For a child under 21, Florida Medicaid needs a referral with a doctor's order, a comprehensive diagnostic evaluation led by a licensed practitioner, a behavior assessment with standardized test scores (the Vineland-3 and, for ages 2 to 18, the BASC-3 PRQ), a behavior plan, and prior authorization. Renewal needs a reassessment at least every six months.
Who writes the referral and the order?
The AHCA coverage policy says the referral must come from an independent physician or a practitioner qualified to diagnose, such as a primary care doctor or pediatrician, a developmental-behavioral pediatrician, a pediatric neurologist, a psychiatrist or a child psychologist. It must include a physician's order for behavior analysis services, and your child must have behavior that limits a major life activity, in areas such as safety, communication or self-care.
What is a comprehensive diagnostic evaluation?
A comprehensive diagnostic evaluation (CDE) must follow national evidence-based standards, be led by a licensed practitioner working within their scope, and include findings and treatment recommendations. One practitioner or a team can do it.
It may use parent and teacher reports, testing of development, behavior, hearing or vision, and genetic or other medical tests. AHCA says one CDE is typically enough for the treatment period, though the reviewer may ask for an update, for example if the child's condition changes.
What does the BCBA add?
Before treatment starts, the lead analyst, usually a BCBA, completes a behavior assessment and plan. The policy sets these rules:
- The Vineland-3 Comprehensive Parent Interview Form for every child, plus its Maladaptive Behavior Domain from age 3.
- The BASC-3 Parenting Relationship Questionnaire (PRQ) for children ages 2 through 18.
- The full scoring report goes with the prior authorization request.
- The behavior plan sets goals, strategies, timeframes and how progress is reported. You and the lead analyst both sign it.
How does prior authorization work?
All behavior analysis services need prior authorization. The provider sends the request to your child's Medicaid plan (or to Acentra, AHCA's reviewer, if your child is not in a plan), and the reviewer decides based on medical necessity. AHCA tells providers to follow each plan's directions, so forms can differ; ask your plan or provider which ones apply.
How often is it renewed?
The behavior plan covers an authorization period of up to six months. To renew, the provider completes a reassessment and updated plan at least every six months, with progress data and a graph for each targeted behavior. The two core instruments are repeated every 12 months, and a full assessment may be requested if you change providers.
Can a doctor's order alone start ABA with Medicaid?
No. The policy also calls for a comprehensive diagnostic evaluation, a behavior assessment with scores, and prior authorization.
Do I need to repeat the diagnostic evaluation every six months?
Not usually. AHCA says one CDE is typically enough for the treatment period. The six-month renewal is a reassessment by the provider.
General information as of October 21, 2026, not legal, medical or coverage advice for your child. Each plan may ask for extra papers, so confirm with your plan or AHCA's Medicaid helpline, 1-877-254-1055.
Sources
- Florida Medicaid Behavior Analysis Services Coverage Policy (December 2024). Agency for Health Care Administration (AHCA), accessed October 21, 2026.
- Behavior Analysis Services Information. Agency for Health Care Administration (AHCA), accessed October 21, 2026.