The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Health Policy
BILL: SB 514
INTRODUCER: Senator Hooper
SUBJECT: Private Instructional Personnel
DATE: March 24, 2023
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Sagues Bouck ED Favorable
2. Brown Brown HP Pre-meeting
3. RC
I. Summary:
SB 514 modifies the requirements of a Registered Behavior Technician (RBT). Under the bill,
the RBT is no longer be required to be employed by an enrolled Medicaid provider to provide
Applied Behavior Analyst services in a K-12 public school, and instead, must be employed by a
certified behavior analyst or a professional licensed under chapter 490, the “Psychological
Services Act” or chapter 491, Clinical, Counseling, and Psychotherapy Services, of the Florida
Statutes.
The bill has no fiscal impact.
The bill provides an effective date of July 1, 2023.
II. Present Situation:
Applied Behavior Analysis Services
Behavior Analysis measures outcomes through data collection and the direct observation of
behavior.
1
Applied Behavior Analysis (ABA) is the use of principles and methods of behavior
analysis to bring about meaningful changes in socially important behaviors.
2
ABA is best known
1
Florida Association for Behavior Analysis, What is Behavior Analysis?, https://www.fabaworld.org/what-is-behavior-
analysis (last visited Mar 22, 2023).
2
Association of Professional Behavior Analysts, Identifying Applied Behavior Analysis Interventions white paper, (2017),
available at https://cdn.ymaws.com/www.apbahome.net/resource/collection/1FDDBDD2-5CAF-4B2A-AB3F-
DAE5E72111BF/APBAwhitepaperABAinterventions.pdf, at 16 (last visited Mar 22, 2023).
REVISED: BILL: SB 514 Page 2
for its success in treating individuals with autism spectrum disorder (ASD)
3
and other
developmental disabilities.
4
Florida law defines ABA as “the design, implementation, and evaluation of environmental
modifications, using behavioral stimuli and consequences, to produce socially significant
improvement in human behavior, including but not limited to, the use of direct observation,
measurement, and functional analysis of the relations between environment and behavior.”
5
Autism Spectrum Disorder Prevalence
In 2019 and 2020, 410 out of the 12,554 children aged 3 to 17 years included in the National
Health Interview Survey
6
were diagnosed with ASD. The prevalence of ASD increased from
2.79 percent in 2019 to 3.49 percent in 2020.
7
By 2030, the need for substance abuse, behavioral disorder, and mental health counselors is
expected to grow by 19 percent in Florida.
8
Currently, Florida employs 17,710 individuals in
such positions and has 17,598 job openings.
9
Specifically, for certified ABA providers, Florida
supplies approximately four ABA providers per 100 children with ASD, when approximately six
to eight are needed, depending on the level of treatment required.
10
ABA Service Providers and Certification
Florida’s Agency for Persons with Disabilities (APD) is required to recognize a non-profit
corporation for the certification of behavior analysts. The non-profit corporation is required to:
11
Adhere to the national standards of boards that determine professional credentials; and
Have a mission to meet professional credentialing needs identified by behavior analysts, state
governments, and consumers of behavior analysis services.
3
ASD means any of the following disorders as defined in the most recent edition of the Diagnostic and Statistical Manual of
Mental Disorders of the American Psychiatric Association: Autistic disorder, Asperger’s syndrome, and Pervasive
developmental disorder not otherwise specified. Section 627.6686(2), F.S.
4
Behavior Analyst Certification Board, Autism & Intellectual/Development Disabilities, https://www.bacb.com/wp-
content/uploads/2020/05/Behavioral-Treatment-of-Autism-and-Other-Developmental-Disabilities-Fact-Sheet_210108.pdf
(last visited Mar. 22, 2023).
5
Sections 627.6686(2)(a), F.S. and 641.31098(2)(a), F.S.
6
Centers for Disease Control and Prevention, National Health Interview Survey, https://www.cdc.gov/nchs/nhis/data-
questionnaires-documentation.htm (last visited Mar. 22, 2023).
7
Neurology Advisor, Prevalence of Autism Spectrum Disorder Up Among Youths,
https://www.neurologyadvisor.com/topics/autism-spectrum-disorder/prevalence-autism-spectrum-disorder-youths-
us/#:~:text=The%20estimated%20prevalence%20of%20autism%20spectrum%20disorder%20%28ASD%29,Pediatrics.%20T
he%20prevalence%20of%20ASD%20is%20globally%20increasing. (last visited Mar., 22, 2023).
8
Department of Economic Opportunity, Florida Insight Occupational Data Search, https://floridajobs.org/economic-
data/employment-projections/occupational-data-search (last visited Mar. 22, 2023).
9
Id.
10
Yidan Xue Zhang and Janet R. Cummings, Supply of Certified Applied Behavior Analysts in the United States;
Implications for Service Delivery for Children with Autism, Psychiatric Services, Volume 71, Issue 4 April 01, 2020,
available at https://ps.psychiatryonline.org/doi/epdf/10.1176/appi.ps.201900058 at 387. (last visited Mar. 22, 2023).
11
Section 393.17(2), F.S. BILL: SB 514 Page 3
Further, the certification procedure recognized by the APD must undergo regular psychometric
review and validation, pursuant to a job analysis survey of the profession and standards
established by content experts in the field.
12
The APD recognizes the certification awarded by
the Behavior Analyst Certification Board, Inc.,
13
which certifies the three provider types: Board
Certified Behavior Analysts, Board Certified Assistant Behavior Analysts, and Registered
Behavior Technicians.
The Behavior Analyst Certification Board’s requirements for certification are outlined below:
Board Certified Behavior Analyst (BCBAs):
14
o At least a master’s degree in applied behavior analysis or a closely-related field;
o Completion of 270 hours of graduate-level instruction in specified behavior analysis
topics;
o Completion of specified hours of supervised experiential training in ABA; and,
o Passage of the BCBA examination.
Board Certified Assistant Behavior Analyst (BCaBAs):
15
o At least a bachelor’s degree;
o Completion of 180 classroom hours of instruction in specified behavior analysis topics;
o Completion of specified hours of supervised experiential training in ABA; and,
o Passage of the BCaBA examination.
Registered Behavior Technician (RBTs):
16
o At least a high school diploma;
o Be at least 18 years old;
o Completion of 40 hours of training in specified behavior analysis topics;
o Completion of the RBT competency assessment; and
o Passage of the RBT examination.
The RBT is a paraprofessional certified in behavior analysis. RBTs may assist in delivering ABA
services under the direction and supervision of a BCBA or a BCaBA.
17
Medicaid Coverage of ABA Services
Florida Medicaid has covered ABA services since 2012.
18
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 BCBA. The rule
established “lead analysts” as those professionals either holding a BCBA certification or
professionals licensed by the state under chapters 490 or 491, F.S. The rule also recognizes other
12
Id.
13
Rule 65G-4.0011, F.A.C.
14
Behavior Analyst Certification Board, Board Certified Behavior Analyst Handbook (2022), available at
https://www.bacb.com/wp-content/uploads/2021/09/BCBAHandbook_210915-2.pdf . (last visited Mar. 22, 2023).
15
Behavior Analyst Certification Board, Board Certified Assistant Behavior Analyst Handbook (2022), available at
https://www.bacb.com/wp-content/uploads/2021/09/BCaBAHandbook_210915-2.pdf. (last visited Mar. 22, 2023).
16
Behavior Analyst Certification Board, Registered Behavior Technician Handbook (2022), available at
https://www.bacb.com/wp-content/uploads/2021/09/RBTHandbook_210915-3.pdf . (last visited Mar. 22, 2023).
17
Id.
18
See The Florida Bar Foundation, Federal judge orders state of Florida to cover applied behavioral analysis therapy for
autism, (July 1, 2012), https://thefloridabarfoundation.org/federal-judge-orders-state-of-florida-to-cover-applied-behavioral-
analysis-therapy-for-autism/ (last visited Mar. 22, 2023). BILL: SB 514 Page 4
personnel who are permitted to provide ABA services, such as those holding BCaBA credentials
and RBT credentials.
19
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 the AHCA.
20
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.
21
An RBT
may only apply as a sole proprietor enrolling as a member of a Medicaid-enrolled behavior
analysis group, and the AHCA requires a behavior analysis group to have at least one lead
analyst as a group member.
22
ABA Services in Florida’s Public Schools
In an educational setting, behavior analysis provides a scientific approach to designing,
implementing, and evaluating instruction based on analyzing interactions between what the
teacher does and student learning.
23
Section 1003.572, F.S., was created in 2013
24
to encourage cooperation and coordination of
services for students with disabilities through public and private instructional collaboration.
Private instructional personnel who are hired by or contracted by parents to collaborate with
public instructional personnel must be permitted to observe the student in the educational setting,
act as a team with instructional personnel in the educational setting, and provide services in the
educational setting.
25
Private instructional personnel must undergo a background screening, and
the student’s public instructional personnel and principal must consent to the time and place.
26
Section 1003.572, F.S., defines term “private instructional personnel” to include:
27
Individuals certified under s. 393.17, F.S., (a Board Certified Behavior Analyst) or
individuals licensed under ch. 490, F.S.,
28
or ch. 491, F.S.,
29
for applied behavior analysis
services.
19
Rule 59G-4.125, F.A.C.
20
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/bhfu/pdf/Enrolling_as_a_Florid
a_Medicaid_Behavior_Analysis_Provider.pdf.; A Medicaid Provider Enrollment Level 2 background screening is also
required.(last visited Mar. 22, 2023).
21
Id. at 13.
22
Id. at 12-21.
23
Behavior Analyst Certification Board, Behavior Analysis in Education, https://www.bacb.com/wp-
content/uploads/2020/05/Behavior-Analysis-in-Education-Fact-Sheet_210108.pdf (last visited Mar. 22, 2023).
24
Section 5, ch. 2013-236, Laws of Fla.
25
Section 1003.572(3), F.S.
26
Id.
27
Section 1003.572(1), F.S.
28
Chapter 490, “Psychological Services Act” regulates psychological services in the state of Florida, including but not
limited to, the process and requirements to become a Florida Department of Health licensed psychologist, defining the scope
of practice of psychology, and the continuing education requirements of a licensed psychologist.
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,
clinical social worker, and mental health counselor. BILL: SB 514 Page 5
Speech-language pathologists licensed under s. 468.1185, F.S.
Occupational therapists licensed under part III of ch. 468, F.S.
Physical therapists licensed under ch. 486, F.S.
Psychologists licensed under ch. 490, F.S.
Clinical social workers licensed under ch. 491, F.S.
III. Effect of Proposed Changes:
SB 514 modifies the requirements of a Registered Behavior Technician (RBT). Under the bill,
the RBT would no longer be required to be employed by an enrolled Medicaid provider to
provide Applied Behavior Analyst (ABA) services in a K-12 public school, and instead, must be
employed by a certified behavior analyst or professional licensed under chapter 490 or chapter
491, F.S.
Given the increasing prevalence of Autism Spectrum Disorder (ASD) among school-aged
children, the bill may help to increase the supply of ABA providers to meet the needs of this
population.
The bill provides an effective date of July 1, 2023.
IV. Constitutional Issues:
A. Municipality/County Mandates Restrictions:
None.
B. Public Records/Open Meetings Issues:
None.
C. Trust Funds Restrictions:
None.
D. State Tax or Fee Increases:
None.
E. Other Constitutional Issues:
None.
V. Fiscal Impact Statement:
A. Tax/Fee Issues:
None. BILL: SB 514 Page 6
B. Private Sector Impact:
None.
C. Government Sector Impact:
None.
VI. Technical Deficiencies:
None.
VII. Related Issues:
None.
VIII. Statutes Affected:
This bill substantially amends section 1003.572 of the Florida Statutes.
IX. Additional Information:
A. Committee Substitute – Statement of Changes:
(Summarizing differences between the Committee Substitute and the prior version of the bill.)
None.
B. Amendments:
None.
This Senate Bill Analysis does not reflect the intent or official position of the bill’s introducer or the Florida Senate.