HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/HB 255 Private Instructional Personnel Providing Applied Behavior Analysis Services
SPONSOR(S): Early Learning & Elementary Education Subcommittee, Plasencia and others
TIED BILLS: None IDEN./SIM. BILLS: SB 538
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Early Learning & Elementary Education 18 Y, 0 N, As CS Sleap Brink
Subcommittee
2) Health & Human Services Committee 20 Y, 0 N Calixte Calamas
3) Education & Employment Committee 18 Y, 0 N Sleap Hassell
SUMMARY ANALYSIS
Applied Behavior Analysis (ABA) is an umbrella term referring to the principles and techniques used to assess,
treat, and prevent challenging behaviors while promoting new, desired behaviors. ABA has been recognized as
a treatment option for a range of behavioral health conditions, with an emphasis on the treatment of autism
spectrum disorder.
Current law requires public K-12 schools to allow certified applied behavior analysts and mental health
professionals licensed under chapter 490 or chapter 491, to provide ABA services in a classroom setting.
However, this requirement does not apply to behavior technicians working under the direction of these certified
or licensed professionals.
The bill adds a registered behavior technician who holds a nationally recognized paraprofessional certification
in behavior analysis, practices under the supervision of either certified behavior analysts or professionals
licensed under chapter 490 or chapter 491, and who is employed by an enrolled Medicaid provider, to the list
of private instructional personnel who must be allowed to provide ABA services in the classroom setting.
The bill does not appear to have a fiscal impact.
The bill provides an effective date of July 1, 2022.
This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives .
STORAGE NAME: h0255f.EEC
DATE: 2/23/2022
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Present Situation
Applied Behavior Analysis
Applied Behavior Analysis (ABA) is an umbrella term referring to the principles and techniques used to
assess, treat, and prevent challenging behaviors while promoting new, desired behaviors. ABA focuses
on improving social skills, communication, reading, and academics as well as adaptive learning skills,
such as fine motor dexterity, hygiene, grooming, domestic capabilities, punctuality, and job
competence. ABA can be effective for children and adults with psychological disorders in a variety of
settings, including schools, workplaces, homes, and clinics. 1
ABA has been recognized as a therapeutic intervention in the treatment of autism spectrum disorder
(ASD).2 ASD is a developmental disability that impacts the social, emotional, and communication skills
of affected individuals. The disorder includes a range of conditions that were previously diagnosed
separately – such as autism, Asperger syndrome, and other non-specific developmental disorders.3
ABA has become widely accepted among health care professionals, is used in many schools and
treatment clinics, and is considered an evidence-based best practice treatment by the U.S. Surgeon
General, American Psychological Association, American Academy of Child and Adolescent Psychiatry,
and American Academy of Pediatrics.4
Providers of ABA Services
Research suggests that ABA interventions should generally be provided under the supervision of a
trained behavioral psychologist or behavior analyst. In general, behavior analysts perform patient
assessments to determine levels of adaptive and maladaptive behaviors, and develop a treatment plan.
Behavior analysts supervise other professionals, such as behavior technicians, who implement the
treatment plan, and monitor progress.5
The Behavior Analyst Certification Board (BACB) was established in 1998 to develop uniform
standards for determining who is qualified to provide professional ABA services. 6 It is an independent,
nonprofit organization whose behavior analyst credentialing programs are accredited by the National
Commission for Certifying Agencies of the Institute for Credentialing Excellence. 7 The BACB certifies
professional practitioners at two levels: the Board Certified Behavior Analyst (BCBA) and the Board
Certified Assistant Behavior Analyst (BCaBA). The BACB also issues a credential for
paraprofessionals, known as the Registered Behavior Technician (RBT). 8 Requirements for the three
credentials are:
1 “Applied Behavior Analysis,” Psychology Today, https://www.psychologytoday.com/us/therapy-types/applied-behavior-analysis
(last visited Feb. 21, 2022).
2 Id.
3 U.S. Centers for Disease Control and Prevention, “What is Autism Spectrum Disorder?,”
https://www.cdc.gov/ncbddd/autism/facts.html (last visited Feb. 21, 2022).
4 See U.S. Centers for Disease Control and Prevention, Treatment and Intervention Services for Autism Spectrum Disorder,
https://www.cdc.gov/ncbddd/autism/treatment.html (last visited Feb. 21, 2022) and Autism Speaks, Applied Behavior Analysis,
https://www.autismspeaks.org/applied-behavior-analysis (last visited Feb. 21, 2022).
5 Association of Professional Behavior Analysts, Identifying Applied Behavior Analysis Interventions (2017), at 17-22, available at
https://cdn.ymaws.com/www.apbahome.net/resource/collection/1FDDBDD2-5CAF-4B2A-A B3F-
DAE5E72111BF/APBAwhitepaperABAinterventions.pdf.
6 Board Analyst Certification Board, Board Certified Behavior Analyst Handbook (Jan. 2022), at 1, https://www.bacb.com/wp-
content/uploads/2022/01/BCBAHandbook_220110.pdf. [ hereinafter BCBA Handbook ].
7 Id.
8 Behavior Analyst Certification Board, Credentials, https://www.bacb.com/ (last visited Feb. 21, 2022).
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Board Certified Behavior Analyst (BCBA) 9
at least a master’s degree in applied behavior analysis or a closely-related field;
completion of 315 hours of graduate-level instruction in specified behavior
analysis topics;
completion of specified hours of supervised experiential training in ABA; and
passage of the BCBA examination.
Board Certified Assistant Behavior Analyst (BCaBA) 10
at least a bachelor’s degree;
completion of 225 classroom hours of instruction in specified behavior analysis
topics;
completion of specified hours of supervised experiential training in ABA; and
passage of the BCaBA examination.
Registered Behavior Technician (RBT)11
at least a high school diploma, or equivalent;
completion of 40 hours of training in specified behavior analysis topics;
completion of the RBT initial competency assessment; and
passage of the RBT examination.
A BCBA with doctoral training in behavior analysis may receive the designation of Board Certified
Behavior Analyst-Doctoral (BCBA-D). The BCBA-D is not a separate certification, and it does not grant
any privileges above or beyond the BCBA certification. 12
The BACB specifies that BCaBAs may not provide behavior-analytic services without the supervision of
a BCBA.13 The RBT is a paraprofessional certified in behavior analysis and may assist in delivering
ABA services under the direction and supervision of a BCBA or a BCaBA. 14 All individuals certified as a
BCBA or BCaBA must accumulate continuing education credits to maintain their credentials and
recertify every two years.15 A certified RBT is not required to accumulate continuing education credits,
however, the RBT must recertify every year.16 A certified RBT may perform specific activities such as
assisting with specified assessments and implementing specified behavior reduction procedures 17
under the supervision of a qualified supervisor,18 and must obtain ongoing supervision for a minimum of
five percent of the hours spent providing ABA services each calendar month. 19
9 BCBA Handbook , supra note 6, at 5-8, 34.
10 Behavior Analyst Certification Board, Board Certified Assistant Behavior Analyst Handbook (Jan. 2022), at 5-8, available at
https://www.bacb.com/wp-content/uploads/2022/01/BCaBAHandbook_220110.pdf. [hereinafter BCaBA Handbook ]
11 Behavior Analyst Certification Board, Registered Behavior Technician Handbook (Jan. 2022), at 3-16, available at
https://www.bacb.com/wp-content/uploads/2022/01/RBTHandbook_220112.pdf. [hereinafter RBT Handbook ]
12 BCBA Handbook , supra note 6, at 1. Certification requirements are provided for those eligible under faculty teaching and research
and postdoctoral experience.
13 BCaBA Handbook , supra note 10, at 1.
14 RBT Handbook , supra note 11, at 1 and 17-19.
15 BCBA Handbook , supra note 6, at 37 and BCaBA Handbook , supra note 10, at 33.
16 RBT Handbook , supra note 11, at 17.
17 Behavior Analyst Certification Board, RBT Task List (2nd Edition) (Dec. 2018), available at https://www.bacb.com/wp-
content/uploads/2020/05/RBT-2nd-Edition-Task-List_181214.pdf.
18 Id. at 18. RBT supervisors must hold a BCBA or BCaBA certification or be licensed in another behavioral health profession that has
applied behavior analysis in its scope of practice and are competent in applied behavior analysis.
19 RBT Handbook , supra note 11, at 17.
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As of February 2022, the BACB reported the following monthly certificant data for Florida: 20
252 BCBA-D certifications
5,002 BCBA certifications
1,917 BCaBA certifications
26,616 RBT certifications
Medicaid Coverage of ABA Services
Florida Medicaid has covered ABA services since 2012.21 In 2017, the Agency for Health Care
Administration (AHCA) adopted a provider reimbursement rule, setting a formal classification for ABA
providers that closely follows the certification hierarchy of the BACB. The rule established “lead
analysts” as those professionals either holding a BCBA certification or professionals licensed by the
state under chapters 490 or 491. The rule also recognizes other personnel who are permitted to provide
ABA services, such as those holding BCaBA credentials and RBT credentials.22
To enroll as a behavior analysis provider in Florida’s Medicaid Program, a provider must submit an
enrollment application along with documentation of proof of certification, which is then evaluated and
verified by AHCA.23 Depending on the type of BCBA certification, a provider may apply as a sole
proprietor or a sole proprietor enrolling as a member of a group. 24 An RBT may only apply as a sole
proprietor enrolling as a member of a Medicaid-enrolled behavior analysis group and AHCA requires a
behavior analysis group to have at least one lead analyst as a group member. 25
Effective May 14, 2018, the AHCA instituted a moratorium on Medicaid enrollment for behavior analysis
practices in Broward and Miami-Dade counties.26 The moratorium resulted from AHCA’s determination
that some providers of ABA services in the affected areas had falsified enrollment credentials and used
fraudulent billing practices. AHCA initially authorized the moratorium for a six-month period, but has
extended the moratorium several times and it continues in effect until at least May 2022. 27
Florida’s Agency for Persons with Disabilities (APD) requires all providers of behavior analysis services
in the Medicaid home and community based waiver program to be licensed to practice under chapters
49028 or 491,29 or be certified by a nonprofit corporation that adheres to the national standards of
boards that determine professional credentials and whose mission is to meet professional credentialing
20 Behavior Analyst Certification Board, Region-Specific Certificant Data -Florida,
https://www.bacb.com/services/o.php?page=101134 (last visited Feb. 21, 2022).
21 See The Florida Bar Foundation, Federal judge orders state of Florida to cover applied behavioral analysis therap y for autism,
(July 1, 2012), https://thefloridabarfoundation.org/federal-judge-orders-state-of-florida-to-cover-applied-behavioral-analysis-therapy-
for-autism/ (last visited Feb. 21, 2022).
22 Rule 59G-4.125, F.A.C.
23 Agency for Health Care Administration, Enrolling as a Florida Medicaid Behavior Analysis Provider (April 25, 2019), at 9,
available at
https://ahca.myflorida.com/medicaid/Policy_and_Quality/Policy/behavioral_health_coverage/bh fu/pdf/Enrolling_as_a_Florida_Medic
aid_Behavior_Analysis_Provider.pdf.; A Medicaid Provider Enrollment Level 2 background screening is also required.
24 Id. at 13.
25 Id. at 12-21.
26 Agency for Health Care Administration, AHCA Announces Moratorium on Enrollment of New Behavioral Analysis providers (May
14, 2018), available at https://ahca.myflorida.com/Executive/Communicat ions/Press_Releases/ pdf/BA_provider_release5142018.pdf.
27 Agency for Health Care Administration, Florida Medicaid Health Care Alert (Nov. 10, 2021), http://www.icontact-
archive.com/archive?c=227375&f=11179&s=13873&m=854301&t=850d8a08f66cb 5c2e1e49656573dbe0caeb447b 39b 9d192096e73
2cbe37425f5 (last visited Feb. 21, 2022). Under the moratorium, individual rendering providers in Miami-Dade and Broward counties
wishing to link to a behavior analysis group that is already enrolled in Florida Medicaid may cont inue to do so. The moratorium
remains in effect for the enrollment of new behavior analysis group providers and individual providers practicing independent of a
group.
28 Chapter 490, “Psychological Services Act” regulates psychological services in the s tate of Florida, including but not
limited to, the process and requirements to become a Florida Department of Health licensed psychologist, defining the scope o f
practice of psychology, and the continuing education requirements of a licensed psychologis t.
29 Chapter 491, regulates mental health counseling, clinical social work, and marriage and family therapy, including but not limited to
the process and requirements to become a Florida Department of Health licensed marriage and family therapist, clinica l social worker,
and mental health counselor.
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needs identified by behavior analysts, state governments, and consumers of behavior analysis
services.30 The APD recognizes the certification for behavior analysts awarded by the BACB. 31
Applied Behavior Analysis Services in Schools
Current law encourages the collaboration of public and private instructional personnel to enhance but
not supplant the school district’s responsibilities under the federal Individuals with Disabilities Education
Act.32 The school must provide therapy services to meet the expectations provided by federal and state
law.33 The coordination of services and plans between public school and private instructional personnel
is encouraged to avoid duplication or conflicting services or plans. 34
Current law defines “private instructional personnel” to include: 35
Individuals certified under s. 393.17, F.S. (Certified Behavior Analysts) or individuals licensed
under chapters 490 or 491 for applied behavior analysis services.
Speech-language pathologists licensed under s. 468.1185, F.S.
Occupational therapists licensed under part III of chapter 468.
Physical therapists licensed under chapter 486.
Psychologists licensed under chapter 490.
Clinical social workers licensed under chapter 491.
Private instructional personnel, including providers of ABA services, who are hired or contracted by a
student’s parents to collaborate with public instructional personnel must be permitted to observe the
student in the educational setting, collaborate with instructional personnel in the educational setting,
and provide services in the educational setting, so long as the following requirements are met:
the student’s teacher and principal consent to the time and place; and
the private instructional personnel must pass a background screening. 36
A school district is prohibited from imposing any additional requirements beyond those specified in law
for private instructional personnel, and the district may not charge any fees. 37
The statute does not expressly address other behavior analysis professionals, such as RBTs, who
implement the treatment plans established by behavior analysts.
Effect of Proposed Changes
The bill adds an RBT who holds a nationally recognized paraprofessional certification in behavior
analysis, who practices under the supervision of either certified behavior analysts or professionals
licensed under chapter 490 or chapter 491, and who is employed by an enrolled Medicaid provider, to
the list of private instructional personnel who must be allowed to provide ABA services in a K-12 public
school.
B. SEC