What is an Autism Care Demonstration steerage score?
Wednesday, May 10, 2023
The Autism Care Demonstration (ACD) steerage score is an applied behavior analysis (ABA) provider’s network ranking. The score is based on a provider’s ability to meet ACD requirements.
Health Net Federal Services, LLC (HNFS) ranks providers for quality using a scale from 1-5.
- ABA providers who successfully meet ACD steerage requirements receive a score of 1.
- ABA providers who do not successfully meet all ACD steerage requirements receive scores of 2-5.
The lower the number, the higher an ABA provider ranks in Network Provider Directory searches by TRICARE beneficiaries. This means an ABA provider with a steerage score of 1 will return at the top of search results.
- Assigned to a service location.
- Based on claims processed during a three-month reporting period and not date of service.
- Reset each three-month reporting period.
- Referral to assessment. ABA providers must render the first date of service of the assessment (Current Procedural Terminology [CPT®] code 97151) within 28 calendar days from the date HNFS verified the referral after receiving an approved authorization to start the initial assessment. Note: HNFS has up to 15 business days to complete active provider placement, so ABA providers need to complete the first date of service of CPT code 97151 within 28 days of the “service from date” on the initial assessment authorization.
- Assessment to treatment. After receiving an approved authorization to start treatment, ABA providers must complete CPT codes 97153, 97155, 97156, 97157, or 97158 services within 28 calendar days of the last date of service in the 14-day window that is allowed for CPT code 97151.
- Quality measure. ABA providers must render the first parent/caregiver training (CPT codes 97156 or 97157) within 30 days of approval of each treatment authorization.
As of Aug. 1, 2021, and within 30 days of the approved treatment authorization, ABA providers must start parent training (CPT codes 97156 or 97157). Once HNFS approves a treatment authorization, we strongly encourage ABA providers to implement parent/caregiver training as soon as possible. ABA providers can begin training parents/caregivers on behavior intervention plans and goals independently of direct ABA service hours.
For more information on the steerage model, visit our Referrals for Applied Behavior Analysis Services page. For general questions email ACDNetwork@hnfs.com.