quality providers’ ability to render service. The most effective way to put a stop to these proposed changes is by reaching out to your lawmakers and asking them to STOP THE CUTS. You can seamlessly email and call them NOW using the FABA Action Center.

Here is a summary of the updates that were announced:

Changes to Reimbursement Rates
AHCA believes the current rates are significantly higher than is necessary to ensure access to the service statewide, especially when examining the actual wages earned by professionals providing the service. AHCA is working to realign provider reimbursement rates with a revised methodology. 

The proposed changes in the rates include:

• The rates for a Behavior Analysis Assessment will decrease from $385.19 to $301.31
• The rates for a Behavior Analysis Reassessment will decrease from $192.59 to $150.65
• The rates for a Behavior Analysis Lead, per quarter hour, will remain the same at $19.05
• The rates for a Behavior Analysis Assistant, per quarter hour, will decrease from $15.24 to $10.52
• The rates for a Behavior Analysis Registered Behavior Technician, per quarter hour, are decreasing from $12.19 to $5.98

Provider Enrollment Moratorium
AHCA is seeking to partially lift the moratorium in Miami-Dade and Broward counties. This will include registered behavior technicians, lead analysts, and board certified assistant behavior analysts seeking enrollment to participate as a member of a provider group that is already enrolled in Florida Medicaid. However, the moratorium will remain in effect for new group providers and lead analysts wishing to practice independently. The goal is for this to take place at the end of April. AHCA will host provider enrollment trainings in late April and early May.

Health Care Clinic License
Provider groups will be required to prove that they have a health care clinic license by December 31, 2019 or provide a copy of the certificate of exemption. This requirement is not new, but stronger verification procedures will be implemented. 

Multidisciplinary Team Approach
In an attempt to streamline the delivery of medically necessary services, AHCA will be implementing a Multidisciplinary Team (MDT) approach. The MDT approach includes telephone or home visit contacts with parents, medical documentation review by clinicians from two separate disciplines, and a team meeting that can include the provider.

Coverage Policy Revisions
The behavior analysis coverage policy will be combined into one policy with other Medicaid-covered behavior modification and intervention services. 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.

Electronic Visit Verification
The Agency is working on implementing an Electronic Visit Verification (EVV) requirement. The EVV policy will require providers to check in and check out using an app on a mobile phone. This will link the provider check in with a claim submission and ensures submitted claims information is valid and aligns with prior authorization information.

This is the first of a series of meetings that will be held across the state. Over the next month and a half, additional meetings will be held at the following locations:

• Tampa
  Friday, April 5 at 10:30am
• Orlando
  Thursday, April 18 at 10:30am
• Jacksonville
  Friday, April 19 at 10:30am
• Miami
  Thursday, April 25 at 10:30am
• Ft. Lauderdale
  Friday, April 26 at 10:30am
• Pensacola
  Friday, May 10 at 10:30am

It’s important to note that none of these changes are finalized right now, so it is critical that FABA members do everything possible to attend these meetings and provide feedback and public testimony. We also need as many providers and parents as possible to email their lawmakers and the governor using the FABA Action Center. 

May 19, 2017 – Attention FL Medicaid ABA Providers!

Please find below some helpful resources, courtesy of AHCA.

The Medicaid Public Web Portal provides access to the Provider Services page where providers can obtain helpful information including:

• Electronic Data Interchange (EDI) including companion guides for the creation of claims, EDI software and manuals, EDI forms and agreements, and Submission Information such as an interactive Web site for testing claims transactions and sample files.
• Provider Enrollment guidance and forms.
• Provider support including alerts of policy or protocol changes, links to Medicaid handbooks and fee schedules, and contact information.
• Provider Training

https://portal.flmmis.com/FLPublic/Provider_PublicHome/tabId/36/Default.aspx

Web-based Trainings

• The Provider Electronic Solutions (PES) Web-based Training (WBT) is an interactive walk-through that introduces providers to the available menu items in PES and provides step-by-step instructions for completing and submitting claims via PES.
• The Web Portal WBT is designed to demonstrate various functionality of the Medicaid Web Portal through an interactive walk-through that introduces providers to the available menu items that provide important provider information such as provider demographics and recipient eligibility.

http://portal.flmmis.com/FLPublic/Provider_ProviderServices/Provider_Training/Provider_Training_WBT/tabId/86/Default.aspx

The Medicaid Provider Contact page provides links to contact information for the following:

• The Medicaid Fiscal Agent, DXC Technology, for claims and provider enrollment inquiries and assistance with access to the Medicaid Secure Web Portal.
• Recipient and Provider Assistance to contact a Medicaid representative.
• Fiscal Agent Field Representative Map
• Online tool for submission of and inquiry and to request a contact from the Fiscal Agent.

https://portal.flmmis.com/FLPublic/Provider_ProviderServices/Provider_ProviderSupport/Provider_ContactUs/tabId/40/Default.aspx

May 15, 2017 – Attention providers of Medicaid ABA services:

The FAQs for Behavior Analysis services have been posted to the AHCA website. They are located at the bottom of the page after the Enrollment Begins Now section. For your convenience, the link is Included below.

https://portal.flmmis.com/FLPublic/Provider_ProviderServices/Provider_ProviderSupport/Provider_ContactUs/tabId/40/Default.aspx

April 18, 2017 – Florida Behavior Analysis Month

The Florida Senate approved Resolution No. 1814 Commending FABA on its 37th Anniversary, and recognizing the month of October 2017 as “Florida Behavior Analysis Month”!!! The resolution was introduced by Senator Bean.

April 24, 2017 – ATTENTION MEDICAID PROVIDERS OF ABA SERVICES!

AHCA has reported a drop in authorization requests since the deadline was pushed back to May 15. It is important that providers keep sending their authorization requests during this transition period to avoid the last minute rush just prior to May 15. If too many requests come in at the last minute, it could delay authorizations for everyone.

March 23, 2017 – Important Updates/Clarifications

Many of us have heard in the Beacon trainings (regarding the Medicaid Behavior Analysis Services Policy) that clients must have maladaptive behavior to be approved for Behavior Analysis services. In a recent meeting between the FABA Legislative Committee and AHCA, we were told that Behavior Assessments that are missing maladaptive behaviors will not be denied for that reason alone. Instead, they will be escalated to a higher level review to determine medical necessity. Medically necessary services, which include habilitative services according to EPSDT, are covered.

To help providers understand what is important to include in their authorization requests, Beacon has reported some trends in the Behavior Plans received from Lead Analysts. These include:

• Lack of parent/caregiver goals
• Service intensity not justified in the plan
• Group code requested but no group goal addressed
• Plan not individualized to the recipient

However, to date, Beacon has not denied any authorizations. Please make sure to pay close attention to the above trends to help facilitate the authorization process.

Many of our members have contacted FABA to ask for help because their Type 39 Provider application has still not been approved. AHCA has been informed about this urgent issue and is looking into options to remedy the situation. In the meantime, they have suggested that those who need help with applications should contact the following:

[email protected]
For more information:
Medicaid Provider Type 39 enrollment number:
1-800-289-7799
(option 4) for Provider Enrollment

March 15, 2017 – Behavior Assessments that are missing maladaptive behaviors

Many of us have heard in the Beacon trainings (regarding the Medicaid Behavior Analysis Services Policy) that clients must have maladaptive behavior to be approved for Behavior Analysis services. In a recent meeting between the FABA Legislative Committee and AHCA, we were told that Behavior Assessments that are missing maladaptive behaviors will not be denied for that reason alone. Instead, they will be escalated to a higher level review to determine medical necessity. Medically necessary services, which includes habilitative services according to EPSDT, are covered.

To help providers understand what is important to include in their authorization requests, Beacon has reported that the most common reasons that authorization requests have been denied include:

• Lack of parent/caregiver goals
• Service intensity is not justified

Many of our members have contacted FABA to ask for help because their Type 39 Provider application has still not been approved. AHCA has been informed about this urgent issue and is looking into options to remedy the situation. In the meantime, they have suggested that those who need help with applications should contact the following: [email protected]

Please make sure to check the http://www.fabaworld.org website for important announcements and updates.

February 3, 2017 – AHCA Agrees to Delay Implementation of Behavior Analysis Policy Until March 1, 2017

The implementation of the new Medicaid Behavior Analysis Policy for children age 0-20 was planned to start on February 1, 2017.  As of that date, many ABA agencies and individual providers had not yet received their new Type 39 provider number.  This would have meant that many providers would not be able to get reimbursed for their services until their application was approved.  Since many providers would not be able to continue providing services without pay, resulting in loss of services for many recipients, the FABA Legislative Committee brought these concerns to AHCA.  After some deliberation, AHCA agreed to delay the requirement to begin using the new billing codes (which can only be provided by Type 39 providers) until March 1, 2017.

The requirement to have an authorization from Beacon prior to April 3, 2017 is still in place, so all providers planning to provide services for recipients age 0-20 on or after April 3 will need to request an authorization.

FABA Successfully Challenges AHCA Policy on Behavior Analysis Services & Encourages Its Members to Immediately Enroll In The BA Services Program

As we previously reported, on November 14, 2016, the Florida Association for Behavior Analysis filed a petition with the Division of Administrative Hearings in Tallahassee, challenging the Agency for Health Care Administration’s (AHCA) adoption of Proposed Rule 59G-4.125, F.A.C., regarding its Behavior Analysis Services Policy.

FABA’s challenge to the published policy focused on preserving positive changes to the policy achieved during the workshop and hearing process, as well as making sure that the policy is limited to behavior analysis services, not services that have no connection to behavior analysis. For example, it was important the policy was clarified that psychological testing, neuropsychology, psychotherapy, cognitive therapy, sex therapy, psychoanalysis, hypnotherapy, and long-term counseling are not to be reimbursed under the behavior analysis policy. Further, it was essential that the policy require that lead analysts who are not BCBA’s but who are licensed under Chapter 490 or 491, have training and expertise in the field of behavior analysis.

A link to the second notice of change for the policy is found here:
http://www.ahca.myflorida.com/medicaid/review/Rules_in_Process/NOC/59G-4.125_BA_Coverage_Policy_afterNOC2_trk_chgs.pdf and incorporates revisions made in each of the workshops and the final proposed rule hearing. FABA and AHCA filed a joint motion to dismiss the petition based upon AHCA’s changes to the behavior analysis policy, which has been accepted by the administrative law judge.

With the major policy considerations resolved as a result of the litigation, FABA encourages its members to ENROLL IMMEDIATELY in the behavior analysis provider program at the Florida Medicaid Web Portal. As most of you know, ABA services for Medicaid recipients under the age of 21 will soon be required to be provided under the new Medicaid Behavior Analysis policy, and ABA services provided through all other Medicaid funding streams (e.g., Early Intervention, Community Behavioral Health, iBudget Waiver, “state plan” Autism services) will be discontinued.

Although the policy is expected to be officially promulgated in mid-February, the implementation of the new policy starts February 1, 2017, which is only a week away.  According to AHCA and Beacon, all services provided on or after that date will have to be billed under the new policy’s service codes and limits, and only agencies and individuals with Type 39 provider numbers will be able to provide those services.  If you are currently providing ABA services under another Medicaid policy and have not received your Type 39 provider number yet, you will not be able to be paid for services after 2/1/17.  All ABA provider types (BCBA “Lead Analyst,” BCaBA “Assistant Behavior Analyst,” and RBT) are required to obtain an individual provider number, even if providing services under a Type 39 group.

Between 2/1/17 and 4/2/17, providers need to be submitting authorization requests for ABA services to Beacon because all services provided on or after April 3, 2017 will be required to have an authorization from Beacon in order to be paid.  Only approved Type 39 providers will have access to the Beacon system to submit authorization requests.  Beacon has pre-recorded trainings to explain the authorization process and the elements required in the Behavioral Assessment and Reassessment.

Link to AHCA Behavior Analysis Services Provider
Information: http://ahca.myflorida.com/medicaid/Policy_and_Quality/Policy/behavioral_health_coverage/bhfu/BA_Services.shtml

Link to the Beacon pre-recorded trainings:
http://fl.beaconhealthoptions.com/provider/prv-archive.html

Link to the most recent version of the proposed Behavior Analysis policy:
http://ahca.myflorida.com/medicaid/review/Rules_in_Process/NOC/59G-4.125_BA_Coverage_Policy_afterNOC2_trk_chgs.pdf

Link to the proposed Behavior Analysis billing codes and fee schedule:
http://ahca.myflorida.com/medicaid/review/Rules_in_Process/Develop/2016-08-01_BA_Fee_Schedule.pdf

Link to the AHCA Provider Enrollment Application:
https://portal.flmmis.com/flpublic/Provider_ProviderServices/Provider_Enrollment/Provider_Enrollment_EnrollmentApplication/tabid/67/Default.aspx?desktopdefault=%20

Link to the AHCA Provider Enrollment Application Guide:
http://portal.flmmis.com/FLPublic/Portals/0/StaticContent/Public/Public%20Misc%20Files/Guide_for_App_for_2015_Final_2015-02-27.pdf

May 30, 2016 – Medicaid Policy on Behavior Analysis Coverage

• Link to most recent draft of the rule – –
  http://www.fabaworld.org/wp-content/uploads/2016/12/59G_4-125_BA_Services_Coverage_Policy_NOC_December-2-2016.pdf
• Link to most recent fee schedule for services – –  https://ahca.myflorida.com/medicaid/review/Promulgated/Fee_Schedules/2016_01_01_Behavior_Analysis_Fee_Schedule.pdf
• Link to ACHA memo regarding provider enrollment – – http://www.fdhc.state.fl.us/medicaid/Policy_and_Quality/Policy/behavioral_health_coverage/bhfu/BA_Services.shtml

April 14, 2016, – New Insurance Coverage Law for Down Syndrome Treatment Includes Behavior Analysis Services

On April 14, 2016, Governor Rick Scott signed House Bill 221, which requires health maintenance organization contract and certain insurance policies to cover behavior analysis services for the treatment of Down Syndrome. Previously, Florida statutes provided that behavior analysis services were only mandated for the treatment of autism, however this change significantly expands the law. Thank you to Senate President Andy Gardiner who help shepherd this long-overdue amendment to the insurance law. This change is effective July 1, 2016, and FABA will be working with the Office of Insurance Regulation to make sure families can access this new insurance benefit.

April 7, 2016 – AHCA Holds Workshop On Medicaid Policy For Behavior Analysis Service & Contracts With Beacon Health Options For Utilization Management

On April 7, 2016, the Agency for Health Care Administration held its third workshop on the new policy for behavior analysis services. FABA participated in the workshop and commented on the need to include an accurate definition of behavior analysis as well other issues that should be addressed before the policy is finalized. AHCA is expected to publish a revised policy and a notice of hearing on the policy in the near future. AHCA also selected Beacon Health Options as its vendor to handle utilization management for behavior analysis services for the treatment of autism under the Medicaid program. FABA met with members of Beacon’s leadership team to discuss their role in authorizing and reviewing behavior analysis services for the Florida Medicaid program. Beacon has considerable experience working with BCBAs in other states and FABA looks forward to Beacon presenting at the Annual Meeting in September.