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Autism Care Demonstration Comprehensive Care Plans: Requirements and Relation to Access to Care

Wednesday, March 15, 2023

Under TRICARE’s Autism Care Demonstration (ACD), beneficiaries with assigned Autism Services Navigators (ASNs) must develop and update comprehensive care plans (CCPs) while enrolled in the ACD. CCPs detail beneficiary information such as current providers and current health and wellness status; help keep track of family-centered goals, parent engagement, and education; identify any needed local resources; and help with tracking requirements specific to the TRICARE basic benefit, state/federal programs, other health insurance, local resources, and comorbid disorders (when applicable). CCPs complement, but do not replace, treatment plans developed by applied behavior analysis (ABA) providers. The initial CCP is a continuously evolving document that must be updated a minimum of once every six months. As an ABA provider, when you communicate the importance of completing initial and updated CCPs with beneficiaries and family members, you help beneficiaries avoid possible gaps or delays in care related to not meeting CCP requirements.

Initial CCPs

Once a beneficiary has been assigned an ASN, the initial CCP is due within 90 days. The initial CCP details the beneficiary’s baseline information and support needs. ASNs and family members will work together to create an individualized CCP that encompasses the beneficiary’s specific needs.

Updated CCPs

Once HNFS has received the initial CCP, the ASN and family members must update the beneficiary’s CCP within six months. CCPs can be updated as often as needed to ensure that the plan is accurate and represents the beneficiary’s current treatment needs. Updated CCPs also contain information on medical team conferences.

CCPs and Access-to-Care

The beneficiary and ABA treatment team are impacted if HNFS does not receive initial or updated CCPs by their due dates. If HNFS does not receive the initial CCP by the due date, existing ABA authorization must be suspended until we receive and process the initial CCP. This will cause a gap in care for the beneficiary and interrupt the ABA treatment team’s assessment or proposed treatment timelines.

This is similar for updated CCPs. If HNFS does not receive an updated CCP every six months, the beneficiary will continue to receive ABA treatment until the end of their current authorized treatment period. However, once HNFS receives a subsequent treatment request, we will cancel the request until we receive and process the updated CCP. Once we have processed the updated CCP and verify that all prescreen eligibility, treatment plan, referral, and outcome measure requirements have been met, we will initiate the clinical necessity review process.

How You Can Help

Members of the beneficiary’s care team will receive a copy of the CCP for review. When an ABA provider is familiar with a beneficiary’s CCP and related requirements, during the ABA providers regular direct visits to see the beneficiary, they can engage with the family to encourage them to check in with their ASN and stay current with initial and updated CCPs. This will help the beneficiary avoid potential gaps in care and ensure the treatment team delivers uninterrupted services.

Visit our Initial Authorizations: Assessments & First Treatment, Subsequent Authorizations and Autism Services Navigators (ASN) pages for more information.