Autism Care Demonstration: Initial Assessments
After Health Net Federal Services, LLC (HNFS) verifies the referral for applied behavior analysis (ABA) services, we assign it to an ABA provider. This provider selection process can take up to 15 business days.
HNFS follows an “active provider placement” process when assigning providers to ensure beneficiaries have access to an ABA provider within TRICARE’s access to care standards.
- We contact ABA providers within a 60-mile radius of your home address to ask about availability for the initial assessment and treatment.
- We will assign you with the first provider who meets criteria for accepting a new referral.
- We will consider parent (and referring provider) preferences in the provider selection process, but are ultimately required to select providers who meet access-to-care standards. This includes parent preferences for location of services (center/clinic vs. home), time of day (morning, afternoon, evening, weekends) and specific providers or attributes.
Assessment Approval Letters
Providers and beneficiaries can access approval letters online. Access your secure inbox under the Secure Tools section of the main home page.
- Approval letters contain the assigned ABA provider’s contact information.
- Your ABA provider should contact you within three business days of assignment to schedule the first, initial assessment session.
- If your provider has not connected with you within one week, please contact your ASN (if assigned one) or HNFS' ACD customer service team.
Note: HNFS approval letters sent to the ABA provider contain the beneficiary’s phone number on record in DEERS. If this phone number is not current, you may need to reach out to the ABA provider to schedule the assessment.
Completing the Initial Assessment
Your assigned ABA provider has 45 days to complete the initial assessment. However, they are required to schedule the first visit with your child to begin the assessment within 28 days from when HNFS first verified the referral.
We will contact you or your provider to confirm whether there were any delays in starting the assessment within access-to-care standards.
Note: If you choose to waive access to care standards, you or your provider may be contacted by HNFS so we can document the waiver.
What happens during an assessment?
The initial assessment allows for ABA providers to develop a treatment plan that is unique to your child and includes all treatment recommendations and goals. As such, the assessment must include:
- direct observation of your child
- background information (such as diagnoses, family history, how long your child has been receiving ABA services)
- a functional behavior assessment
- results from a parent/caregiver interview and parent report rating scales
- the development of a treatment plan that meets all TRICARE requirements (this will include a current Individual Education Program [IEP] for children receiving ABA services within a public or private school setting)
- the results of the parent PDDBI
HNFS will contact you or your provider to confirm whether there were any delays in starting the assessment within TRICARE access to care standards.
Second Opinions – Assessments
If you would like a second opinion on the initial assessment results and recommendations, HNFS can authorize a second opinion while you continue with your current ABA provider.
- Second opinion assessments follow the same requirements as an initial assessment. (A new referral is not required for second opinions if it’s within the two-year timeline.)
- The second opinion assessment can be completed by a different ABA provider but only one ABA provider may be authorized to provide treatment at a time.