Autism Care Demonstration: Subsequent Authorizations
If your applied behavior analysis (ABA) provider recommends ABA services should continue beyond the initial six-month treatment period, he or she will submit a new request to Health Net Federal Services, LLC (HNFS). We must receive this request 30 to 60 days before your existing authorization expires.
Similar to the initial request for treatment authorization, we will review the provider’s request for reauthorization to verify the following:
- Autism Care Demonstration (ACD) eligibility
- Updated treatment plan that documents beneficiary progress and corresponding treatment recommendations
- Parent and teacher Pervasive Developmental Disorder Behavior Inventory scores
- Outcome measure scores
- An Individualized Education Program, when applicable
- Current two-year referral
- Current comprehensive care plan (when an autism services navigator has been assigned)
It also includes a new clinical necessity review of the treatment plan, as well as a review of:
- Progress toward improved symptom presentation,
- Parent engagement and
- Outcome measure changes.
Referral Cycle Check
When we receive requests to reauthorize services, HNFS must verify the two-year ABA referral is still valid. As the ABA referral is valid for two years, we do not need a new referral at each six-month authorization renewal period.
If the two-year referral will expire before the start of the next six-month authorization period, please work with your primary care manager or specialist to get a new two-year referral. We will be unable to authorize ongoing services if the two-year referral on file has expired.