AGENCY FOR HEALTH CARE ADMINISTRATION
RULE NO.:RULE TITLE:
59G-4.125Behavior Analysis Services
NOTICE OF CHANGE
Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 42 No. 196, October 7, 2016 issue of the Florida Administrative Register.
59G-4.125 Behavior Analysis Services.
(1) through (2) No change.
The Florida Medicaid Behavior Analysis Services Coverage Policy incorporated by reference in subsection (2) has been changed as follows:
Section 1.0 is renumbered as necessary.
Subsection 1.1, Description, title deleted. Text moved to section 1.0.
Sub-subsection 1.3.6, Prohibited Procedures, deleted.
Sub-subsection 4.2.1, Behavioral Assessment, renamed Behavior Assessment and deleted the following:
The development of a behavior plan is a component of the assessment.
Sub-subsection 4.2.2, Behavior Analysis, now reads:
Up to 40 hours per week, per recipient, consisting of services identified on the recipient’s behavior plan in order to reduce maladaptive behaviors and to restore the recipient to his or her best possible functional level. Services include:
•Implementing behavior analysis interventions, and monitoring and assessing the recipient’s progress towards goals in the behavior plan
•Behavior analysis interventions, for example, discrete trial teaching, task analysis training, differential reinforcement, non-contingent reinforcement, conducting task analyses of complex responses, and teaching using chaining, prompting, fading, shaping, response cost, and extinction
•Training the recipient’s family, caregiver(s), and other involved persons on the implementation of the behavior plan and intervention strategies (the recipient must be present when clinically appropriate)
Sub-subsection 4.2.3, Behavior Reassessment, deleted the following:
The development of a behavior plan review is a component of the reassessment.
Subsection 5.2, bullets now read:
• Any procedure or physical crisis management technique that involves the use of seclusion or manual, mechanical, or chemical restraint utilized to control behaviors
• Behavior plans and behavior plan reviews separately; development of these documents is included in the reimbursement for behavior assessments and reassessments
• Services funded under section 110 of the Rehabilitation Act of 1973
• Services including seclusion and restraint procedures
• Services not listed on the fee schedule
• Services on the same day as therapeutic behavioral on-site services
Subsection 6.2, Specific Criteria, now reads:
Providers must maintain the following documentation in the recipient’s file:
• Behavior plan and behavior plan review
• Notations when the recipient’s family or caregiver is not able to participate in BA services, and instances when
it was clinically inappropriate for the recipient to be present during training services
• Written physician’s order
Subsection 7.2, Specific Criteria, now reads:
Providers must obtain authorization from the quality improvement organization (QIO) prior to the initiation of BA services and every 180 days thereafter.
Providers may request authorization more frequently upon a change in the recipient’s condition requiring an increase or decrease in services.
