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Required Documents for Behavioral Analysis (BA) Providers

Date: 06/16/25

Sunshine Health follows the AHCA Medicaid Behavioral Analysis Services Policy Handbook (PDF) and all of its requirements.

Please remember that providers are required to include the following documents when submitting a clinical authorization request:

Initial Assessment Requests with Sunshine Health:

  • Comprehensive Diagnostic Evaluation (CDE)
  • Referral for Applied Behavior Analysis (ABA)

Concurrent/Ongoing Treatment requests:

  •  CDE
    • Note: A CDE is not required with every ongoing request, if the CDE was included with the initial request
  • Referral for ABA
    • Note: A referral is not required with every ongoing request, if the referral was included with the initial request
  • Behavior Assessment System for Children (BASC) Scoring Report
  • Vineland Scoring Report
  • Treatment Plan

A CDE must be completed per the AHCA BA Policy Handbool (PDF). All CDEs must include the diagnosis identified during the evaluation and treatment recommendations. A CDE must also include treatment recommendations, background and status from a parent/guardian interview, diagnostic testing and the signature of the licensed practitioner and date.

 The CDE must be completed by one of these practitioners:

  • Primary care physician (PCP) specializing in family practice, internal medicine or a pediatrics specialty
  • Board-certified or board-eligible physician with a specialty in developmental behavioral pediatrics, neurodevelopmental pediatrics, pediatric neurology or adult or child psychiatry
  • Child Psychologists (PhD or PsyD)

The recipient must have been referred by an independent physician or practitioner qualified to assess and diagnose disorders related to functional impairment. The referral must be made and signed by one of the following practitioner types:

  • PCP specializing in family practice, internal medicine or a pediatrics specialty
  • Board-certified or board-eligible physician with a specialty in developmental behavioral pediatrics, neurodevelopmental pediatrics, pediatric neurology or adult or child psychiatry
  • Child Psychologists (PhD or PsyD)

Behavior Analysis (BA) Resources

Questions?

Sunshine Health has a wealth of resources available to help answer your questions and address your concerns:

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