Authorization for Services

POLICY:

General Criteria

The authorization requirements described below are applicable to the fee-for-service delivery system. Additional guidance on general authorization requirements is provided in the resources below.

Authorization requirements shall be determined by the terms of the applicable payer contract.

For recipients funded by Florida Medicaid, providers shall also refer to Florida Medicaid's General Policies on authorization requirements.

Specific Criteria

Providers must obtain prior authorization from the applicable payer or its designated utilization management entity before initiating behavior analysis services and at intervals required by the payer (e.g., every 180 days or as otherwise specified).

Providers may request authorization more frequently when there is a documented change in the recipient's condition that warrants an increase, decrease, or modification of services.

Initial Intake

Every prospective client shall complete the Client Intake Questionnaire at or before the first scheduled appointment. No assessment, treatment planning, or direct behavior analysis service shall commence until the completed questionnaire has been received, reviewed by the assigned clinician, and filed in the client record. The questionnaire captures baseline demographic, clinical history, caregiver contact, and consent information, and is the first required entry in the client folder (see Appendix 4 - Client Folder Checklist).

Initial eligibility verification and intake authorization procedures are supported by Appendix 2 - Confirmation of Patient ID & Appendix 3 - Client Intake Questionnaire.