Autism Care Demonstration: Provider Steerage Model
Thursday, January 6, 2022
On Jan. 1, 2022, Health Net Federal Services, LLC (HNFS) implemented a steerage model for network ABA providers participating in the Autism Care Demonstration (ACD) per the guidelines outlined in the TRICARE Operations Manual, Chapter 18, Section 4.
What is a steerage model? A steerage model determines a provider’s ranking in the network based on their performance against a set of predetermined metrics. The ACD steerage model ranks ABA providers according to access to care standards and other quality measures that positively impact TRICARE beneficiaries.
What are the ACD steerage model measures?
- Measure one is tied to the provider’s performance compared with TRICARE’s access-to-care standards for initial assessments (achieved when service delivery occurs within 28 days of the verified referral).
- Measure two is tied to the provider’s performance compared with TRICARE’s access-to-care standards for treatment (achieved when the last date of service of the assessment (CPT® 97151) in the 14-day window to the first day of adaptive behavior treatment (CPT 97153, 97155, 97156, 97157, 97158) is 28 days or less).
- Measure three is tied to the average number of days from the treatment authorization start date (service from date on authorization) to the first parent training session (CPT 97156 and 97157).
How does my ranking in the steerage model affect me? ABA providers who rank highest in the steerage model will be given priority placement in HNFS' Network Provider Directory; meaning when beneficiaries search for ABA providers in their area, providers with the highest value ranking per the steerage model show up first. In addition, HNFS assigns referrals to ABA providers based, in part, on their ranking.
What’s a high-value designation? HNFS modeled the steerage model ranking after Roadmap (a leading provider in data analytics) methodology to help us rank providers using the three quality measures listed above. HNFS designates high-value providers between a 1 and 5 (1 being the highest quality).
What other changes are you making to your online directory? In addition to the steerage model, we are finalizing enhancements to our Network Provider Directory to allow beneficiaries to search for providers using three attributes: autism spectrum disorder (ASD) diagnosing providers, parent mediated training providers and respite care providers. Until those updates are completed, we offer a separate ACD-specific directory at www.tricare-west.com/go/directory.
What if I have a question about this process or my ranking? Providers with questions about the process or their ranking can email ACDnetwork@healthnet.com to connect with a Provider Engagement Specialist.