Autism Services Navigators
Autism Services Navigators (ASNs) oversee and/or collaborate with families, helping them navigate:
- Autism spectrum disorder (ASD) evaluation
- Coordination and facilitation of care
- Assessments throughout treatment under the Autism Care Demonstration (ACD) care
- Promotion of individualized options, services and local level resources
The ASN’s role is that of a health care advocate; an ASN does not perform clinical necessity reviews of treatment plans or make TRICARE coverage determinations.
Eligible beneficiaries who decline the services of an ASN lose ACD program eligibility.
What licensing or certification requirements must an ASN meet?
An ASN must have one of these licenses or certifications (Note: License or certification must be current):
- Registered nurse (Note: Must have case management experience)
- Clinical psychologist
- Licensed clinical social worker (LCSW)
- Other licensed mental health professional (Note: Must be certified in case management)
In which clinical areas must an ASN have experience?
- Mental/behavioral health
Are there additional areas in which an ASN must have experience?
- Health care environment
- Case management
Who is eligible to receive the services of an ASN?
As of Oct. 1, 2021, Health Net Federal Services, LLC (HNFS) assigns an ASN to a beneficiary who is new to the ACD once that beneficiary has met enrollment criteria. The assigned ASN will then serve as the primary health care advocate for the beneficiary and the beneficiary’s family, helping navigate ACD benefits and resources.
What is the process for being assigned an ASN?
To reduce any potential gaps in care, HNFS introduces the ASN concept during the pre-enrollment phase. This ensures beneficiaries enrolled in the ACD understand the requirements of the program, the role of an ASN and steps for getting care once enrolled.
Eligible beneficiaries will be assigned an ASN within three business days of enrollment. The ASN will reach out to the family before the start of ABA services to:
- Educate on an ASN’s role.
- Explain what the beneficiary/family can expect with care coordination.
- Begin the process for developing the beneficiary's comprehensive care plan (CCP).
How does the ASN coordinate care?
An ASN functions as a single point of contact for a beneficiary/beneficiary’s family, other health care providers and military hospitals and clinics (if applicable).
Coordination efforts cover:
- ABA and medical services (for example, physical therapy, occupational therapy, etc.)
- Extended Health Care Options (ECHO) services
- Exceptional Family Member Program (EFMP) services
- CCP-related services
- Treatment goals and CCP goals that are complementary and meet a beneficiary’s needs
- Medical team conference meetings and documentation
How does the ASN promote continuity of care?
An ASN works to ensure a beneficiary has treatment continuity of care for events such as moving or provider unavailability. Once a beneficiary’s family or a health care provider has notified HNFS of a permanent change of station or transition:
- For at least one month up to and one month after moving to another TRICARE region (East, West, overseas), a beneficiary shall be covered by two ASNs (one for the previous TRICARE region and one for the new TRICARE region). These ASNs will communicate with each other to ensure smooth transfer of services.
- Within 10 calendar days of having been notified of a beneficiary relocating, the ASN in the previous TRICARE region will send all of the beneficiary’s ACD-related documentation to the ASN in the new TRICARE region.
- The ASN in the new TRICARE region will work with the beneficiary’s family to make sure no required information is missing and that all ACD program requirements continue to be met.
Refer beneficiaries to our Autism Care Demonstration: Moving page for more information.
Comprehensive Care Plans
What is a CCP?
For beneficiaries assigned an ASN, the ASN will work with the family to develop a written CCP that is specific to the needs of the beneficiary and their family. CCPs complement, but do not replace, treatment plans developed by ABA providers. Per TRICARE requirements, HNFS must receive a completed initial CCP within the first 90 days of an ASN having been assigned to a family. (Note: This 90-day period may expire during an approved assessment or treatment period.)
As providers, you offer invaluable assistance helping parents/caregivers understand the CCP requirement. When a CCP isn’t submitted on time, HNFS must cancel the corresponding active ABA authorization. This creates the potential for delays or gaps in care, which may negatively impact the beneficiary, their family and any ABA providers working with the beneficiary. We offer the following questions and answers for you to share with your patients to help them understand and meet CCP requirements.
What are the requirements of a CCP?
Written CCPs must be in place within 90 calendar days of an ASN being assigned to the family and must be updated every six months (including applicable updated outcome measures and evaluations such as the Pervasive Developmental Disorder Inventory [PDDBI] Parent and Teacher Forms; Parenting Stress Index, Fourth Edition Short FOrm [PSI-4-SF]; and Stress Index for Parents of Adolescents [SIPA]).
- Care and services related to diagnosing ASD
- Timelines for transition (for example, permanent change of station)
- Discharge planning
- Transition planning
- Outcome measure results
The ASN will let a beneficiary’s parents/caregivers, primary care manager and/or referring provider know once the beneficiary’s CCP has been completed and share the CCP with these providers prior to the beneficiary starting ABA services under the ACD.
Important: ABA services may be suspended if the beneficiary’s CCP is not completed within applicable timelines.
Who must complete a CCP?
Beneficiaries who enrolled in the ACD after Oct. 1, 2021, and who are eligible to receive assigned ASNs, must complete CCPs with their assigned ASNs.
Are a CCP and a treatment plan the same thing?
CCPs are separate from and do not take the place of ABA provider-developed treatment plans. CCPs and treatment plans are used together to ensure beneficiaries receive comprehensive services and support.
When is a CCP due?
Once HNFS assigns an ASN to a beneficiary, the beneficiary’s initial CCP must be completed within 90 days. After the initial CCP completion date, updates and reviews will be once every six months.
What happens if an initial CCP (or an update) is not completed on time?
For beneficiaries who have active ABA authorizations, HNFS must cancel the authorization. We will reissue a new authorization once we have received and processed the completed CCP from the ASN. Authorizations will not be retroactive and a gap between authorizations will occur. All services under the ACD are required to be pre-authorized and services should not be rendered without an approved authorization for the dates of service. If HNFS has not received a beneficiary’s CCP by the due date and a current, active authorization is not in place, the beneficiary cannot get ABA services until HNFS has received the completed CCP.
For beneficiaries with active authorizations, the beneficiary may continue to receive treatment until the end of the authorization period. The CCP will need to be updated once every six months from the initial CCP's completion date before the next treatment authorization will be approved.
How can a provider help with a CCP?
To help avoid delays or gaps in care, you can help encourage timely CCP submissions by:
- Checking in with the family during the initial assessment and/or treatment period about CCP status.
- Reminding the family about the initial CCP 90-day completion requirement and any six-month update requirements.
- Suggesting beneficiaries connect with their assigned ASNs for any questions they have concerning their CCPs.
Note: Providers who are part of a beneficiary’s care team will be given a copy of the initial CCP to review and invited to participate in a medical team conference to support care coordination.
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