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Autism Care Demonstration: New Parent Resources, Autism Services Navigators and Other Oct. 1 Updates

Thursday, September 23, 2021

As the phased implementation for TRICARE’s Autism Care Demonstration (ACD) heads into October, exciting new support resources become available to ACD beneficiaries and their families. Health Net Federal Services, LLC (HNFS) offers the following information to describe these changes. 

New resources available to support beneficiaries and their families

By Oct. 1, ACD beneficiaries and their families will have new resources available to them.

  • 24/7 access to familysupport.findhelp.com, HNFS’ online directory of local resources developed to connect families to free or low-cost resources and social support services available outside of their TRICARE benefit. 

  • An ACD parent toolkit designed to serve as a parent’s guide to the benefits, services and requirements of the ACD. Families can access the TRICARE West Region parent toolkit, along with ACD program information, the online resource directory, and much more at our newly-updated ACD section at www.tricare-west.com/go/ACD. 

New to the ACD as of Oct. 1

  • Autism Services Navigators (ASNs). Effective Oct. 1, 2021, HNFS will assign ASNs to beneficiaries new to the ACD once enrollment criteria have been met. ASNs will serve as a primary health care advocate, helping beneficiaries and their families navigate the benefits and resources available through the ACD. ASNs are licensed professionals with clinical experience in pediatrics, behavioral health, mental health, and/or autism spectrum disorder (ASD). The ASN will help identify individual support needs and assist in coordinating care, including care transition support as needed. 

  • Comprehensive care plans (CCPs). 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. CCPs must be in place within 90 calendar days of the ASN being assigned to the family and are updated every six months. ABA services may be suspended if the CCP is not completed within applicable timelines. 

Definitive diagnosis requirements for enrollment

  • Diagnosis and eligibility criteria, diagnosing and referring provider types. Last month, we distributed education on new diagnosis and eligibility criteria that is required as of Oct. 1 before we can enroll a beneficiary to the ACD. This included details on the DSM-5 Diagnostic Checklist and required assessment tools. We also informed you about Oct. 1 changes to which provider types can diagnose ASD and submit ABA referrals. Please visit the “News Articles” section of www.tricare-west.com/go/ACD-provider if you missed this important information.

  • Diagnostic evaluation for certain beneficiaries. Effective Oct. 1, if a beneficiary’s ASD diagnosis occurred at age eight or older, or it has been more than two years since the initial diagnosis to the referral for ABA services, TRICARE requires contractors receive an updated diagnostic evaluation prior to authorizing services. This evaluation must be from an approved ASD-diagnosing provider type and indicate a definitive ASD diagnosis.