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BA Authorization Update: PCP Acknowledgement Form Required for All New Requests

Date: 07/31/26

UPDATE: The health plan has listened to providers’ concerns about obtaining a new PCP acknowledgment form with every authorization request on or after August 1, 2026. In response, the PCP Acknowledgement and Care Coordination Form (PDF) is now required to be updated annually. Although the form only needs to be completed once each year, the original signed document must still be submitted with every prior authorization (PA) request.

Sunshine Health will begin requiring Behavior Analysis (BA) providers to include a PCP Acknowledgement and Care Coordination Form (PDF) with all new BA authorization requests. This requirement applies only to new BA authorization requests submitted on or after August 1, 2026.

Authorizations submitted on or after August 1, 2026, will not be approved without this form. The goal is to ensure Primary Care Providers (PCPs) are aware when these services have been requested or are being provided to their members.

This collaboration is crucial to ensure appropriate care coordination and to support the management of value-based contracts (VBC). PCP awareness is important because BA services may intersect with the member’s medical, behavioral health, developmental, medication, safety, family support, and school-related needs.

PCPs are uniquely positioned to identify care coordination considerations based on their broader view of the member's overall health. Completion of this form does not require the PCP to determine the number of BA hours, approve the BA treatment plan, or make an authorization decision. This also does not change any other requirement that must be included with the BA authorization request:

  • The BA provider remains responsible for the clinical assessment and treatment plan.
  • This does not replace the need for a Comprehensive Diagnostic Evaluation (CDE) or appropriate referral per AHCA BA coverage guidelines.
  • The health plan remains responsible for reviewing authorization requests based on medical necessity and Medicaid coverage requirements.

Sunshine Health asks that the PCP review the member and provider information, indicate awareness of the BA services, and note any relevant care coordination considerations, if applicable. Examples may include medical diagnoses, current medications, behavioral or safety concerns, recent hospitalizations or emergency department visits, specialty referrals, family or caregiver concerns, or other information that may support coordinated care.

The completed, signed form must be included as part of the BA authorization request.

If you have questions, please contact your Sunshine Health Provider Engagement Account Manager (PEAM) or call Provider Services at 1-844-477-8313.

Download the PCP BA Acknowledgement Form

PCP Acknowledgement and Care Coordination Form (PDF)

Questions?

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

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