SUPPORTING MENTAL HEALTH, EMOTIONAL WELL-BEING, AND RECOVERY THROUGH COMPREHENSIVE COMMUNITY-BASED CARE

1. GOVERNING AGENCIES

Agency: Florida Agency for Health Care Administration (AHCA)
Role: Oversees Medicaid provider enrollment, service authorization, and reimbursement for Behavioral Health Services

Agency: Florida Department of Children and Families (DCF) — Office of Substance Abuse and Mental Health (SAMH)
Role: Administers state-funded and Medicaid-funded behavioral health programs, including crisis services and community mental health centers

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight ensuring Behavioral Health Services meet Medicaid standards and quality of care requirements

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2. BEHAVIORAL HEALTH SERVICE OVERVIEW

Behavioral Health Services include a broad range of interventions that support individuals’ mental and emotional well-being, facilitate recovery, and promote full participation in community life.

Approved providers may deliver:

• Individual, group, and family therapy (psychotherapy)
• Psychiatric evaluation, medication management, and monitoring
• Behavioral assessment and intervention planning
• Crisis intervention, stabilization, and mobile crisis response services
• Skills training in coping mechanisms, emotional regulation, and social functioning
• Psychosocial rehabilitation services
• Peer support and recovery coaching (where authorized)

Services must align with a participant’s individualized Treatment Plan and focus on improving behavioral health outcomes and quality of life.

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3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register business with the Florida Division of Corporations (Sunbiz)
• Obtain EIN from the IRS and NPI (Type 2)
• Obtain applicable behavioral health licensure through DCF for Mental Health or Substance Abuse treatment (if providing residential or intensive outpatient services)
• For outpatient therapy services, licensure may not be required if services are delivered by licensed clinicians ( LCSWs, LMHCs, LMFTs, Psychologists, Psychiatrists)
• Enroll as a Medicaid provider through Florida’s Medicaid Management Information System (FLMMIS)
• Maintain general liability, professional liability, and malpractice insurance

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4. AHCA/DCF PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

• Submit Provider Enrollment Application for Behavioral Health Services through AHCA’s Florida Medicaid portal
• Apply for DCF licensure if operating a licensed mental health or substance abuse treatment facility

Application and Documentation Submission:

• Submit Articles of Incorporation, proof of EIN/NPI, applicable clinical licenses, operational policies, treatment plan templates, and insurance certificates
• Provide documentation of staff credentials, emergency protocols, incident management systems, and participant intake procedures

Program Readiness Review:

• AHCA and DCF review provider readiness including clinical quality, documentation compliance, participant protections, and Medicaid billing systems

Approval & Medicaid Enrollment:

• Upon approval, configure billing codes appropriate to each service type (e.g., outpatient therapy, crisis intervention, psychiatric services)

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5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business License (Florida Division of Corporations)
• IRS EIN confirmation
• NPI confirmation
• Clinical licensure verification for staff (LCSW, LMHC, LMFT, psychologist, psychiatrist, etc.)
• DCF behavioral health license (if required based on services offered)
• Proof of general, professional, and malpractice insurance

HCBS-Compliant Policy & Procedure Manual including:

• Participant intake, assessment, diagnosis, and individualized treatment planning
• Behavioral health service delivery protocols and clinical supervision plans
• HIPAA confidentiality, participant rights, and grievance handling procedures
• Emergency preparedness, crisis response, and suicide prevention policies
• Staff credentialing, background checks, and clinical supervision documentation
• Medicaid billing, service authorization tracking, and audit readiness systems

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6. STAFFING REQUIREMENTS

Role: Clinical Director / Behavioral Health Program Manager
Requirements: Master's or Doctorate degree in a behavioral health discipline; active Florida licensure; experience supervising behavioral health programs; background screening clearance

Role: Licensed Clinicians (LCSW, LMHC, LMFT, Psychologists, Psychiatrists)
Requirements: Active Florida license in relevant discipline; Medicaid enrollment credentialing; background screening clearance

Role: Behavioral Health Specialists / Case Managers / Peer Support Specialists
Requirements: Bachelor’s degree preferred (Peer Specialists may require certification); training in behavioral health support; background screening clearance

All staff must complete:

• HIPAA confidentiality, participant rights, and abuse prevention training
• Crisis intervention, suicide prevention, and emergency response training
• Annual competency evaluations and Medicaid compliance training

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7. MEDICAID WAIVER PROGRAMS AND BEHAVIORAL HEALTH INITIATIVES

The following Florida Medicaid programs and waivers authorize Behavioral Health Services:

• Florida Medicaid State Plan Behavioral Health Services
• Long-Term Care (LTC) Waiver for behavioral supports in older adults
• Florida Assertive Community Treatment (FACT) programs
• Children's Mental Health Waivers (for serious emotional disturbance)
• Substance Abuse and Mental Health (SAMH) programs via DCF

Approved providers may deliver:

• Comprehensive outpatient behavioral health treatment
• Crisis response and stabilization
• Intensive case management and psychosocial rehabilitation
• Medication-assisted treatment (MAT) for co-occurring disorders (if licensed)

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8. TIMELINE TO LAUNCH

Phase: Business Formation and Initial Licensing (if applicable)
Timeline: 1–2 months

Phase: Staff Hiring, Credentialing, and Clinical Program Development
Timeline: 2–3 months

Phase: AHCA Medicaid Enrollment and Readiness Review
Timeline: 60–90 days

Phase: Medicaid Billing System Setup and Claims Management
Timeline: 30–45 days

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9. CONTACT INFORMATION

Florida Agency for Health Care Administration (AHCA)
Website: https://ahca.myflorida.com/

Florida Department of Children and Families (DCF) — Substance Abuse and Mental Health (SAMH)
Website: https://www.myflfamilies.com/service-programs/substance-abuse/

Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov/

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10. SCOPE OF WORK

• Business registration and EIN/NPI setup
• DCF licensing (if applicable) and AHCA Medicaid provider enrollment support
• Development of Behavioral Health Services Policy & Procedure Manual
• Staff credentialing templates and participant intake/treatment planning forms
• Medicaid billing setup and claims management
• Website, domain, and email setup
• Clinical documentation, service tracking, and audit readiness templates
• Crisis response, emergency preparedness, and suicide prevention policies
• Quality assurance programs for clinical outcome monitoring
• Community outreach and partnership development strategies

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — FLORIDA BEHAVIORAL HEALTH SERVICES PROVIDER

We support behavioral health agencies, therapy practices, and crisis response organizations in launching Medicaid-compliant Behavioral Health Services under Florida’s Medicaid State Plan and HCBS waiver programs.