Florida Medicaid ABA Reference Card: the Rules at a Glance
What it is for
A quick reference of the Florida Medicaid rules for behavior analysis that come up every week: who can receive and who provides, the core instruments, plan and reassessment periods, signatures, authorization for fee-for-service and SMMC plans, 15-minute units and unit limits, parent participation, group size, session notes and what is not covered. Every row cites the AHCA document it comes from and links to the blog guide that explains it. Print it or keep it open next to your documentation.
What it includes
- Who can receive, who provides and who supervises
- Instruments, plan period, reassessments and signatures
- Authorization, units and unit limits by code
- Parents, groups, session notes and what is not covered
- A link to the full guide on every row
- Printable PDF
Part 1 of 4
Who can receive and who provides
| Topic | Florida Medicaid rule | Full guide |
|---|---|---|
| Who can receive | Recipients under 21 who need medically necessary behavior analysis1 | Initial assessment |
| Referral | From an independent physician or practitioner, with a physician’s order and a comprehensive diagnostic evaluation (CDE)1 | Initial assessment |
| Lead Analyst | BCBA, FL-CBA, or a practitioner licensed under Chapters 490 or 491, F.S.1 | Florida license |
| Supervision | BCaBAs under a BCBA; RBTs under a BCBA or BCaBA; supervision according to CASP’s practice standards1 | RBT supervision |
Part 2 of 4
Assessment, plan and reassessment
| Topic | Florida Medicaid rule | Full guide |
|---|---|---|
| Core instruments | Vineland-3 for all recipients, with the Maladaptive Behavior Domain from age 3; BASC-3 PRQ for ages 2 through 181 | Initial assessment |
| Scoring reports | The complete scoring report goes with the prior authorization request1 | Initial assessment |
| Plan period | Up to six months1 | Reauthorization |
| Reassessment | At least every six months; core instruments every 12 months1 | Reauthorization |
| Signatures | Lead Analyst and the parent or guardian sign the assessment and the plan1 | Initial assessment |
Part 3 of 4
Authorization and units
| Topic | Florida Medicaid rule | Full guide |
|---|---|---|
| Fee-for-service | QIO authorization before services start and at least every 180 days1 | Prior authorization |
| SMMC plans | Since the February 2025 transition, services for plan enrollees are reimbursed through the plan, and providers contract with it3 | Prior authorization |
| Plan change | The new plan honors treatment authorized before enrollment for up to 90 days3 | Reauthorization |
| 15-minute units | Total minutes divided by 15; a remainder of 8 minutes or more is one unit1 | CPT codes |
| Weekly hours | Up to 40 hours per week of intervention, as in the prior-authorized plan1 | CPT codes |
| 97151 | Up to 24 units per behavior assessment; with the TS modifier, up to 18 for a reassessment2 | Fee schedule |
| 97152 and 0362T | 97152: up to 8 units per behavior assessment. 0362T: up to 16 units for an initial assessment or reassessment, prior authorized2 | Fee schedule |
Part 4 of 4
Parents, groups and session notes
| Topic | Florida Medicaid rule | Full guide |
|---|---|---|
| Parent participation | Every effort to include parents, documented; if they cannot take part, the reasons, the likely impact and how it is reduced1 | Parent training |
| Telemedicine training | The Lead Analyst may train parents or guardians up to two hours per week1 | Parent training |
| Group size | Six participants at most1 | CPT codes |
| Session notes | Signed and dated by the rendering practitioner, with the date, time, location and duration1 | Session notes |
| Not covered | Seclusion or restraint to control behavior; acting as a 1:1 aide, companion or shadow; travel time; childcare1 | Session notes |
| What may change | AHCA’s ABA Task Force studies service-authorization limits and possible caps on service duration, with recommendations for the Governor, the Senate President and the House Speaker by December 31, 20264 | Task Force |
Questions about the tool
Does this card replace the coverage policy?
No. It condenses the rules you check most often. Each row cites the AHCA document, and the policy itself decides any case the card does not cover.
Does it apply to SMMC health plans?
Plans must follow the coverage policy unless the AHCA contract says otherwise. The card does not cover each plan's own authorization process or forms: check them with the plan.
Sources
- Florida Medicaid Behavior Analysis Services Coverage Policy. Agency for Health Care Administration (AHCA), December 2024, Rule 59G-4.125, F.A.C.
- Behavior Analysis Fee Schedule. Agency for Health Care Administration (AHCA), October 1, 2024.
- SMMC New Program Highlight: Behavior Analysis Services. Agency for Health Care Administration (AHCA), October 18, 2024.
- Applied Behavior Analysis Task Force. Agency for Health Care Administration (AHCA), accessed October 15, 2026.
Educational tool. It does not replace clinical judgment, legal advice or your payer’s rules. Always check the current version of each source.