Autism Care Demonstration: Outcome Measures

Health Net Federal Services, LLC (HNFS) must receive completed outcome measure scores before we can authorize treatment. If we have not received outcome measure scores from your applied behavior analysis (ABA) provider, we may contact you to coordinate their completion. We will work with you to help resolve any barriers you may have to getting these completed.

Tools

Outcome measures help providers develop treatment plans and evaluate patient improvements (or regression). Under the Autism Care Demonstration (ACD), TRICARE requires the following age-based outcome measures for beneficiaries:

• Pervasive Developmental Disorder Behavior Inventory (PDDBI, 2 years–18.5 years, but can accept as early as 1.5 years), 
• Vineland Adaptive Behavior Scales, Third Edition (Vineland-3, 0 years–99 years) and
• Social Responsiveness Scale, Second Edition (SRS-2, 2.5 years–99 years)

Additional age-based outcome measures that evaluate parent stress are also required; however, they are not used for developing treatment plans or evaluating patient improvements. The Parenting Stress Index, Fourth Edition Short Form (PSI-4-SF) and Stress Index for Parents of Adolescents (SIPA) are standardized, reliable measures of stress and family dynamics that help to identify where additional support resources may benefit both the family and the beneficiary.

• PSI-4-SF (0 years–12 years and 11 months) or 
• SIPA (11 years–19 years and 11 months)

Important: The PSI-4-SF and SIPA have overlapping age ranges. The PSI-4-SF is appropriate up to 12 years and 11 months, and the SIPA is appropriate for individuals ages 11 years through 19 years and 11 months. 

• For beneficiaries ages 11 years through 12 years and 11 months at the time of authorization/reauthorization, either the PSI-4-SF or SIPA will be accepted.
• For beneficiaries older than 12 years and 11 months at the time of authorization/reauthorization, the SIPA will be accepted.  

See table below for frequency requirements. HNFS cannot authorize initial or ongoing ABA services until all required outcome measures are complete.

Important: The name of the person completing all outcome measures and their relationship to the beneficiary must be indicated on all forms. 

Notes about the PSI-4-SF and SIPA: Research has shown that parents’ stress levels can impact the child and the child’s environment, which may affect their symptoms. PSI-4-SF and SIPA stress indexes and scores are not factors for treatment planning or coverage determination. 

Performing Providers

The PDDBI must be executed by the responsible ABA supervisor conducting the assessment or reassessment. HNFS may authorize the additional four outcome measures to providers in our preferred outcome measure network. These providers have been identified as being capable of performing all four outcome measures (Vineland-3, SRS-2, PSI-4-SF, SIPA) for any beneficiary within access-to-care standards. 

Authorizations

• For the Vineland-3, SRS-2, PSI-4-SF, and SIPA, your child may be authorized to a provider who is not the ABA treating provider. 
• HNFS may authorize outcome measures directly to ABA providers without a referral from your child’s primary care manager or autism spectrum disorder-diagnosing provider. 
• Outcome measure authorizations are separate from initial assessment and treatment authorizations. 
• The outcome measures are reports based on answering questions in a survey format. Your child does not need to be present or participate in the completion of outcome measures.
• HNFS’ preferred outcome measure network of providers may complete these with you indirectly (via email or postal mail) from any location in the TRICARE West Region.

Requirements

HNFS must receive scores for all applicable outcome measures before we can authorize ABA treatment. Outcome measures must be performed at the following intervals: 

• Baseline data is before the first treatment authorization. For beneficiaries new to the ACD only, we can accept the Vineland-3, SRS-2, SIPA, and PSI-4-SF scores for up to one year prior to the start of treatment.
• Every six months/every year renewal dates are based on the date we receive the specific outcome measure. 
• The PSI-4-SF and SIPA have overlapping age ranges. The PSI-4-SF is appropriate up to age 12 years and 11 months, and the SIPA is appropriate for beneficiaries from ages 11 years through 19 years and 11 months. For beneficiaries ages 11 years to 12 years and 11 months at the time of authorization/reauthorization, either measure will be accepted. For beneficiaries older than 12 years and 11 months, they will need to complete the SIPA.

Important: Outcome measures must be completed within 90 days of their due date. If we receive outcome measure results too soon, you will need to repeat them within this time frame.

Renewals

Future renewal periods will be based on the date the outcome measures are received by HNFS. This means each outcome measure may have its own chronological timeline based on the date we received a valid and complete measure. 

Submitting Results

• Civilian providers submit outcome measure scores to HNFS through our online authorization submission tool.
• Beneficiaries and military hospitals or clinics can submit outcome measure scores via fax to 1-877-910-0945.

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