Before You Submit ABA Intake: A Florida Family Checklist

A documents, insurance, and questions checklist for Florida families.

Educational note: This guide is educational and does not replace medical, legal, school, or insurance advice. Authorization, plan rules, and timelines vary by plan and by family. Always confirm requirements directly with your specific Medicaid managed care plan or insurance carrier, and with the ABA provider you choose.

Read this first — intake is not the same as authorization. Submitting an intake form starts the review process. The payer still determines coverage, medical necessity, authorization, and approved hours. No ABA provider — including Blooming — can guarantee approval, a specific number of hours, or a specific timeline before the plan reviews the case.

Many ABA intake delays in Florida come from missing or incomplete paperwork, not from the family doing anything wrong. A family submits intake, gets a callback within a day or two, and then loses a week because a diagnostic evaluation was incomplete, an insurance plan name was wrong, or a referral was never written. None of that is the family's fault. But all of it is avoidable.

This guide is a checklist of what to gather, what to ask, and what to expect before you submit ABA intake — for Blooming or any provider. The goal is simple: arrive at your intake call with everything ready so the provider can spend the conversation explaining what happens next, not asking you for documents you can email in two minutes.

A few framing notes before the checklist:

• Intake is not the same as authorization. Submitting intake starts the process. The plan still reviews medical necessity, decides whether to authorize services, and decides how many hours to approve.
• Assessment is not the same as approved therapy hours. An assessment recommends hours; the plan reviews and decides what is authorized. Be careful with any provider that promises specific hours before the assessment is done.
• Florida Medicaid covers ABA for children under 21 when medically necessary. Adults 21 and older access ABA through the Agency for Persons with Disabilities (APD) iBudget Waiver. Both pathways have prior-authorization requirements.

Clinical Documents to Gather

These are the documents your ABA provider — and the plan reviewing the authorization — may ask for. Have these ready before your intake call. Specific requirements vary by plan.

Comprehensive Diagnostic Evaluation (CDE)

The CDE is the foundation document. Florida Medicaid generally requires it to initiate Behavior Analysis (BA) services. Many commercial plans request similar diagnostic documentation.

A complete CDE generally includes:

• An autism (or other qualifying) diagnosis using current DSM criteria
• Diagnostic testing results — for autism, this commonly means tools like the ADOS-2 or the ADI-R
• A parent or guardian interview describing developmental history and current functioning
• Treatment recommendations
• The licensed practitioner's signature and date

Plans commonly specify which practitioners can write the CDE. For example, Sunshine Health lists the following categories: a primary care physician (family medicine, internal medicine, or pediatrics), a board-certified physician in developmental-behavioral pediatrics, neurodevelopmental pediatrics, pediatric neurology, or child or adult psychiatry, or a licensed child psychologist (PhD or PsyD). This is an example only. Families should follow the requirements of their child's specific plan. Confirm your child's plan's specific requirements before scheduling the evaluation.

If your CDE is older than a couple of years, ask your pediatrician or the practitioner who diagnosed your child whether an updated evaluation is needed. Plans look closely at recency.

Physician's Referral or Order for ABA

Many Florida Medicaid managed care plans and commercial insurers require a physician referral or order for ABA in addition to the CDE. The referring practitioner is typically the same category that can write the CDE.

If you do not have a referral yet, the intake team at any ABA provider can usually walk you through what to request from your pediatrician.

Prior Therapy Records (Speech, OT, PT)

If your child has had speech-language, occupational, or physical therapy evaluations or treatment, gather:

• Most recent evaluation reports
• Current plans of care
• Discharge summaries from any prior providers

This helps the ABA provider coordinate goals with the rest of your child's care team. It also helps avoid duplication-of-services denials, which can happen when overlapping therapy is not documented.

Prior ABA Records, If Any

If your child has received ABA before, gather:

• Most recent assessment reports (plans commonly request adaptive-behavior and behavior-rating scoring reports, such as the Vineland and BASC, at reassessment)
• Treatment plan from the prior provider
• Discharge summary, if services ended

These are not always required at initial intake, but they help significantly during the new provider's assessment and any reauthorization request.

Medical History

A brief medical history covering seizures, sleep concerns, GI issues, current medication, allergies, or significant medical events. The CASP Practice Guidelines describe this kind of background as standard intake context.

Insurance and Identity Documents

These are the documents the front-desk intake team needs to verify eligibility and submit a clean prior-authorization request.

Medicaid Members

• Your child's Florida Medicaid Gold Card or Medicaid member ID number
• The name of your Medicaid Managed Care plan as printed on your insurance card. Florida transitioned Medicaid Behavior Analysis services into managed care effective February 1, 2025; if you are unsure which plan your child is on, call Florida KidCare at 1-888-540-KIDS or check the Florida MyACCESS portal
• Secondary insurance card, if you have one
• Any plan-change history in the last six months — if your child recently switched Medicaid managed care plans, make a note. Continuity-of-care protections may apply in some plan-change situations

Commercial Insurance

• The member card for the primary insured
• The subscriber ID, group number, and plan administrator phone number (printed on the card)
• Plan documents that describe behavioral health benefits, autism coverage, and prior-authorization requirements. Some state-regulated commercial plans in Florida may include autism coverage requirements — check your specific plan documents or call your plan directly

Identity and Legal

• Child's birth certificate
• Parent or legal guardian government ID
• Court guardianship or custody paperwork, if your child's legal guardianship situation is anything other than the biological parents living together

Legal guardianship matters because informed consent for ABA must come from the person legally authorized to give it. The BACB Ethics Code addresses informed consent, including explaining, documenting, and revisiting consent when circumstances change.

Contact and Address Information

• The address where most ABA services will be delivered — home, school, daycare, or another natural setting
• The school or daycare name and contact, if services will happen there
• A phone number you actually answer
• An email you actually check

What Florida Medicaid and HMO Plans Commonly Look For

Florida Medicaid and Medicaid HMO plans evaluate Behavior Analysis authorization requests against the Florida Medicaid Behavior Analysis Services Coverage Policy. The framework looks like this — specific plan requirements vary.

• Medical necessity — the assessment must establish that ABA is clinically necessary for the child's diagnosis and functional needs
• A documented qualifying diagnosis — autism spectrum disorder or another qualifying diagnosis, made by a qualifying practitioner
• Prior authorization before services start — Florida Medicaid generally does not pay for ABA delivered before authorization is issued, except in narrow continuity-of-care situations
• A treatment plan with measurable goals — vague goals may be sent back for revision
• Reassessment and an updated behavior plan every six months — required for continued authorization under Florida Medicaid policy
• Compliance with the 40-hours-per-week service cap — Florida Medicaid sets this as a ceiling, not a default. Authorized hours are individualized to the assessment, not automatic

Plans add their own documentation requirements on top of this baseline. For example, Sunshine Health publishes a specific list of required documents at initial authorization and reassessment. Confirm your specific plan's requirements with the ABA provider's intake team — they handle these forms every day and know what each plan is asking for.

What Families Should Know About Authorization

This is the most misunderstood part of the ABA process. Some plain-language ground rules:

Intake is the first step, not the last step

When you submit intake to an ABA provider, the provider verifies eligibility, helps identify missing documents, and schedules an assessment. None of that authorizes services yet. The assessment happens, then the assessment goes to your insurance plan, then the plan authorizes a specific number of hours per week for a specific time period.

Assessment recommendations are not approved hours

The BCBA's assessment will recommend hours based on your child's needs. The plan reviews that recommendation and decides what to authorize. Sometimes those numbers match. Sometimes they do not. If a plan authorizes fewer hours than the BCBA recommended, the provider can appeal on the family's behalf. Be wary of any provider that promises a specific number of hours before the assessment is done.

Timelines vary by plan and by case

We will not give you a number. Any ABA provider that guarantees authorization within a specific number of days is making a promise they cannot keep across plans, assessment types, and individual case complexity. Anyone honest will tell you: clean documentation makes things faster, missing documents make things slower, and even clean cases sometimes wait on the plan's internal review.

Authorization can be denied, modified, or reduced

This is normal — not catastrophic. Families have appeal rights when this happens. The next section covers that at a high level.

Questions Families Should Ask Any ABA Provider

Use these questions during your intake call. They are equally fair to ask Blooming, a competitor, or a friend of a friend who runs a small practice. A good provider answers them clearly without dodging.

Service Delivery

• Are you center-based, home-based, school-based, daycare-based, or community-based?
• Where will my child's sessions actually take place?
• If services happen at school or daycare, how do you handle coordination with the staff there?

Supervision and Staffing

• Who is the BCBA supervising my child's case? What is their certification number? You can verify any BCBA on the BACB Registry at bacb.com
• How often does the supervising BCBA review the data?
• Who provides direct services — RBT, BCaBA, or BCBA?
• How is RBT supervision documented?

Family Training

• How many hours of caregiver training are built into the authorization period?
• Will I receive written materials, or only verbal instruction?
• Who at the agency owns family training — the RBT, the BCBA, or both?

Communication

• How do you communicate with schools, pediatricians, and other providers on the care team?
• How do you handle therapist or RBT changes? RBT turnover is common in the field — what is your continuity plan?
• Who is my single point of contact for billing, authorization, and scheduling questions?

Goals, Assent, and Family Priorities

• How are treatment goals chosen — by the BCBA alone, or with our family's input?
• How is my child's assent measured and respected, especially when my child cannot fully verbalize agreement or disagreement?
• The BACB Ethics Code addresses assent. How does your team operationalize that day to day?

Operations

• Are you currently in-network with my child's specific Medicaid managed care plan or commercial insurance? Confirm by plan name.
• What is your typical timeline between intake and the first session — understanding that it depends on plan, region, and document readiness?
• How do you handle the 6-month Florida Medicaid reauthorization cycle?

Common Intake Delays — and How to Avoid Them

These are the recurring delays Blooming and most Florida ABA providers see during intake. Most are fixable in 24 hours if a family knows what to look for.

• Missing or incomplete diagnostic evaluation. The CDE was completed by someone who does not qualify under the plan's rules, or it is missing the practitioner's signature, the parent interview section, the diagnostic testing, or a current date. Fix: ask your pediatrician's office to provide a current copy. If the original evaluator does not qualify under your plan, get a CDE from a qualifying practitioner.
• Expired or missing physician referral. The plan requires it; the family does not have it; intake stalls. Fix: ask the pediatrician's office to write or update the referral as soon as you confirm with the ABA provider that one is needed.
• Wrong insurance plan information. A family thinks they are on Plan A but actually changed to Plan B last quarter and never received the new card. Fix: confirm your child's current plan with Florida KidCare (1-888-540-KIDS) or in the Florida MyACCESS portal before intake.
• Medicaid plan change mid-process. Children get moved between Medicaid managed care plans. If this happens mid-intake or mid-authorization, alert your ABA provider immediately. Continuity-of-care protections may apply.
• Missing school documents. If services will happen at school or daycare, the provider often needs the school's name, contact, and sometimes a school release form. Fix: get this together before intake if school-based services are likely.
• No proof of guardianship. Step-parents, grandparents, foster parents, and other caregivers cannot give informed consent for ABA without the right legal paperwork. Fix: have the guardianship or custody order ready in your binder.
• Duplicate provider or active authorization with another provider. A child generally cannot have ABA services authorized simultaneously with two providers. If your child was recently with another provider, gather the discharge summary so the transition is clean.

If Authorization Is Denied, You Have Appeal Rights

Authorization denial is not the end of the road.

Families have appeal rights if services are denied, reduced, suspended, or terminated. Deadlines can be short. Read the notice carefully and contact the plan or a qualified advocate if needed.

For Florida Medicaid managed care, the plan must issue written notice explaining the denial and your appeal rights. Plan-level appeals and Medicaid Fair Hearings each have specific deadlines and procedural rules — listed in the Sources section below.

Disability Rights Florida provides free legal advocacy for disability-related issues, including Medicaid denials. Their hotline is 1-800-342-0823. Florida Health Justice Project publishes a plain-language family guide to the Medicaid managed care appeal process.

This guide is not legal advice. If your child's authorization is denied, work with your ABA provider's intake team on the plan appeal, and call Disability Rights Florida or a Medicaid attorney if you need direct legal support.

What Blooming Does During Intake

When a family submits intake to Blooming, our front-desk team:

• Reviews the information you submitted
• Checks whether the documents you have provided appear complete
• Helps identify missing items so you know what to gather
• Explains the next step clearly so you know what is coming before the assessment
• May help your family understand what your plan is asking for
• Does not determine eligibility or coverage — your plan makes those decisions
• Does not guarantee authorization, approved hours, or specific timelines
• Does not request unnecessary protected health information (PHI) by text message — sensitive details are handled through HIPAA-appropriate channels

Blooming Behavioral Health serves Broward, Miami-Dade, and Palm Beach. Services are delivered in natural settings — at home, in school, in daycare, in the community — and are not clinic-based.

If you would like a no-commitment intake conversation, we are reachable at (754) 799-3780 or through /start-intake.

Preparation is what makes the next 30 to 90 days move smoothly. The checklist above does most of the work for you.

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Florida Medicaid Policy

1. AHCA — Florida Medicaid Behavior Analysis Services Information page. https://ahca.myflorida.com/medicaid/medicaid-policy-quality-and-operations/medicaid-policy-and-quality/medicaid-policy/medical-and-behavioral-health-coverage-policy/behavioral-health-and-health-facilities/behavior-analysis-services-information
2. Florida Medicaid Behavior Analysis Services Coverage Policy (PDF). https://ahca.myflorida.com/content/download/25728/file/Florida%20Medicaid%20Behavior%20Analysis%20Services%20Coverage%20Policy.pdf
3. AHCA — SMMC 3.0 BA Program Highlight (October 18, 2024). https://ahca.myflorida.com/content/download/25045/file/SMMC%203.0_BA%20Program%20Highlight_10182024.pdf
4. AHCA — Medicaid Fair Hearings (procedure, deadlines, fair-hearing request information). https://ahca.myflorida.com/medicaid/florida-medicaid-complaints/medicaid-fair-hearings

Plan-Specific Documentation (cited as worked examples — confirm your specific plan)

5. Sunshine Health — Required Documents for Behavioral Analysis (BA) Providers. https://www.sunshinehealth.com/newsroom/aba-docs.html
6. Sunshine Health — Behavior Analysis Quick Reference Guide. https://www.sunshinehealth.com/providers/Billing-manual/ba.html
7. Sunshine Health — Sunshine Health to Provide Behavior Analysis Services (January 23, 2025). https://www.sunshinehealth.com/newsroom/ahca-aba-alert.html

Clinical Standards

8. BACB — Ethics Code for Behavior Analysts (August 2024 revision). https://www.bacb.com/wp-content/uploads/2022/01/Ethics-Code-for-Behavior-Analysts-240830-a.pdf
9. CASP — ABA Treatment of Autism Spectrum Disorder: Practice Guidelines (Version 3.0, May 2024). https://www.casproviders.org/asd-guidelines/

Family Eligibility Verification

10. Florida KidCare. https://floridakidcare.org/

Family Appeal Support — Deadlines and Procedures

11. AHCA — Medicaid Fair Hearings page (full deadline and procedure information). https://ahca.myflorida.com/medicaid/florida-medicaid-complaints/medicaid-fair-hearings
12. Florida Health Justice Project — How to File an Appeal With Your Medicaid Managed Care Plan (plan appeal deadlines, continuation-of-benefits windows, Fair Hearing deadlines). https://floridahealthjustice.org/publications/how-to-file-an-appeal-with-your-medicaid-managed-care-plan/
13. Disability Rights Florida — Behavior Analysis Services. https://disabilityrightsflorida.org/disability-topics/disability_topic_info/behavior_analysis_services
14. Disability Rights Florida (main). https://disabilityrightsflorida.org/ — Hotline: 1-800-342-0823

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