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.[2]
Florida writes the claim clock for Medicaid health plans, Florida Community Care included into statute: “Managed care plans shall comply with ss. 641.315, 641.3155, and 641.513” (§ 409.967(2)(j)). Under § 641.3155 a provider must send the claim to the plan “within 6 months after” the date of service (and to a secondary payer within 90 days of the primary’s final determination). For an electronic claim the plan must acknowledge receipt within 24 hours of the next business day and, within 20 days, pay it or notify the provider that it is denied or contested, with an itemized list of what is missing (the provider then has 35 days to supply it). Every claim must be paid or denied within 90 days of receipt, and failure to do so within 120 days “creates an uncontestable obligation to pay the claim.” Paper claims run 40, 120 and 140 days. Late payments bear 12% simple interest.[1][6][7]
FCC’s provider manual: providers must file “within the time set forth in their Florida Community Care participating provider Agreement(s) unless applicable law requires a greater time period,” and where Florida law applies, “claims must be filed within 180 days after the date of service.” On payment: “Claims are processed daily and combined into a weekly payment. Remittance advices are also generated on a weekly basis,” viewable in Availity for EFT payees. No submission cutoff day or time is published.[1][6][7]
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.[4][2]
The state policy requires no autism diagnosis and sets no diagnosis-recency rule, but FCC’s own ABA prior authorization form does. For members under 21 its Section G asks the provider to “specify ASD diagnosis established and by whom,” marks the documentation mandatory, and states: “Documentation must be within the last 24 months by a MD, PhD in Psychology or PsyD. Diagnosis must meet DSM-5 criterion to diagnose ASD. Validated assessment tools must be included.” Treat a diagnostic report older than 24 months as a likely return. Underneath, the state cycle applies: reassessment and an updated behavior plan at least every six months, and the two core instruments re-administered every 12 months.[3][4]
Ask the plan: The FCC Utilization Department (1-833-322-7526): whether a request without a current ASD diagnosis is still reviewed under the state policy, which requires no autism diagnosis.
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.[4][2]
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.[4][2]
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 requests for new courses of treatment “should be submitted to FCC’s Utilization Department using the Florida Community Care ABA Prior Authorization Request Form,” 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.[2][4]
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.[4][2]
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.[1][9]
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.[10][9][1]
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.[4][2]
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.[4]
Ask the plan: The FCC Utilization Department for whether an authorization can carry 97153 and 97155 on the same clock time.
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: its ABA prior authorization form asks only for the CPT/HCPCS code and the units requested per authorization period.[4][3]
Ask the plan: The FCC Utilization Department for any per-day claim edit, plus the current AHCA BA fee schedule for per-assessment unit caps.
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.[4]
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.[4]
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).[2][4]
Weekly: FCC processes claims daily and combines them into a weekly payment, with weekly remittance advices (in Availity for EFT payees). File within your agreement’s limit, or 180 days from the date of service where Florida law applies.
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.
Not published as a yes or no. Florida law lets MMA plans “limit the providers in their networks based on credentials, quality indicators, and price” (s. 409.975(1), F.S.), so a plan may decline a new BA group. Ask Florida Community Care’s provider relations or contracting team whether it is adding BA groups in your region.
AHCA’s BA coverage policy, which every MMA plan must follow, says “a full assessment may be requested if there is a change in provider,” and a change in a practitioner’s credential (an RBT becoming a BCaBA) is not grounds for a reassessment. Expect the new agency to request its own assessment and treatment authorization; ask Florida Community Care how it closes the previous provider’s authorization.
Florida law binds Florida Community Care as an MMA plan (§ 409.967(2)(j) → § 641.3155): pay or send a denial/contest notice within 20 days of an electronic claim (40 for paper), pay or deny within 90 days (120 for paper), and 12% interest on late payments. The statute also requires providers to file within 6 months of the date of service.
The state packet (an independent physician's referral and order for BA services plus a CDE), submitted on FCC's own ABA Prior Authorization Request Form by fax, email or the provider portal. For members under 21, the form also asks who established the ASD diagnosis: "Documentation must be within the last 24 months by a MD, PhD in Psychology or PsyD. Diagnosis must meet DSM-5 criterion to diagnose ASD. Validated assessment tools must be included." Expect an older diagnostic report to come back.
Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed October 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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