FABA attended the second meeting with the AHCA ABA Task Force. Handouts from the meeting are linked below.

Download Meeting 2 Handouts

As part of our ongoing commitment to keeping you updated on state policy changes, we are sharing the latest information regarding the Agency for Health Care Administration (AHCA) Applied Behavior Analysis (ABA) Task Force.

The first meeting of the Agency for Health Care Administration’s ABA Task Force was a productive discussion that underscored both the critical role behavior analysis services play for Florida families and the importance of protecting the integrity of the Medicaid program.

The newly released CPT Codes that will take effect on 01/01/2027. CMS released the codes within the Medicare Physician Fee Schedule Proposed Rule on 07/14/2026. (https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2027-medicare-physician-fee-schedule-proposed-rule)

On March 3rd, 2026, the US House Committee on Energy and Commerce launched investigations into Medicaid fraud across 10 states.

The Florida Association for Behavior Analysis (FABA) has partnered with The Council of Autism Service Providers (CASP) to launch a new Voter Voice campaign.

The ABA Coding Coalition is comprised of representatives from the Council of Autism Service Providers (CASP), the Association of Professional Behavior Analysts (APBA), the Behavior Analysis Certification Board (BACB), and Autism Speaks. The ABA Coding Coalition has announced at multiple conferences (The Autism Law Summit, APBA, CASP, and ABAI) that the ABA Billing Codes are changing effective 2027. The current ABA Billing Codes include Category I codes 97151 through 97158 plus two Category III Codes: 0362T and 0373T. It is anticipated that 97151 through 97158 will be updated to reduce ambiguity. It is also anticipated that six new codes will be added to capture services not currently described. Finally, it is anticipated that the two Category III codes (0362T and 0373T) will be deleted.

1. Negotiate directly with the SMMC plan for a higher contracted rate. Some providers have had success when they demonstrate unique value, geographic need, or specialized services.
2. Decline or choose not to renew the contract if the reimbursement level is not sustainable for their organization. While this is never an easy decision, it is within the provider’s rights. 

FABA has released an official position statement addressing the growing federal and state scrutiny of fraud, waste, and abuse (FWA) in Medicaid-funded Applied Behavior Analysis services in Florida.

• denials and requests for additional or new CDEs
• requiring CDEs that are more restrictive than AHCA policy
• denials for lack of medical necessity
• lengthy timelines to credentialing; and for some payers no credentialing at all
• lengthy timeline to begin services due to CDE requirements that are more restrictive than AHCA policy

• I need help now (faster): https://disabilityrightsflorida.org/contact/select_form
• Phone: 800-342-0823 

Dear Members, 

House Bill 1103 (2025), signed by Governor Ron DeSantis yesterday, June 9th, enhances transparency, streamlines enrollment, and revises oversight structures for services provided to individuals with developmental disabilities.

• Requires the Agency for Persons with Disabilities (APD) to provide newly enrolled clients with a list of qualified organizations within 5 days, and to promptly post quarterly waiver expenditure reconciliation reports online.
• Mandates APD participation in transition planning for certain young adults and requires posting of updated priority category data for waiver enrollment at least every 5 days.
• Establishes a Statewide Family Care Council to review local reports, advise APD on policy, and coordinate consistent input from local family care councils, with revamped membership criteria, reporting requirements, and administrative support.
• Clarifies that certain Medicaid-eligible persons may voluntarily enroll in managed care rather than being automatically enrolled.
• Expands the pilot program statewide for individuals with developmental disabilities by making enrollment voluntary, specifying a weekly data exchange among agencies, creating a call center for enrollment assistance, expanding available benefits, and requiring individualized assessments within 5 days of enrollment.
• Directs APD to contract for a study of the current budget allocation algorithm, including possible improvements or alternatives that better fit waiver expenditure needs.
• These provisions are set to take effect on July 1, 2025, marking a significant advancement in Florida’s commitment to improve the quality of life and independence for individuals with disabilities.

AHCA has reached out to FABA to help share information to providers. Here is the information they asked us to share:

The FABA Public Policy Committee (PPC) received numerous emails from members and non-members expressing frustration over the need for additional communication regarding the upcoming transition to Managed Care. In response, the PPC urged AHCA to provide more detailed information, including guidance on billing and renewal authorizations during the CoC. Emphasizing the importance of continued communication, the PPC advocated for one final online event to share vital information with providers.

FABA has been made aware of a recent letter from Sunshine Health to its contracted ABA providers. FABA is aware that the letter references a 20% cut in reimbursement rates. While FABA cannot advise providers how to respond to the letter, any reduction in reimbursement will have negative implications for providers and their clients. 

1. APD Providers: The FABA Public Policy Committee has been hearing concerns about APD's Local Review Committee (LRC) process for years. We are currently conducting a survey on the LRC process. Please take this opportunity to share your feedback. Your individual comments will be anonymous, but results will be summarized and shared with APD. 

2. AHCA Medicaid providers serving youth in their late teens: FABA is looking for members with concerns about the process for transitioning ABA services for clients on the Medicaid State plan to the iBudget or CDC system. If you have concerns or recommendations in this area, please email the FABA Public Policy Committee at [email protected]

The misclassification of employees as independent contractors may deny workers minimum wage, overtime pay, and other protections. The US Department of Labor (DOL) published a final rule on January 10, 2024, related to the classification of employee versus independent contractor. The rule takes effect on March 11, 2024. Join us for a FABA member-only event to discuss the new changes including the analysis for determining employee and independent contractor status, what it means for BCBAs and RBTs who are currently acting as independent contractors, and what it means for ABA Providers who are employers of BCBAs and RBTs.

Join us on September 22, 2023 at 9:30 AM EST for a presentation by the FABA Education Workgroup of the Public Policy Committee.

Participants will gain an orientation to and receive an overview of House Bill 255 with the allowance of PIPs (private instructional personnel) in the school setting.  We will discuss how to effectively collaborate with outside organizations including clarification of medical necessity.  In addition, we will hear from participants on current barriers and hear from others on successful practices to access the school environment.  We will provide some tips and tricks for effective entry and communication.  We will also share helpful resources.

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Thank you to everyone who has reached out regarding AHCA's Invitation to Negotiate (ITN) for Managed Care. You may find the entire document on the My Florida Marketplace Website (https://vendor.myfloridamarketplace.com/search/bids/detail/4836). The ITN is long (956 pages) plus 4 addendums. On pages 757, 758, and 788 the ITN references Behavior Analysis Services and specifically that the Managed Care Plan's transition of care includes coordination and transition of behavior analysis services from fee-for-service to managed care delivery.