Florida Medicaid Provider Alert

April 27, 2018 Provider Type(s): 39 BEHAVIOR ANALYSIS SERVICES eQHealth Solution’s Phase II Begins May 1 The Agency for Health Care Administration (Agency) has contracted with eQHealth Solutions (eQHealth) to complete prior authorizations for Behavior Analysis (BA) services. Beginning May 1, 2018, eQHealth will initiate the second phase of BA prior authorizations. The below questions and answers detail what the second phase of BA prior authorization includes for BA providers. What is eQHealth’s first phase of BA implementation? eQHealth issued administrative authorizations for BA assessments, reassessments, and 20 hours of services per week per recipient. Administrative authorizations did not include a clinical review for medical necessity. If recipients required additional services, providers had to submit documentation demonstrating medical necessity. The first phase of BA implementation is from March 26, 2018 through April 30, 2018. What is eQHealth’s second phase of BA implementation? eQHealth will determine prior authorizations based on the medical necessity of recipient’s request for services. eQHealth will no longer issue automatic administrative approvals of authorizations for BA assessments, reassessments, or BA services. The second phase of BA implementation begins May 1, 2018. What documentation do I submit for the first and second phase of BA implementation? When submitting prior authorization requests to eQHealth, BA providers will need to submit documentation that meets the requirements in section 9.0 of the Behavior Analysis Services Coverage Policy. Where can I access training documents and information about eQHealth’s second phase of BA implementation? Trainings and information can be located on eQHealth’s website: http://fl.eqhs.org/. Where can I locate information on the Agency’s website? The Agency’s BA website can be located at: http://ahca.myflorida.com/medicaid/Policy_and_Quality/Policy/behavioral_health_coverage/bhfu/BA_Services.shtml. Who can I call for additional questions or assistance? eQHealth can be reached at 1-855-444-3747. QUESTIONS? FLMedicaidManagedCare@ahca.myflorida.com COMPLAINTS OR ISSUES? ON LINE https://apps.ahca.myflorida.com/smmc_cirts/ | CALL 1-877-254-1055 Agency for Health Care Administration | 2727 Mahan Drive, Tallahassee, FL 32308 | http://ahca.myflorida.com