Our Services Process

MEDICAL NECESSITY & JUSTIFICATION FOR SERVICES

The fact that a provider (developmental pediatrician, child psychiatrist/neurologist, licensed psychologist) has prescribed, recommended, or approved medical or allied care, goods, or services does not, in itself, make such care, goods or services medically necessary or a covered service. Therefore, there is a possibility your referral for Applied Behavior Analysis (ABA Therapy) may not be approved by the State of Florida’s Medicaid program or by a private insurance health plan even though it has been recommended for you. Here is an example of medical necessity criteria…

–Be necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain

–Be individualized, specific, and consistent with symptoms or confirmed diagnosis of the illness or injury under treatment, and not in excess of the patient’s needs

–Be consistent with generally accepted professional medical standards as determined by the Medicaid program, and not experimental or investigational

–Be reflective of the level of service that can be safely furnished, and for which no equally effective and more conservative or less costly treatment is available statewide

–Be furnished in a manner not primarily intended for the convenience of the recipient, the recipient's caretaker, or the provider

Therefore, since Novo Behavioral Services provides services related to behavior, it would be expected the potential client/child would demonstrate maladaptive behavior which interferes with the recipient’s daily functioning. Examples of these maladaptive behavior and their impact on the child’s daily functioning should be indicated within the documents (such as the referral and CDE [see below] provided to Novo Behavioral Services when first contacting us to obtain and receive ABA Therapy services.

Examples of such behavior provided by the Agency for Health Care Administration include:

  • Behavior Posing a Risk to Safety to Self, Others, and/or Property - aggression, self-injury, property destruction, elopement

  • Significant Communication Delays - problems with expressive/receptive language, poor understanding or use of non-verbal communications, stereotyped, repetitive language

  • Self-stimulating behavior, abnormal behavior, inflexible, or intense preoccupations

  • Significant Delays with Self-Care - toileting, grooming, eating, or difficulty recognizing risks or danger

  • Other- behaviors not identified above [be very specific with whatever ‘Other’ behavior you list]

It is important to indicate as many maladaptive behavior which are occurring as possible and to also indicate how many times each behavior is occurring each day, week, or month. In addition, mentioning the impact is important…

Currently and/or in recent past, the behavior listed above have led to (indicated the outcome of such behavior – for example, cannot take child to stores/restaurants, suspended from daycare/school, inability to participate in educational activities, failure to develop social relationships, scratches, bruising, first-aid, stitches, Emergency Room visit, police called, Baker Act, etc). For more information, please call our office.

REFERRALS

When your child receives a diagnosis, you may be referred to an ABA Therapy (Applied Behavior Analysis) provider.  If you or the diagnosing provider wish for us to be the ABA Therapy provider, the referral can be faxed to 888-975-0599 or sent by mail/delivered in-person.  In addition to the medical order / referral, we will need a copy of your Insurance Card along with a copy of the Comprehensive Diagnostic Evaluation (CDE) or alternative documentation as specified below. [Please note: A child does not necessarily have to have an Autism Spectrum Disorder diagnosis to be approved for ABA Therapy. With some commercial insurance plans it may be a requirement, but not with all of them. If you are uncertain if your insurance carrier covers ABA Therapy / Applied Behavior Analysis, please call them directly and ask to speak with a benefits specialist.]

The doctor's order MUST include the following:

  • Date of Order

  • Child Name, Date of Birth, & ID number

  • Child Diagnosis: ICD-10 Code/Description (ex. F84.0 Autism)

  • Doctor's Name, NPI number, and Signature

A Comprehensive Diagnostic Evaluation (CDE) is a thorough review and assessment of the child’s development and behavior using national, evidence-based practice standards, which may include:

  • Parent or guardian interview

  • Teacher assessment

  • Diagnostic testing using tools such as:

    • Autism Diagnostic Observation Schedule (ADOS-2)

    • The Childhood Autism Rating Scale – 2nd edition (CARS2)

    • Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R)

    • Communication and Symbolic Behavior Scales (CSBS)

    • Autism Diagnostic Interview, Revised (ADI-R)

    • Social Communication Questionnaire

    • Battelle Developmental Inventory– 2nd edition

  • Hearing and vision testing

  • Genetic testing

  • Neurological and/or other medical testing

  • The CDE must be led by licensed practitioners qualified to assess child developmental disorders such as:

    • Developmental Pediatricians

    • Child Neurologists

    • Child Psychologists

    • Child Psychiatrists

In order to initiate Behavior Analysis services while a child is waiting for his/her scheduled appointment for the CDE, the following documentation may be allowed, in lieu of the CDE:

  • Children 0 – 36 Months of Age

    • Early Intervention Services Evaluation / Individual and Family Support Plan

  • Children Older Than 36 Months of Age

    • Individual Education Plan (IEP) or school district assessment for IEP

    • Neurological Evaluation

    • History and physical from a licensed physician documenting behaviors and evaluation conducted to ascertain diagnosis:

      • Documentation of Challenging Behavior (doctors office notes, previous evaluation/assessment or written statements indicating types of challenging behavior, how often they occur, and what negative impact the behavior problems produce - interferes with daily function)

        i. Safety - aggression, self-injury, property destruction, elopement

        ii. Communication - problems with expressive/receptive language, poor understanding or use of non-verbal communications, stereotyped, repetitive language

        iii. Self-stimulating, abnormal, inflexible, or intense preoccupations

        iv. Self-care - difficulty recognizing risks or danger, grooming, eating, or toileting

        v. Other- behaviors not identified above

screening

Once we receive the referral, we will contact the client/family to request they answer some basic screening questions in order to help us understand if we believe we can help and if we can begin services right away or not.  Depending upon availability of a properly fitting professional for your family in your area, you may be assigned to a waiting list. We may also request a no-commitment ‘meet and greet’ visit with you to allow for both your family and us to learn more before moving further along in the process.

LOCATION OF SERVICES

Our services are available to be provided in homes, schools, daycare programs, and other settings.

waitlist

At this time there is a waiting list for our services,. To request to be added to our waiting list, please contact our office for the passcode to our Forms page on this website. At the top of that page you will be able to complete the Request to Be Added to Waiting List form. During this time continue seeking services from other qualified providers who may have an opening so you can begin services as soon as possible.

ASSESSMENT

The length of time to complete the assessment phase varies on a number of factors, but typically is completed within 2-4 weeks.  During this time, there will be face-to-face visiting, interviews with caregivers, requests for you to provide behavior data/collect behavior data, and completion of behavioral questionnaires to help us better understand the context of challenging behavior, motivators for your child, and more.

TREATMENT PHASE / THERAPY

Once the assessment is completed, the behavior analyst will develop a behavior intervention plan for your family.  The plan will include the assessment findings, therapy/treatment recommendations, along with goals, and other considerations for safely managing the child's behavior.  Your consent for these treatment recommendations is required.  Examples of treatments include, but are not limited to: functional communication training, problem solving skills, compliance programs, environmental supports, visual aides, priming, management of challenging behavior, and more.

DATA COLLECTION

In addition to data collection by our behavioral staff, parents/caregivers are also expected to collect data on their child's behavior in the home and community in order to help us measure improvements and ensure we are meeting behavioral objectives and goals.  To ease this burden, we offer HIPAA compliant electronic data collection which can be collected on your smartphone, tablet, or computer.

PARENT/CAREGIVER INVOLVEMENT

Although our behavioral providers may provide some direct therapy to your child, you also are encouraged and expected to participate in sessions and implement the behavioral interventions in the plan outside of sessions.  Please note, no-shows, late cancellations, and lack of data collection can lead to discontinuation of our behavioral services.

LENGTH/DURATION OF SERVICES

The length and duration of services which the behavior analyst will recommend must be based upon medical necessity.  Medical necessity is defined by your health insurer (commercial insurance, Medicaid, etc.).  Your health insurer is the entity which provides us the authorization for our services and what length/duration we will be approved to provide.