Client Alert: Medicaid Behavioral Analysis Service Providers In Florida Must Obtain Health Care Clinic License or Exemption Certificate Shumaker, Loop & Kendrick, LLP

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The Florida Agency for Healthcare Administration (“AHCA”) has added a Medicaid registration requirement for behavior analysis services. Behavior Analysis Providers use Applied Behavior Analysis to help children with Autism Spectrum Disorders. It is a type of therapy that focuses on improving specific behaviors, such as social skills, communication, reading, and studying, as well as adaptive learning skills, such as fine motor dexterity, l hygiene, grooming, domestic skills, punctuality and professional skills. .

As of July 1, 2020, these providers must show their Florida Health Care Clinic License or Exemption Certificate to the AHCA in order to receive Medicaid payments from the AHCA. A healthcare clinic license is generally required if you provide healthcare services and submit reimbursement fees for them. The AHCA has made it clear that behavior analysis services are “health care services” within the meaning of the Health Care Clinics Act. (See Agency for Healthcare Administration, Behavior Analysis Services Information, Behavior Analysis FAQs located here. However, many exemptions from licensure are available. These exemptions include one for companies wholly owned by certain licensed professionals (i.e. doctors or psychologists). Spouses and certain family members may also be homeowners under this exemption with certain licensees in their family. Behavioral analysis providers should ask their legal counsel to check their ownership structure and other facts to determine if they can get an exemption. Even if the provider is legally exempt, they must apply for and receive an exemption certificate from the AHCA in order to receive Medicaid payments.

If the behavioral analysis provider is not exempt from licensing to practice in a health care clinic, then they should start planning their licensing request immediately. It may take several months to prepare the application and meet the requirements and several additional months for the AHCA to process and inspect the facility or mobile phone provider. In order to obtain a health care clinic license, providers must meet certain financial stability and projection requirements prepared by a certified public accountant. They must also obtain background checks of people associated with their services, prepare special policies and procedures, have a medical clinical director contracted with specific obligations, and be inspected. Each vendor physical location must be licensed separately. However, if the provider does not have a defined installation location, they may qualify as a mobile clinic licensee.

Behavioral analysis providers in Florida should start evaluating and preparing their request for a health care clinic license or exemption now so as not to jeopardize their Medicaid payments in Florida. Additionally, failure to obtain a license or exemption when necessary could be a basis for Medicaid payment denials or claims against the provider for a Medicaid overpayment.


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