Autism Care Demonstration: Receiving Applied Behavior Analysis Services
After the clinical necessity review is complete and applied behavior analysis (ABA) services have been approved, the initial treatment authorization is valid for a six-month period. Your provider will need to submit a subsequent authorization request for care beyond six months.
Access-to-Care Standards for Treatment
TRICARE's access-to-care standards are in place to minimize any delays accessing ABA services.
- ABA treatment must start within 28 calendar days from the last date of service of the beneficiary's initial assessment.
- The first parent/caregiver training session must be within 30 days of when the treatment authorization was approved.
- ABA providers must render a minimum of six parent/caregiver sessions every six months.
- ABA supervisors must complete a direct visit at least once per month. Note: There may be exceptions to this if the beneficiary is not available for the direct visit for an entire month.
Health Net Federal Services, LLC (HNFS) will verify the start date of ABA treatment. If access-to-care standards are not met, we will contact you or the provider to determine the reason for the delay. If you choose to waive access-to-care standards, you must notify HNFS so we can document the waiver.
Parent/Caregiver Training
An important component of a strong, clinical ABA program includes training parents/caregivers on ABA principles and working effectively with the beneficiary to achieve measurable goals and target specific skills.
HNFS encourages ABA providers to engage parents/caregivers early and often to ensure generalization of ABA teaching techniques in environments outside of treatment.
Changing ABA Providers (Second Opinions)
If for any reason, you want to change ABA providers, you can start the process by requesting a second opinion.
- If HNFS authorized services to an ABA group, you can work with that group directly to request a change in ABA supervisors and/or assistant behavior analysts. You will not need a second opinion authorization.
- If HNFS authorized services to a sole ABA provider, or if you want to make a change at the ABA group level, please call our ACD customer service line to request a second opinion authorization.
Keep in mind:
- Second opinion authorizations have the same requirements as initial assessments.
- Second opinions can be completed by a different ABA provider, but only one ABA provider may be authorized to provide treatment at a time.
