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Required Documents for Behavioral Analysis (BA) Providers

Date: 05/15/25

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 Requests with Sunshine Health or after the Continuity of Care (CoC) period ends:

  • Comprehensive Diagnostic Evaluation (CDE)
  • Referral for Applied Behavior Analysis (ABA)
  • Behavior Plan (must be signed)
  • Behavior Assessment System for Children (BASC) Scoring Report
  • Vineland Scoring Report

Concurrent/Ongoing Treatment requests:

  • Behavior Re-Assessment
  • BASC Scoring Report
  • Vineland Scoring Report

A CDE must be completed per the AHCA BA Policy Handbook (PDF). All CDEs must include the diagnosis identified during the evaluation and treatment recommendations. 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

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 psychologist

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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