A moratorium on behavioral analysis services in Miami-Dade and Broward counties imposed by the Agency for Healthcare Administration expired as of Nov. 13, 2022. And it appears that AHCA has decided not to extend it for another six months as it has in the past since it was first imposed in 2018.

AHCA said the moratorium’s goal was to fight fraud and safeguard taxpayer dollars, while ensuring patient access to care. Authority to impose a moratorium was included in the Affordable Care Act, and AHCA, with the approval of the Centers for Medicare and Medicaid Services, decided to exercise its authority.

In 2018, AHCA announced that the cost of applied behavior analysis therapy to Florida more than doubled from 2016 to 2018. The agency blamed unqualified providers delivering unnecessary services.

In implementing the moratorium AHCA stated it had found widespread problems with providers attempting to bill “unbelievable hours,” such as more than 24 hours in a day.

As a result of an investigation, AHCA also found some Medicaid recipients also were enrolled as BA providers and some providers had falsified their credentials.

The moratorium was designed to give AHCA time to complete a comprehensive assessment of the BA provider population and remove from the provider network those individuals and entities who are not qualified to participate or whose participation was believed to have been based solely to commit fraud.

The Behavior Analyst Certification Board is advising providers to make sure their BACB certification is accurate and has warned providers to beware of cases that might cause them to be in violation of the Ethics Code for Behavior Analysts. Such cases might involve a provider being offered a fee in exchange for use of their BACB certification to enroll as a Medicaid provider.

If you need assistance in understanding how this applies to you, contact the firm at 305-358-4500 or email info@vitalehealthlaw.com.