Autism Care Demonstration: Initial Assessments
Assigning Providers
After Health Net Federal Services, LLC (HNFS) verifies a referral for applied behavior analysis (ABA) services, we locate and assign an ABA provider. This provider selection process can take up to 15 business days.
To ensure beneficiaries have access to an ABA provider within TRICARE's access-to-care standards, HNFS uses an “active provider placement” process when assigning providers.
- We contact ABA providers within a 60-mile radius of your home address to ask about availability for the initial assessment and treatment.
- We will assign the first provider with the highest steerage ranking who meets criteria for accepting a new referral.
- We will consider parent/caregiver (and referring provider) preferences in the provider selection process, but are ultimately required to select providers who meet access-to-care standards. This includes parent/caregiver preferences for location of services (center/clinic vs. home), time/day of week (morning, afternoon, evening, weekends) and specific providers or attributes. Refer to our Access-to-Care Standards page for more information about preferences and waiving access-to-care standards.
Assessment Approval Letters
Providers and beneficiaries can access approval letters online. You can access letters through your Secure Inbox (log in required).
- Beneficiary approval letters contain the assigned ABA provider’s contact information.
- Your ABA provider should contact you within three business days of assignment to schedule the first, initial assessment session.
- If your provider has not connected with you within one week, and you have an assigned Autism Services Navigator (ASN), please contact your ASN. If you do not have an assigned ASN, please contact HNFS ACD customer service line.
Important: HNFS approval letters sent to the ABA provider contain the beneficiary’s phone number on record in the Defense Enrollment Eligibility Reporting System (DEERS). If this phone number is not current, you may need to reach out to the ABA provider to schedule the assessment. Note: If you need to update your information in DEERS, you can make changes online at milConnect.
Completing the Initial Assessment
Your assigned ABA provider has 45 days to complete the initial assessment. However, they are required to schedule the first visit with your child to begin the assessment within 28 days from the "service from" date on the authorization letter.
We will contact you or your provider to confirm whether there were any delays in starting the assessment within access-to-care standards.
Note: If you choose to waive access-to-care standards, you or your provider may be contacted by HNFS so we can document the waiver.
What happens during an initial assessment?
The initial assessment allows ABA providers to develop a treatment plan that includes treatment recommendations and goals unique to your child. The initial assessment must include:
- Direct observation of your child.
- Background information (such as diagnoses, family history, how long your child has been receiving ABA services).
- A functional behavior assessment.
- Results from a parent/caregiver interview and parent/caregiver report rating scales.
- The development of a treatment plan that meets all TRICARE requirements (this will include a current Individual Education Program [IEP] for children receiving ABA services within a public or private school setting).
- Results of the Pervasive Developmental Disorder Behavior Inventory (PDDBI) Parent Form.
HNFS will contact you or your provider to confirm whether there were any delays in starting the assessment within access-to-care standards.
Second Opinions – Assessments
If you would like a second opinion on initial assessment results and recommendations, HNFS can authorize a second opinion while you continue with your current ABA provider.
- Second opinion assessments follow the same requirements as initial assessments. (A new referral is not required for second opinions if it’s within the two-year time frame.)
- The second opinion assessment can be completed by a different ABA provider, but only one ABA provider may be authorized to provide treatment at a time.
