Eligible Provider

POLICY:

General Criteria

Providers must meet the qualifications specified in this policy and any additional requirements established by applicable federal and state laws, licensing regulations, and individual payer guidelines in order to render and be reimbursed for behavior analysis services.

Who Can Provide

Behavior analysis services must be rendered by qualified professionals operating within the scope of their licensure, certification, and training, and in accordance with applicable payer requirements.

Eligible providers may include:

• Lead Analysts, who are one of the following:
  • Board Certified Behavior Analyst (BCBA) credentialed by the Behavior Analyst Certification Board (BACB).
  • Florida Certified Behavior Analyst (FL-CBA) credentialed by the Behavior Analyst Certification Board (BACB).
  • Practitioners licensed in accordance with Chapter 490 or 491, Florida Statutes (F.S.), with documented training and expertise in the field of behavior analysis.
• Assistant-Level Providers:
  • Board Certified Assistant Behavior Analyst (BCaBA) credentialed by the Behavior Analyst Certification Board (BACB), practicing under appropriate supervision.
  • Registered Behavior Technician (RBT) credentialed by the Behavior Analyst Certification Board (BACB), providing services under the supervision of a qualified lead analyst, consistent with applicable laws and payer requirements.

All individuals providing services for the Company must meet the qualification, credentialing, and compliance standards established by the organization and applicable regulatory authorities. Hiring, screening, and role expectations are governed by Appendix 13 - Background Screening and Exclusion Monitoring Policy. Position-specific qualifications and responsibilities are outlined in Appendix 14 - Job Description: Clinical Director; Appendix 15 - Job Description: BCBA and Appendix 16 - Job Description: RBT. Required employment documentation and verification procedures are detailed in Appendix 17A - Initial Job Application and Appendix 17B - Required Documents Checklist. These appendices are incorporated herein by reference and must be adhered to in order to ensure provider eligibility and ongoing compliance. Supervision and reporting relationships for clinical and administrative staff are defined in Appendix 25 - Organizational Chart.