Policies and Procedures
Sources
Every regulatory, professional, and payer reference our Florida handbook and policies are written against. When a clinic uploads documentation, this is the registry the verification agent will measure it against.
- Sources
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- Linked
- 33
- Link pending
- 0
How this list is used.
These references back every chapter, appendix, and form in the handbook and policies. As clinics move to the self-serve portal, their uploaded documentation will be compared against this registry. Entries marked Link pending need their canonical URL pasted in once verified.
Florida Medicaid and AHCA
Coverage policy, provider manuals, and bulletins issued by the Agency for Health Care Administration.
- 01
Agency for Health Care Administration
Florida Medicaid General Handbooks
Provider general handbooks that govern enrollment, claims, and program integrity for all Florida Medicaid providers.
Linked - 02
Agency for Health Care Administration
Florida Medicaid Behavior Analysis Services Coverage Policy (Provider Type 39)
Definitive coverage policy for Florida Medicaid behavior analysis services, including eligibility, documentation, and service limits.
Linked - 03
Florida AHCA Medicaid Policy Portal
Behavior Analysis Services Information
AHCA's central landing page for active and proposed BA policy, including provider notices and policy updates.
Linked
Florida Administrative Code
The administrative rules that bind every Florida Medicaid behavior analysis provider.
- 04
Florida Administrative Code
Rule 59G-1.010, Definitions and Medical Necessity Criteria
Defines the medical necessity standard every Florida Medicaid service (including ABA) must meet to qualify for reimbursement.
Linked - 05
Florida Administrative Code
Rule 59G-1.054, Recordkeeping and Documentation Requirements
Sets the recordkeeping, retention, and audit-readiness obligations that bind every Florida Medicaid provider.
Linked - 06
Florida Administrative Code
Rule 59G-4.125, Behavior Analysis Services
The rule that directly governs Florida Medicaid behavior analysis: covered services, provider qualifications, supervision, and documentation.
Linked
Council of Autism Service Providers (CASP)
Industry-standard ABA practice guidelines and organizational benchmarks.
- 07
Council of Autism Service Providers
CASP Official Website
Industry body publishing ABA practice guidelines and policy positions.
Linked - 08
Council of Autism Service Providers
Applied Behavior Analysis Treatment of Autism Spectrum Disorder: Practice Guidelines for Healthcare Funders and Managers (Version 3.0)
The reference clinical guideline cited by funders and audited against during medical necessity review.
Linked - 09
Council of Autism Service Providers
CASP Resources Library and Guidance Documents
Position statements, white papers, and operational guidance documents.
Linked - 10
Council of Autism Service Providers
CASP Organizational Guidelines
Recommended organizational practices for ABA service providers, used as a benchmark for clinic operations.
Linked
Autism Commission on Quality (ACQ)
Accreditation body for ABA organizations focused on quality and consumer safeguards.
Behavior Analyst Certification Board (BACB)
Certification, ethics, and supervision requirements for BCBAs, BCaBAs, and RBTs.
- 12
Behavior Analyst Certification Board
BACB Official Website
Authoritative source for BCBA, BCaBA, and RBT certification requirements and disciplinary actions.
Linked - 13
Behavior Analyst Certification Board
BACB Ethics Code for Behavior Analysts
Mandatory ethics standards for BCBAs and BCaBAs. Violations are grounds for disciplinary action and decertification.
Linked - 14
Behavior Analyst Certification Board
BACB RBT Handbook
Eligibility, examination, supervision, ethics, and maintenance requirements for Registered Behavior Technicians.
Linked - 15
Behavior Analyst Certification Board
BACB BCBA Certification Information and Handbook
Eligibility, examination, supervised experience, and continuing-education rules for BCBAs.
Linked
ABA Coding Coalition
Authoritative CPT code definitions and billing guidance for adaptive behavior services.
- 16
ABA Coding Coalition
ABA Coding Coalition Official Website
Joint industry body that publishes guidance on adaptive behavior service CPT codes.
Linked - 17
ABA Coding Coalition
ABA Coding Coalition Resources and CPT Guidance
Authoritative CPT code definitions, unit conventions, and documentation expectations for ABA billing.
Linked
Professional associations
National and state behavior analyst associations whose positions shape clinical and ethical practice.
- 18
Association for Behavior Analysis International
ABAI Official Website
International professional association whose accreditation and position statements influence training and credentialing.
Linked - 19
Florida Association for Behavior Analysis
FABA Official Website
Florida-specific professional advocacy and continuing education for behavior analysts.
Linked
Florida managed care plans
Payer-specific documentation, authorization, and provider portal requirements for Florida Medicaid MCOs.
- 20
Sunshine Health
Sunshine Health Behavior Analysis Provider Resources
Provider portal, prior-auth criteria, and BA-specific forms for Sunshine Health (Florida Medicaid MCO).
Linked - 21
Sunshine Health
Sunshine Health ABA Documentation and Authorization Requirements
Documentation and authorization requirements clinics must meet for Sunshine Health BA claims to be paid.
Linked - 22
Humana Healthy Horizons Florida
Humana Healthy Horizons Florida ABA Toolkit
Humana's Florida Medicaid plan: ABA-specific provider toolkit and authorization workflows.
Linked - 23
Acentra Health Florida
Acentra Health Florida Behavior Analysis Services Resources
Utilization management partner used by Florida Medicaid for behavior analysis prior authorizations.
Linked
Commercial and private payers
Coverage mandates, parity law, and carrier medical policies that govern ABA for commercially insured families.
- 24
Florida Legislature
Fla. Stat. 627.6686, Coverage for Autism Spectrum Disorder
Florida's autism insurance mandate for state-regulated health insurers. Requires coverage of diagnosis and treatment, including behavior analysis, for eligible children subject to statutory conditions.
Linked - 25
Florida Legislature
Fla. Stat. 641.31098, Coverage for Autism Spectrum Disorder (HMOs)
The parallel autism coverage mandate that binds Florida HMO contracts, including behavior analysis services for eligible children.
Linked - 26
U.S. Department of Labor (EBSA)
Mental Health Parity and Addiction Equity Act (MHPAEA)
Federal parity law limiting how group health plans (including self-funded ERISA plans not bound by state mandates) can restrict behavioral health benefits relative to medical benefits.
Linked - 27
Florida Blue (Blue Cross and Blue Shield of Florida)
Florida Blue Medical and Coverage Policies
The largest Florida commercial carrier's medical policies and provider requirements, including its coverage criteria for applied behavior analysis.
Linked - 28
Aetna
Aetna Clinical Policy Bulletins
Aetna's published clinical policy bulletins, including its applied behavior analysis medical-necessity criteria for commercial members.
Linked - 29
UnitedHealthcare / Optum
Optum Provider Express (Behavioral Health)
UnitedHealthcare's behavioral health provider portal and clinical policies, including ABA authorization and documentation requirements.
Linked - 30
Cigna Healthcare
Cigna Health Care Provider Coverage Policies
Cigna's medical coverage policies and provider requirements, including its coverage position for applied behavior analysis.
Linked
Federal agencies
Cross-cutting federal requirements around Medicare, fraud and abuse, and patient privacy.
- 31
Centers for Medicare and Medicaid Services
CMS Official Website
Federal regulator overseeing Medicaid and Medicare programs and managed care contracts.
Linked - 32
U.S. Department of Health and Human Services
Office of Inspector General (OIG)
Federal enforcement body for healthcare fraud, abuse, and exclusions. Publishes the LEIE exclusion list.
Linked - 33
U.S. Department of Health and Human Services
HIPAA Guidance
Federal privacy and security rules for protected health information. Binding on every covered entity and business associate.
Linked