Since SMMC 3.0, Florida’s MMA plans own authorization, network, and payment for Behavior Analysis across all nine regions — and commercial payers carry the same ABA exposure with no behavior-analytic bench of their own. ICMS brings that bench: UM LITE independent BCBA clinical review, delegated credentialing, case management, and payment integrity, under one agreement. Your plan retains complete payment and benefit/coverage determination authority. Full delegated utilization management follows in early 2027.
Providers: free to join, non-exclusive, no fee ever. ¿Prefieres hablar en español? Nuestro equipo es bilingüe — escríbenos.
With SMMC 3.0 (February 2025), Florida’s MMA plans took over authorization, network, and payment for Behavior Analysis for their enrollees, across nine regions; a residual fee-for-service lane remains for recipients not enrolled in a plan. ICMS supplies the behavior-analytic capability that came with the benefit. Under UM LITE, our BCBAs perform independent clinical review against Rule 59G-4.125, F.A.C. and national evidence-based practice standards, and return documented, auditable recommendations — your plan retains complete payment and benefit/coverage determination authority. Delegated credentialing, case management, and payment integrity are available under the same agreement, with full delegated utilization management scheduled for early 2027. The same capabilities are available to commercial and non-MMA payers covering ABA in Florida, contracted to their own regulatory framework rather than the Medicaid managed care rules.
A geocoded, continuously monitored statewide panel of Medicaid-enrolled ABA and ancillary providers — speech and occupational therapists, psychologists, child psychiatrists, developmental pediatricians, and neurologists — mapped to all nine SMMC regions for auditable network adequacy, with a single point of claims submission to the payer.
Independent BCBA review of authorization requests against Rule 59G-4.125, F.A.C. and national evidence-based practice standards: CDE verification, Vineland-3 and BASC-3, six-month authorization periods. We return documented, auditable recommendations and appropriate claims. The health plan retains complete payment and benefit/coverage determination authority.
End-to-end delegated UM — pre-service and concurrent authorization, retrospective review, and denial and appeal/fair hearing administration against peer-reviewed medical necessity criteria. Requests not meeting criteria escalate to a physician advisor before any adverse determination. Performed on the health plan's IT platform, including Availity Essentials. Scheduled for early 2027.
Primary source verification and cyclical recredentialing designed to NCQA credentialing standards, across the ABA and ancillary provider base that came with the benefit.
Clinically governed enrollment on key indicators — significant physical or behavioral comorbidities — with outreach, engagement, care plan development, and physician oversight. Continuity of care, IEP/504 school coordination, and documented EPSDT compliance for members under 21. Performed on the health plan's IT platform, including Availity Essentials.
Pre-pay review of high-risk claims, post-pay audit, and billing-pattern analytics including impossible-hours and overlapping-service detection. Flat fees plus quality bonuses — never commissions on denials.
Policies, files, and UM committee designed to NCQA utilization management and credentialing standards. ICMS is not currently NCQA or URAC accredited, and does not represent otherwise.
Subcontract terms specifying delegated activities, reporting, remedies, and the government audit and 10-year record-retention rights required by §438.230. Reviews are performed by individuals with appropriate expertise under §438.210(b)(3).
BAAs, security risk assessment, encryption, and incident response for pediatric PHI at scale — including the 10-day third-party agent breach notice we owe our clients under Fla. Stat. §501.171(6).
Reviewer compensation is never tied to denials or review outcomes, consistent with 42 CFR §438.210(e). Our BCBAs remain bound by the BACB Ethics Code for Behavior Analysts. AI is human-in-the-loop with full audit trails — no algorithm generates a clinical recommendation.
UM LITE is our independent clinical review model: review effort concentrates where risk actually is and gets out of the way everywhere else. Administrative burden drops for the plan and for the provider. The clinical standard behind every review does not move — and the coverage decision stays with your plan.
Providers with a verified documentation and outcomes record move to reduced-touch review, so scrutiny concentrates on the files that warrant it.
AI-assisted intake screens every package against Rule 59G-4.125, F.A.C. before a human minute is spent, so gaps surface immediately rather than after a request has already been worked.
Concurrent review aligns to the six-month authorization period set by the Florida Medicaid Behavior Analysis Services Coverage Policy rather than generating ad-hoc re-requests in between.
Billing-pattern anomalies, impossible-hours signals, and overlapping-service conflicts route to payment-integrity analysts — the effort saved on clean files funds scrutiny on the ones that need it.
Where a request is incomplete or clinically unclear, the conversation happens analyst-to-analyst before we finalize a recommendation. Fewer avoidable adverse recommendations means fewer appeals downstream for your plan.
What a complete CDE package, behavior plan, and reassessment look like is published, so submissions arrive complete the first time.
Review targets are set to whichever is tighter: the ceiling under 42 CFR §438.210(d) — 7 calendar days standard and 72 hours expedited for rating periods beginning on or after January 1, 2026 — or the decision timeframe your own product line commits to. Where your contract runs tighter, we run to your number. Florida’s Children’s Medical Services Plan, for example, decides Title XIX and Title XXI requests in 3 calendar days and expedited requests in 2. Recommendations are returned at least 24 hours ahead of your deadline on standard requests, and at least 12 hours ahead on expedited requests.
Under UM LITE, ICMS does not issue benefit determinations. We perform an independent clinical review and return a documented, auditable recommendation. Your plan makes and issues every coverage decision, including any adverse benefit determination and the accompanying notice, under 42 CFR §438.210 and §438.400(b). Full delegated utilization management — pre-service, concurrent and retrospective review with physician advisor escalation and appeal administration — is a separate offering scheduled for early 2027.
Every clinical review is performed by a certified behavior analyst — no exceptions, no auto-decisions. The program is designed and led by BCBA-D and BCBA clinicians with inter-rater reliability oversight. No algorithm ever generates, recommends, or triggers an adverse recommendation.
“Lite” describes administrative burden, not clinical standard. Medical-necessity criteria, documentation requirements, and reviewer credentials are identical on a reduced-touch file and on a fully reviewed one.
ICMS builds modern AI models into its operations the way a good clinician uses an instrument: to see more, sooner. But instruments don't make clinical judgments — certified professionals do. That line is bright, contractual, and non-negotiable.
Building the provider network runs in parallel to our plan work, and it is an asset your delegation inherits: a geocoded, continuously monitored panel of Medicaid-enrolled Florida ABA groups, independent BCBAs, and ancillary providers — speech and occupational therapists, psychologists, child psychiatrists, developmental pediatricians, and neurologists — mapped to all nine SMMC regions for auditable network adequacy, primary-source verified before you need them, and already operating against published documentation standards. The network offers your plan a single point of claims submission. Providers join free and non-exclusively — which is why the panel keeps growing without your plan funding it.
ICMS never charges providers for anything, and never sells services to the providers whose authorization requests we review. Network participation is standards-based and free — permanently. Reviewer compensation is never tied to denials or review outcomes, consistent with 42 CFR §438.210(e).
Our BCBA reviewers remain bound by the BACB Ethics Code for Behavior Analysts, including 1.04 (practicing within a defined role), 1.11 (multiple relationships), and 3.07 (third-party contracts). The Code does not address payer-side utilization review directly, so we hold reviewers to a written reviewer-conduct policy that does — and we will share it with any plan that asks.
ICMS is provider-sponsored. One of its sponsoring organizations, Hopeful Therapies, is an ABA provider enrolled in Florida Medicaid and participates in the ICMS network on the same terms as any other provider.
That affiliation is managed under written conflict-of-interest controls: affiliated providers receive no preference in credentialing, clinical review, or network placement; no ICMS reviewer reviews a request from an entity in which they hold a financial interest; and files involving an affiliated provider are routed to an unaffiliated reviewer and identified in the reporting the health plan receives. The arrangement is documented in every delegation agreement and is available for pre-delegation review.
ICMS performs UM LITE clinical review and credentialing for health plans covering pediatric ABA in Florida. When your authorization request is reviewed, the person reviewing it holds the same certification you do — and the coverage decision itself stays with the health plan.
Reviews and clarifying conversations happen analyst-to-analyst. No more defending clinical decisions to someone reading a checklist who has never written a behavior plan.
One primary-source-verified credentialing file — BACB, Florida Medicaid, exclusions — maintained by us and honored across every plan delegation ICMS wins. Each new payer contract we sign increases the value of already being in.
No participation fee. No exclusivity. Terminable without cause on notice. The agreement asks for standards and data hygiene — it takes nothing from you.
Published documentation standards mapped to Florida’s BA Coverage Policy: what a complete CDE package, behavior plan, and reassessment look like — before you submit, not after a denial. Reviews apply Rule 59G-4.125, F.A.C. and national evidence-based practice standards.
Transparent review status through the provider portal. Review targets are set to whichever is tighter: the standard under 42 CFR §438.210(d) — 7 calendar days standard and 72 hours expedited for rating periods beginning on or after January 1, 2026 — or the decision timeframe the health plan itself commits to. Where a plan runs tighter, we run to the plan’s number. Florida’s Children’s Medical Services Plan, for example, decides Title XIX and Title XXI requests in 3 calendar days and expedited requests in 2, and our recommendation is returned at least 24 hours ahead of that deadline on standard requests, and at least 12 hours ahead on expedited.
In a market where AHCA denied 893 behavior analysis enrollment and reenrollment applications on program-integrity grounds in FY 2024-2025 — more than any other provider type — membership in a standards-based network tells plans and families you operate differently.
Email us your organization info (or your individual BCBA certification) and service counties.contact@icmscare.com · 656-254-1133
We run primary source verification — BACB, Florida Medicaid enrollment, OIG/SAM exclusions — at no cost to you.
One participation agreement covering documentation standards, data sharing, and peer-review procedures. Groups sign once with a staff roster.
Your verified file is honored across ICMS plan delegations as they launch — you're in the panel plans see from day one.
Now enrolling: ABA groups and independent BCBAs serving Medicaid-enrolled children across Florida, with priority onboarding for Miami-Dade, Broward, Tampa Bay, and Orlando service areas. Spanish-speaking and school-based providers: your capabilities are directory-listed — plans ask for them.
No. Never. Our independence commitment is contractual: ICMS is paid by health plans for delegated administration, and we do not accept money from providers in any form. If anyone ever asks you to pay to be in this network, it isn't us.
No — and be wary of any network that implies otherwise. Participation gives you a verified credentialing file, published standards, and analyst-level review. Authorization decisions are always based on medical necessity under the applicable coverage policy.
Completely non-exclusive, in both directions. You keep every plan contract and network relationship you have. You can leave ICMS's network without cause with notice.
Credentialing consent, a current staff roster (BCBA/BCaBA/RBT) you keep updated, adherence to the documentation standards manual, and timely notice of certification or enrollment changes. That's the substance of the agreement.
A BCBA — always. BCaBA reviewers work under BCBA supervision consistent with BACB requirements. Under UM LITE, ICMS performs the clinical review and returns a documented recommendation; the health plan makes and issues the coverage decision, including any adverse benefit determination and its notice, under 42 CFR §438.210 and §438.400(b).
No. We use AI tools to check submissions for completeness and to organize documentation — which means fewer bounce-backs for you — but every clinical review is performed by a BCBA and the program is led by BCBA-D/BCBA clinicians. No AI system at ICMS generates or recommends an adverse review outcome, and ICMS does not issue denials at all under UM LITE — your plan does.
Yes. ICMS is provider-sponsored; one of its sponsoring organizations, Hopeful Therapies, is an ABA provider enrolled in Florida Medicaid. Affiliated providers receive no preference in credentialing, clinical review, or network placement; no ICMS reviewer reviews a request from an entity in which they hold a financial interest; and any file involving an affiliated provider is routed to an unaffiliated reviewer and flagged in the reporting the health plan receives. If you would rather read the written policy before joining, ask and we will send it.
Five minutes, no fee. We use this information to run primary source verification (BACB, NPI, CAQH, Florida Medicaid) — submitting is your consent for us to verify. Fields marked * are required.