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Autism Care Demonstration: You Can Help Improve Comprehensive Care Plan Completion Rates

Thursday, August 25, 2022

Under TRICARE’s Autism Care Demonstration (ACD), families who have an assigned Autism Services Navigator (ASN) work with the ASN to develop a comprehensive care plan (CCP) specific to the beneficiary’s needs. Separate from the treatment plan developed by applied behavior analysis (ABA) providers, the CCP is a written plan developed by ASNs and families. Per TRICARE requirements, Health Net Federal Services, LLC (HNFS) must receive a completed initial CCP within the first 90 days of an ASN having been assigned to a family. (Note: This 90-day period may expire during an approved assessment or treatment period.)

As providers, you offer invaluable assistance helping parents/caregivers understand the CCP requirement. When a CCP isn’t submitted on time, HNFS must terminate the remaining authorized days on the corresponding active ABA authorization. This creates the potential for delays or gaps in care, which may negatively impact the beneficiary, their family and any ABA providers working with the beneficiary. We offer the following questions and answers for you to share with your patients to help them understand and meet CCP requirements.  

Who must complete CCPs?  

Beneficiaries who enrolled in the ACD after Oct. 1, 2021, and who are eligible to receive assigned ASNs, must complete CCPs with their assigned ASNs. 

Are CCPs and treatment plans the same thing? 

CCPs are separate from and do not take the place of ABA provider-developed treatment plans. CCPs and treatment plans are used together to ensure beneficiaries receive comprehensive services and support.

When is a CCP due?

Once HNFS assigns an ASN to a beneficiary, the beneficiary’s initial CCP must be completed within 90 days. 

What happens if CCPs are not completed on time?

For beneficiaries who have active ABA authorizations, HNFS must terminate the remaining authorized days on the authorization. We will reissue a new authorization once we have received and processed the completed CCP from the ASN. Authorizations will not be retroactive and a gap between authorizations will occur. All services under the ACD are required to be prior authorized and services should not be rendered without an approved authorization for the dates of service. If HNFS has not received a beneficiary’s CCP by the due date and a current, active authorization is not in place, the beneficiary cannot receive ABA services until HNFS has the completed CCP. 

How often must CCPs be updated?

CCPs must be updated a minimum of once every six months after the initial CCP. 

How can providers help with CCPs?

To help avoid delays or gaps in care, you can help encourage timely CCP submissions by:

  • Checking in with the family during the initial assessment and/or treatment period about CCP status. 
  • Reminding the family about the initial CCP 90-day completion requirement and any six-month update requirements. 
  • Suggesting beneficiaries connect with their assigned ASNs for any questions they have concerning their CCPs.

Note: Providers who are part of a beneficiary’s care team will be given a copy of the initial CCP to review and invited to participate in a medical team conference to support care coordination.

For more information about CCPs, refer to our Autism Services Navigators/Comprehensive Care Plans page.