Autism Services Navigators
On Oct. 1, 2021, TRICARE introduced the Autism Services Navigator (ASN) role to the Autism Care Demonstration (ACD).
Who is eligible for an ASN?
To be eligible for an ASN, you must be new to the ACD as of Oct. 1, 2021. You also may be eligible for an ASN if you were enrolled in the ACD before Oct. 1, 2021, but there was a gap in applied behavior analysis (ABA) services lasting longer than 12 months.
- If you were assigned an ASN and move, you remain eligible for an ASN as long as you continue to meet eligibility requirements.
- If you were assigned an ASN but decline the support, you will no longer be eligible for the ACD.
Health Net Federal Services, LLC (HNFS) assigns an ASN within three business days after completing the ACD enrollment process.
What is an ASN?
ASNs are licensed professionals (registered nurses, clinical psychologists, licensed clinical social workers, and other mental health professionals) with clinical experience in pediatrics, behavioral health, mental health, and/or autism spectrum disorder (ASD).
How does an ASN support me/my child?
The ASN's role is to support the beneficiary and their family as a health care advocate, helping families navigate the ACD and maximize the services available. Responsibilities of an ASN include:
- Working with families to develop and maintain comprehensive care plans (CCP).
- Coordinating medical and mental health care services with a beneficiary’s providers.
- Coordinating and participating in medical team conference meetings.
- Helping beneficiaries new to the TRICARE West Region with medical appointments and coordinating care continuation for those moving from on TRICARE region to another TRICARE region (East, West, overseas) or moving within their existing TRICARE region.
- Helping connect families with local resources and supports.
Important:
- Beneficiaries who are assigned an ASN and move remain eligible for an ASN as long as they continue to meet eligibility requirements.
- Eligible beneficiaries who decline the services of an ASN lose ACD program eligibility.
- An ASN is a health care advocate for the beneficiary and family; an ASN does not perform clinical necessity reviews of ABA treatment plans or make TRICARE coverage determinations.
What if I'm not eligible for an ASN?
Beneficiaries who entered the ACD prior to Oct. 1, 2021, and are not eligible for an ASN have access to case management services, either directly through HNFS, their assigned military hospital or clinic (if available), or the Exceptional Family Member Program (EFMP).
To connect with HNFS’ case management team, visit the Care Management section of our website. Families also can connect with our case management team by calling our dedicated case/care management line at 1-844-524-3578.
Comprehensive Care Plans
CCPs incorporate every aspect of a beneficiary’s care into one, complete resource document.
What is a CCP?
CCPs are written plans that help with:
- Setting and tracking comprehensive care goals.
- Keeping track of due dates for requirements like referrals and outcome measures.
- Finding ASD-related help and resources.
- Tracking respite care availability through Extended Care Health Option (ECHO) & and EFMP (when applicable).
Your assigned ASN will work with you to complete the initial CCP by the due date. Developing the document requires actively working with your assigned ASN. You may need to connect multiple times through phone calls, emails and meetings throughout the calendar year. Your ASN will submit the completed CCP to HNFS.
When is the initial CCP due?
Once HNFS assigns an ASN to a beneficiary, the beneficiary’s initial CCP must be submitted to HNFS within 90 days. Otherwise, HNFS must cancel any ABA authorizations that already may have been approved for initial assessments or treatment. This means your child might have potential gaps or delays in care.
Our provider already submitted a treatment plan. Is that the same as a CCP?
A CCP is not the same as a treatment plan. Your child’s ABA provider develops the treatment plan. The CCP and treatment plan will be used together to help make sure your child receives the individualized care and support needed.
What if the initial CCP (or an updated CCP) is not completed by the due date?
If HNFS does not receive the initial CCP within 90 days:
- We will cancel any active authorizations in place. This means any visits with your ABA provider will not be covered until HNFS reissues the authorization.
- We won’t be able to approve/start services until the ASN submits the completed CCP for beneficiaries who don’t have any active authorizations in place.
Your ASN will work with you on CCP updates. After the initial CCP's completion date, updates must be made every six months. Important: If a CCP update is overdue, a reauthorization will not be allowed until HNFS receives the updated CCP.
What information is covered in a CCP?
The information in CCPs must cover the following topics.
- Beneficiary information
- Beneficiary health and wellness
- Beneficiary’s participation in school or early intervention program
- Parent and family engagement
- Beneficiary/family-centered goals, action steps and intervention (1 goal for initial CCP)
- Current care team providers
- Parent and family education
- Permanent change of station monitoring (if applicable)
- ABA transition and discharge planning
- Outcome measure cycle dates (if applicable)
- Outcome measure data (if applicable)
Is the CCP ever updated?
Your ASN will work with you on CCP updates. Updates must be made every six months after the initial CCP. Note: If a CCP update is overdue, a reauthorization will not be allowed until HNFS receives the updated CCP.
