The CDE, Explained: What Florida Medicaid Requires for ABA

What a CDE is, what must be inside it, who can write one, whether your child’s existing evaluation qualifies, and what to do if a health plan says it doesn’t — answered in one place.

Educational note: This guide explains publicly available Florida Medicaid and health-plan requirements in plain language. It does not replace medical, legal, school, or insurance advice, and the child’s health plan or Medicaid reviewer makes the final decision on every evaluation and every authorization. Requirements can change; we mark facts with the sources they come from and the date we last reviewed them.

This guide addresses Florida Medicaid behavior analysis coverage for eligible members under age 21. Managed-care and fee-for-service authorization processes differ, and commercial insurance follows separate coverage rules.

You were told your child needs ABA. You sent in the evaluation you had — maybe a thick report from a psychologist, maybe the school’s testing packet, maybe the letter from the developmental pediatrician who made the diagnosis. And then someone said it “doesn’t qualify,” or asked for “the CDE,” and nobody explained what that meant or what exactly was wrong with what you sent.

If that’s where you are, this page is for you. It’s also for the case managers and care coordinators who get asked these questions every week. Our goal is that by the end, you won’t need to search fifteen other websites — you’ll know what the CDE is, whether the report in your hands qualifies, and exactly what to do next if it doesn’t.

Start with the one sentence that resolves most of the confusion:

A CDE is not a specific form and not a specific title. It is any complete diagnostic report that was written by the right kind of licensed professional and contains the right findings — the diagnosis, the evidence behind it, how the condition affects your child’s daily life, and an individualized recommendation for treatment. What’s inside the report decides. The words on the cover page do not.

That cuts both ways, and it explains almost every frustrating phone call about this topic. A report titled “Psychological Evaluation” may satisfy the CDE requirement when the evaluator and report meet the applicable requirements. The report title alone does not decide; the plan or Medicaid reviewer evaluates the complete document. And a report with “Comprehensive Diagnostic Evaluation” printed across the top can fail — if it’s a diagnosis code with generic recommendations and no real findings behind it.

First, Untangle the Words

Most CDE confusion is vocabulary confusion. Five different documents get mixed up constantly, and they are not interchangeable. Here is what each one actually is:

CDE — Comprehensive Diagnostic Evaluation. The full clinical report that establishes your child’s diagnosis: who evaluated your child, what they observed and measured, what the results mean, how the condition affects daily functioning, and what treatment the evaluator recommends. This is the document Florida Medicaid requires with the ABA referral.[1] It is the foundation everything else is built on.

Psychological evaluation. A general label, not a category with fixed contents. Psychologists write evaluations for many different questions — diagnosis, cognition, emotional functioning, behavior. If the psychologist is qualified and the report contains everything a CDE requires, it is a CDE for practical purposes, whatever the cover says. If it answers a different question, it isn’t.

Psychoeducational or school evaluation. Testing done by a school district to answer an educational question: does this student qualify for exceptional student education, and what supports belong in the IEP? Federal special-education rules shape what schools evaluate, and their question is eligibility for services at school — not medical diagnosis.[7] A school evaluation can be thorough and still contain no clinical diagnosis, no medically qualified evaluator, and no ABA recommendation. That’s why “the school already tested him” usually isn’t enough by itself.

Screening tools and single scores. An M-CHAT-R at a well-visit, a CARS-2 score, an ADOS-2 result on its own. These are instruments a qualified evaluator uses inside an evaluation — they are not the evaluation. The CDC is direct about this: no single tool should be the sole basis for an autism diagnosis; a real diagnosis rests on developmental history and professional observation interpreted through accepted criteria.[6] Molina says the same thing from the payer side: scores alone are not a formal diagnosis.[4]

The ABA behavior assessment (and the Vineland/BASC reports). A completely separate document with a different job. After the diagnosis exists, the ABA provider conducts its own assessment of your child’s current skills and behaviors to build the treatment plan — and Florida Medicaid requires that assessment to include specific instruments (more on that below). This assessment never replaces the CDE, and the CDE never replaces it. They are two different pillars of the same authorization.[1][4]

If you keep those five straight, the rest of this page will feel much simpler.

What Must Actually Be Inside a CDE

Florida Medicaid’s Behavior Analysis Services Coverage Policy sets the statewide baseline: the ABA referral must include a physician’s order plus a CDE “performed according to national evidence-based practice standards,” led by a licensed practitioner working within their medical, developmental, or psychological scope — and containing, at minimum, assessment findings and treatment recommendations appropriate to your child.[1] Every Florida Medicaid managed care plan has to honor that baseline; plans can add submission instructions, but they can’t make coverage more restrictive than the state policy without AHCA’s contractual permission.[1]

In practice — combining the state policy with what Sunshine and Molina publish in their own checklists[2][4] — a report that qualifies lets the reader find all nine of these things:

1. A formal diagnosis, stated outright. Not “scores consistent with autism.” Not a code on a superbill. The evaluator names the diagnosis and owns it.

2. The evidence behind the diagnosis. Which interviews, observations, records, criteria, and instruments the evaluator used — and when a test was given, the actual results and what they mean clinically, not just the test’s name.

3. Your child’s real history. Developmental, behavioral, medical, and relevant family history that describes your child. A red flag plans look for: a report so generic it could describe any child.

4. Parent or guardian input. Your interview matters diagnostically — you’re the only witness to your child’s development across years and settings. AHCA, Sunshine, and Molina all name caregiver input in their guidance.[1][2][4]

5. Direct professional observation. The evaluator saw your child and wrote down what they saw. Molina specifically flags missing direct observation as one of the most common reasons a CDE falls short.[4]

6. Functional impact. How the condition actually affects communication, safety, self-care, learning, and relationships — at home, at school, in the community. This is what connects the diagnosis to the “medically necessary” standard ABA authorization runs on.[1]

7. Diagnostic reasoning. The findings tied to accepted diagnostic criteria, with other explanations or co-occurring conditions considered where appropriate. A score without interpretation doesn’t clear this bar.

8. An individualized treatment recommendation. If ABA is clinically indicated, the report says so and says why — for this child, not as a boilerplate list of every available therapy.[1][4]

9. The evaluator’s credentials, signature, and date. The complete signed report — not the patient-portal summary, not the one-page letter. Sunshine names the signature and date explicitly; a missing signature alone can stall an authorization.[2]

Read that list twice and you’ll see the pattern: nothing on it is exotic. A competent diagnostic evaluation contains all nine naturally. Reports fail not because the standard is mysterious but because what got submitted was a fragment — a summary letter, a score sheet, a school packet — instead of the complete clinical report.

Who Is Allowed to Write One

Two related but separate requirements meet here. First, AHCA lists the practitioners who can refer a child for behavior analysis[1]:

• a primary care physician (family practice, internal medicine, or pediatrics);
• a board-certified or board-eligible physician in developmental-behavioral pediatrics, neurodevelopmental pediatrics, pediatric neurology, or adult or child psychiatry; or
• a child psychologist.

Second — and separately — the CDE itself must be led by a licensed practitioner working within their medical, developmental, or psychological scope of practice, whether it is performed by one practitioner or a multidisciplinary team.[1] Plan-specific evaluator lists may be narrower than the state baseline, so verify with the child’s plan.

Two practical notes families ask about constantly:

Yes, your pediatrician is on the list — but a diagnosis noted at a fifteen-minute well-visit is not a CDE. The full evaluation content above is still required, which is why many pediatricians make the diagnosis referral and send families to a developmental specialist or child psychologist for the comprehensive evaluation itself.

School psychologists are a special case. Molina’s guide accepts a licensed school psychologist but states plainly that an unlicensed one does not meet its CDE standard.[4] Since district school psychologists are often certified rather than licensed, verify the credential before assuming a school-based report can qualify. When in doubt, ask the plan first — before paying for or scheduling anything new.

“Does the Report I Already Have Qualify?”

Match your situation:

“It says Psychological Evaluation on the cover.” Check the evaluator and the contents against the nine items above. If a qualified child psychologist wrote it, and it has the history, observation, interpreted testing, stated diagnosis, functional findings, individualized ABA recommendation, signature, and date — send the complete report. The title will not disqualify it.[1] Don’t shorten it, don’t summarize it, don’t send only the last two pages.

“All we have is the school’s evaluation and the IEP.” Send it as supporting information, but don’t expect it to stand alone. It answers an educational question, not a clinical one.[7] What it’s genuinely useful for: it strengthens the functional-impact picture, and it can help the eventual evaluator work faster. What it usually lacks: a medical diagnosis by a qualified clinical evaluator and an ABA recommendation.

“We have the diagnosis letter.” That letter confirms a diagnosis exists — it doesn’t show the plan how the diagnosis was made. Call the office that did the original evaluation and request the complete signed evaluation report. The full report may already exist — the letter may simply be what was handed to you. This phone call is the fastest first step to take.

“The cover literally says Comprehensive Diagnostic Evaluation, and the plan still pushed back.” Then something inside is missing — usually interpreted test results, individualized recommendations, direct observation, or a signature.[4] The label doesn’t cure absent content. Ask the plan the question in the next section, and you’ll know exactly which element to fix.

“Our evaluation is from another state, or from years ago.” AHCA’s policy does not state a defined CDE expiration period, and Molina states that its Medicaid and CMS members’ CDEs have no defined expiration — though it may request an updated evaluation following significant developmental, functional, or diagnostic changes.[4] An out-of-state report follows the same logic as everything else on this page: qualified evaluator, complete contents. Send the full report and let the plan review it before assuming you need to start over.

If the Plan Says Your Evaluation Doesn’t Qualify

Do not book a new evaluation yet. Ask one question first:

“Which exact element is missing?”

Make the plan (or the ABA provider’s intake team relaying the plan’s feedback) name it. The answer changes everything:

• Missing signature or date → the original evaluator’s office may be able to correct this without any new evaluation.
• Missing pages or score reports → request the complete report and attachments; nothing new needs to be performed.
• Evaluator type not accepted → now you know a new evaluation is genuinely needed, and precisely what credential to look for.
• No individualized ABA recommendation → the original evaluator can often issue an addendum after reviewing their own findings — far faster than a full re-evaluation.
• No stated diagnosis / scores only → the evaluating practitioner needs to complete the clinical picture, or a full evaluation is needed.

Families lose months redoing entire evaluations when the actual defect was a missing attachment. The one-question habit above is the single highest-value thing a case manager can teach a family.

If Your Child Has Never Had a CDE

Here’s the path, start to finish:

1. Start with the child’s plan. Call member services (the number on the child’s insurance card) and ask for in-network providers who perform comprehensive diagnostic evaluations for autism — developmental-behavioral pediatricians, child psychologists, pediatric neurologists, or child psychiatrists. Asking the plan first keeps you in-network and gives you names that the plan already recognizes as qualified.

2. Ask the pediatrician in parallel. The pediatrician can make referrals, share screening results the evaluator will want, and write the physician’s order for ABA — which is a separate required document that travels with the CDE in the referral package.[1] Ask for it in the same conversation so it isn’t the missing piece later.

3. When you book the evaluation, say what it’s for. Use this sentence, word for word if you like: “We need a comprehensive diagnostic evaluation that meets Florida Medicaid’s requirements for ABA services — a full report with the diagnosis, testing results and interpretation, functional impact, treatment recommendations, and the evaluator’s signature — not a screening.” This tells the evaluator’s office exactly what the final report needs to contain.

4. Bring your evidence. Prior screenings, the school’s testing, therapy notes, your own written list of concerns and examples. None of it replaces the evaluation; all of it makes the evaluation better and more individualized.

5. Ask for the complete signed report when it’s done — not just the results conversation, not just the portal summary. You want the document itself, and you want to keep a copy permanently in your own records. (If you’ve read our guide on changing ABA providers, you already know why: families who hold their own file move faster through every future transition.)

Wait times for diagnostic evaluations vary by provider and region. That’s exactly why steps 1 and 2 happen in parallel, and why fixing an existing report (previous section) is worth checking before joining a new waitlist.

What Each Health Plan Says

The state policy is the floor. Here’s what the major plans have published on top of it — this is the section to check before submitting:

Sunshine Health. Requires the CDE and ABA referral with initial assessment requests, and with the initial certification and first recertification submission. After that, a new CDE is not required as long as the one on file was submitted. Sunshine’s required contents: the diagnosis identified during the evaluation, treatment recommendations, background from a parent or guardian interview, diagnostic testing, and the licensed practitioner’s signature and date.[2] Its clinical policy lists examples of instruments an evaluator might use — ADOS-2, CARS-2, M-CHAT-R, CSBS, ADI-R, SCQ, Battelle — without mandating any single battery.[3]

Molina Healthcare of Florida. Calls the CDE “the clinical foundation” of the authorization request. Accepts privately obtained CDEs when the practitioner is qualified and contents meet its standards. States the CDE has no defined expiration for Medicaid and CMS members, while reserving the right to request an update after significant developmental or functional change. Flags the most common failures: missing direct observation, scores without interpretation or a stated diagnosis, and unlicensed school psychologists as evaluators.[4]

Simply Healthcare / Carelon Behavioral Health. In its January 2025 provider training, Simply/Carelon instructed providers to submit a diagnostic evaluation completed and signed by a qualifying developmental, neurological, psychiatric, or child-psychology practitioner in the referral package — and, separately, a current treatment plan with member-specific data including current Vineland and BASC scores (that second requirement belongs to the ABA provider’s side of the package, not to the CDE).[5]

Community Care Plan, CMS Health Plan, and other Florida Medicaid plans. All Florida Medicaid managed care plans are bound by the same AHCA baseline described throughout this guide.[1] Individual plans publish their own submission checklists; the ABA provider’s intake team works with those daily and can tell you what a specific plan wants to see.

Commercial insurance. Different world, different rules. A commercial plan may use different terminology, evaluator criteria, recency requirements, and documentation standards. Everything on this page describes Florida Medicaid; for a commercial plan, ask that plan directly.

The Vineland/BASC Confusion, Settled

This is the misunderstanding that sends more families in circles than any other, so here it is as plainly as we can write it.

Florida Medicaid requires specific standardized instruments — the Vineland-3 Comprehensive Parent Interview Form (with the Maladaptive Behavior Domain from age 3) and the BASC-3 Parenting Relationship Questionnaire (ages 2–18) — with complete scoring reports submitted at the initial assessment and at reassessment at least every 12 months.[1]

But those requirements belong to the ABA provider’s behavior assessment — the separate document the ABA provider produces to support the treatment plan and the authorization request. They are not what makes a diagnostic report a CDE:

• A CDE without Vineland or BASC scores can be a fully qualifying CDE.[1][4]
• A report with Vineland and BASC scores is not automatically a CDE — Molina makes this distinction explicitly.[4]
• If someone tells you “your evaluation doesn’t qualify because it’s missing the Vineland,” ask whether they mean the CDE or the behavior assessment. Those are different documents, produced by different professionals, and the fix is different for each.

So when a checklist mentions “required rating scales,” look at which document the checklist is describing. The CDE requires evidence-based assessment findings chosen by the evaluator’s clinical judgment; the behavior assessment requires the specific named instruments above.

Quick Answers

Does a CDE expire? AHCA’s policy does not state a defined CDE expiration period. Molina states that its Medicaid and CMS members’ CDEs have no defined expiration, although it may request an updated evaluation following significant developmental, functional, or diagnostic changes.[1][4]

Can our pediatrician write it? Pediatricians are on the qualified list, but the full report content is still required — a visit note isn’t enough. Many pediatricians refer to a specialist for the comprehensive evaluation.[1]

Does the CDE get ABA approved by itself? No. It’s one part of the package: physician’s order + CDE + the ABA provider’s behavior assessment and plan + plan-specific items. Authorization also renews on its own cycle afterward.[1]

Can Blooming — or any ABA provider — write the CDE? A BCBA credential by itself is not identified by AHCA as sufficient to lead the diagnostic evaluation. A practitioner who separately holds an accepted diagnostic license may work within that license and scope.[1] Blooming’s intake and ABA teams do not diagnose or complete the CDE; they can help identify missing documentation.

Who decides, in the end? For managed-care members, the child’s health plan makes the decision. For fee-for-service members, Florida Medicaid’s designated authorization reviewer applies the state process. Evaluators write reports; providers assemble packages; the reviewer makes the coverage and medical-necessity decision. Nothing on this page overrides that.

We’re switching ABA providers — do we need a new CDE? Changing ABA providers does not automatically create a new statewide CDE requirement. The new provider may need to complete a new behavior assessment, and the plan may request updated documentation — covered in our guide to changing ABA providers.

The Checklist

Before you submit, confirm the complete report contains:

• the child’s identifying information and reason for evaluation;
• the evaluator’s name, license, credentials, and qualifying scope of practice;
• developmental, behavioral, medical, and relevant family history;
• parent or guardian interview information;
• direct professional observation of the child;
• the diagnostic methods and instruments used;
• scores with interpretation and clinical significance where tools were used;
• a formal diagnosis, stated by the evaluator;
• findings connected to accepted diagnostic criteria;
• functional impact across the settings that matter for your child;
• consideration of co-occurring or alternative conditions where appropriate;
• an individualized treatment recommendation, including ABA when indicated;
• the evaluator’s signature and date; and
• every page — the complete report, not a summary.

And confirm the rest of the package is moving in parallel:

• the physician’s order / ABA referral;
• the ABA provider’s behavior assessment;
• complete Vineland-3 and BASC-3 PRQ scoring reports where applicable;
• the behavior plan and measurable goals; and
• anything the specific plan’s checklist adds.

This is a screening aid, not a guarantee — the plan or Medicaid reviewer makes the final call. A complete package gives the reviewer everything the review requires.

How Blooming Helps

Blooming Behavioral Health provides ABA in homes, schools, daycares, and community settings across Miami-Dade, Broward, and Palm Beach counties.

When a family, case manager, or referring professional contacts us, our intake team can read the evaluation you have and tell you — in plain language — whether it appears to contain the core elements plans ask for, what looks like it’s missing, and whether the fix is a phone call or a new evaluation. We’ll explain the difference between the CDE, the referral, and the behavior assessment as it applies to your child’s specific plan, and tell you exactly what Blooming still needs to complete intake. If you’re preparing to submit intake, that guide pairs with this one.

Blooming does not diagnose, does not decide whether an outside evaluation qualifies, does not determine Medicaid eligibility, and cannot guarantee authorization, hours, staffing, or start dates — those belong to the qualified evaluator and the child’s plan or Medicaid reviewer.

To ask about a referral or have an evaluation reviewed, call (754) 799-3780, visit our page for professionals, or begin an intake online.

Clinically reviewed by Celia Santos, Psy.M., BCBA, LBA, Clinical Director.

Reviewed for operational and compliance accuracy by Carlos Marquez, Director of Services and Compliance Officer.

Florida Medicaid Policy

1. Florida Agency for Health Care Administration — Florida Medicaid Behavior Analysis Services Coverage Policy, December 2024 (Sections 1.2, 2.2, 4.2.1, and 7.2; incorporated by reference in Rule 59G-4.125, F.A.C., effective February 10, 2025). https://ahca.myflorida.com/content/download/25728/file/Florida%20Medicaid%20Behavior%20Analysis%20Services%20Coverage%20Policy.pdf

Health Plan Guidance

2. Sunshine Health — Required Documents for Behavioral Analysis (BA) Providers, June 16, 2025. https://www.sunshinehealth.com/newsroom/aba-docs.html
3. Sunshine Health — Clinical Policy: Behavior Analysis Services, FL.CP.BH.500, revision June 2024. https://www.sunshinehealth.com/content/dam/centene/Sunshine/policies/clinical-policies/FL.CP.BH.500.pdf
4. Molina Healthcare of Florida — Behavioral Analysis Services: Authorization & Documentation Guide, Comprehensive Provider Quick Reference Guide, effective July 2026. https://www.molinahealthcare.com/-/media/Molina/PublicWebsite/PDF/Providers/fl/medicaid/08-07-26-MHFL-Comprehensive-BA-QRG-508.ashx
5. Simply Healthcare Plans and Carelon Behavioral Health — Florida Medicaid Provider Training: Behavioral Analysis, January 15, 2025. https://provider.simplyhealthcareplans.com/docs/gpp/FLFL_SIMPLY_CarelonBehavioralAnalysisTrainingRes.pdf?v=202503041513

Clinical and Federal Standards

6. Centers for Disease Control and Prevention — Clinical Testing and Diagnosis for Autism Spectrum Disorder, May 8, 2025. https://www.cdc.gov/autism/hcp/diagnosis/index.html
7. U.S. Department of Education — IDEA Regulations, 34 C.F.R. § 300.304, Evaluation Procedures. https://sites.ed.gov/idea/regs/b/d/300.304