Florida Community Care (FCC), operated by Independent Living Systems, is the smallest and most specialized of the nine plans — focused on long-term care and the CIDD (intellectual/developmental disability) population, which makes its membership unusually ABA-relevant per capita. The BA workflow is lightweight and in-house: a dedicated FCC ABA Prior Authorization Request Form submitted by fax, email (unusual among the nine), or the provider portal to FCC's own Utilization Department, on the state clinical criteria.
Submit the Florida Community Care ABA Prior Authorization Request Form to the in-house Utilization Department by fax (305-675-6138), email (FCCUMDepartment@FCCHealthPlan.com — email PA submission is unusual among Florida's plans and handy for small teams), or through the FCC Provider Portal at secure.healthx.com. The clinical criteria are the state's: referral + order + CDE at entry, no autism-diagnosis requirement, Vineland-3/BASC-3 documentation, authorizations up to 6 months. At the February 2025 carve-in, FCC honored ongoing BA authorizations for the entirety of the continuity-of-care period — a minimum of 120 days after enrollment. Claims run under payer ID FLCCR via Availity or your clearinghouse, and the provider call center is 1-833-322-7526. Given the CIDD focus, expect members with rich existing clinical records — leverage them for the CDE and the most specific supporting diagnoses.[1]
The questions that decide whether a family can start with Florida Community Care, and what they have to bring. Each maps onto something intake should ask on the first call.
Follows the Florida Medicaid rule: BA is for recipients under the age of 21, with EPSDT available above the coverage-policy and fee-schedule limits. FCC’s published BA services page is procedural — which form, which fax, which mailbox — and states no age criterion of its own; the coverage policy forbids a plan from applying more stringent service coverage limits than state policy.[2][1]
No autism diagnosis is required, so no diagnosis-recency rule applies. The state cycle governs: reassessment and an updated behavior plan at least every six months, the two core instruments re-administered every 12 months, and no published expiry on the Comprehensive Diagnostic Evaluation. FCC’s BA page publishes no plan-specific freshness rule.[2][1]
Ask the plan: The Florida Community Care ABA Prior Authorization Request Form itself (via the FCC Provider Portal, or FCCUMDepartment@FCCHealthPlan.com) for any date requirement the form imposes.
The state rule, which FCC cannot narrow: the referral comes from an independent physician or qualifying practitioner (PCP in family practice, internal medicine or pediatrics; a developmental-behavioral, neurodevelopmental, pediatric-neurology or adult/child-psychiatry specialist; or a child psychologist), and the CDE must be led by a licensed practitioner working within their medical, developmental or psychological scope of practice. Given FCC’s long-term-care and CIDD membership, much of that record usually already exists — mine it rather than re-commissioning it.[2][1]
The state pair: the Vineland-3 Comprehensive Parent Interview Form for all recipients (plus the Maladaptive Behavior Domain for ages 3 and older) and the BASC-3 PRQ for ages 2 through 18, with complete scoring reports submitted with every prior-authorization request and re-administration every 12 months. FCC publishes no additional instrument requirement.[2][1]
Required — the state gate (independent physician referral, physician’s order for BA services, and a CDE performed to national evidence-based practice standards) applies unchanged. FCC’s contribution is the channel: prior authorization is required after the continuity-of-care period, and providers “must submit the Florida Community Care ABA Prior Authorization Request Form” for new courses of treatment, by fax to 305-675-6138, by email to FCCUMDepartment@FCCHealthPlan.com, or through the FCC Provider Portal — email submission being unusual among Florida’s nine plans.[1][2]
Follows the Florida Medicaid rule: the only telemedicine provision is up to two hours per week of Lead Analyst caregiver training (97156) under Rule 59G-1.057, F.A.C. FCC’s BA services page publishes no telehealth rule, code list or place-of-service guidance.[2][1]
Ask the plan: The FCC Utilization Department (FCCUMDepartment@FCCHealthPlan.com) or the provider call centre 1-833-322-7526 before scheduling a remote session other than 97156 caregiver training.
FCC’s provider handbook: “Staff process pre-service routine requests within 7 calendar days from the date of receipt,” with notice to provider and enrollee in the same 7 days. Urgent pre-service requests are processed “within 48 hours from the date and time of receipt”; providers can mark a request STAT. No BA reauthorization lead time is published. Note the gap with the AHCA contract, which sets 5 days standard and 2 days expedited for MMA plans. Plan around the 7 days FCC publishes.[3][4]
FCC’s provider handbook publishes no coordination-of-benefits procedure of its own, so the state rule governs. Florida Medicaid pays last. Rule 59G-1.052 says: “Florida Medicaid is the payer of last resort. Providers must exhaust all TPL sources of payment, such as Medicare, TRICARE, private health insurance … prior to submitting or resubmitting a claim.” The AHCA contract binds every MMA plan to that rule. Two consequences for intake: Medicaid pays only “the difference between the Florida Medicaid rate and the third-party payment,” and it pays nothing when “the provider’s TPL claim is denied for failing to obtain the appropriate authorization from the third-party.” So get the commercial plan’s own ABA authorization first.[5][4][3]
Ask the plan: FCC Utilization Management: whether FCC requires its own BA authorization when a commercial plan pays first.
Coverage decides whether Florida Community Care pays. These decide whether the claim survives: how sessions must be staffed and supervised, what may be billed concurrently, the per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.
The state floor: supervision of BCaBAs and RBTs per the Council of Autism Service Providers practice standards, as specified in the supervision plan inside the approved behavior plan, which must name the authorized supervisors; Lead Analyst is a BCBA, FL-CBA or Ch. 490/491 licensee, a BCaBA works under a BCBA, and an RBT under a BCBA or BCaBA. FCC publishes no ratio or caseload cap of its own.[2][1]
The state rule is the floor and FCC publishes no variation: the supervisee is not reimbursed when the supervisor is reimbursed for the same time period, and simultaneous services by more than one BA provider are non-covered unless medically necessary, prior authorized and indicated in the approved behavior plan.[2]
Ask the plan: The FCC Utilization Department for whether an authorization can carry 97153 and 97155 on the same clock time.
The state rule: “session notes must be signed and dated by the rendering practitioner,” carrying date, time, location, duration, behaviors observed, skills targeted, the recipient’s response, protocol modification or therapist direction, an explanation if the parent or guardian was absent, and the participants; the behavior assessment and behavior plan are signed by the Lead Analyst and the parent or guardian. FCC adds no published signature rule.[2]
The state rule: a school-based request must include the IEP, or a 504 plan, or documentation naming the school and explaining that neither is available; 1:1 shadow, personal care assistance, companion and chaperone services are non-covered “regardless of activity or setting,” as are caregiver/childcare services and travel time; BA is non-covered on the same day as behavioral health overlay, therapeutic behavioral on-site, or therapeutic group care. The same-day exclusions deserve a second look on a long-term-care and CIDD population that often carries other Medicaid benefits.[2]
Claims run under payer ID FLCCR through Availity or your clearinghouse, with the provider portal at secure.healthx.com and a provider call centre at 1-833-322-7526. The state enrollment structure decides whose NPI may render: a professional claim (837P / CMS-1500) under an individually enrolled practitioner — Lead Analyst 392, BCaBA 391, RBT 390 — with 390s and 391s enrollable only as members of an enrolled BA group (393).[1][2]
The state weekly ceiling: up to 40 hours per week of BA intervention as prior-authorized in the behavior plan, EPSDT available above it, group treatment capped at six participants, and 15-minute units on the CMS 8-minute rule. FCC publishes no per-day unit table.[2]
Blocked on: The FCC ABA Prior Authorization Request Form and the FCC Utilization Department, plus the current AHCA BA fee schedule for per-assessment unit caps.
Yes — the state Behavior Analysis benefit on AHCA criteria (no autism diagnosis required), authorized by FCC's in-house Utilization Department via its ABA PA form.
The FCC ABA Prior Authorization Request Form by fax to 305-675-6138, email to FCCUMDepartment@FCCHealthPlan.com, or through the FCC Provider Portal — email submission is an FCC-specific convenience.
Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed September 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.
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