Autism Care Demonstration Outcome Measures
All beneficiaries participating in the Autism Care Demonstration must receive an outcome evaluation at baseline (within one year of initial diagnosis) and every two years thereafter while receiving services.
As of Jan. 29, 2018, the Vineland, 3rd Edition (Vineland-3) and Social Responsiveness Scale, Second Edition (SRS-2) are the required outcome measures for this evaluation. The beneficiary's physician primary care manager (P-PCM) or a TRICARE-authorized specialized autism spectrum disorder (ASD) diagnosing provider can submit the referral for the outcome measures.
Once referred, the measures can be performed by a TRICARE-authorized ASD-diagnosing provider in one of the following specialties:
- developmental behavioral pediatrics
- neurodevelopmental pediatrics
- child neurology
- adult or child psychiatry
- doctoral-level licensed clinical psychologist
- doctoral-level nurse practitioners
If the specialized ASD diagnosing provider is not able to complete one or both of the outcome measures, he or she can submit a referral to Health Net Federal Services, LLC (HNFS) requesting a TRICARE-authorized ABA provider (BCBA or BCBA-D) complete them. An approval from HNFS is required for outcome measures performed by an ABA provider. HNFS authorizes one unit per measure for CPT® T1023.
Note: A P-PCM cannot refer a beneficiary to an ABA provider to perform the outcome measures. The referral must be submitted by the specialized ASD diagnosing provider. If the beneficiary’s current ABA provider does not conduct the outcome measures, HNFS will identify an alternate provider to complete the testing via telehealth.
TRICARE requires outcome measures be performed at the following intervals:
- Baseline: Within one year of the initial diagnosis the beneficiary must receive the Vineland-3 and SRS-2.
- Every two years: Every two years the beneficiary must receive the Vineland-3 and SRS-2.
How to Submit
- ABA providers and civilian specialized ASD diagnosing providers can submit a copy of the testing on behalf of the beneficiary online. (Use the P154 – Outcome Measures request type.)
- Beneficiaries and military hospitals or clinics can submit the request via fax to 1-866-678-0615.