Autism Care Demonstration: Discharge Summary Best Practices

Thursday, August 29, 2024

Part of caring for Autism Care Demonstration (ACD) beneficiaries includes caring about their future after ACD treatment. Discharge summaries include essential information about why a beneficiary’s applied behavior analysis (ABA) services ended and can help TRICARE contractors with determining any current or upcoming support a beneficiary may need. This is vital to continuity of care. Please review this refresher on discharge summary requirements.

What belongs in a discharge summary?

• Transition timelines: Beneficiaries must be notified a minimum of 45 days before their last date of service. In the rare occurrence this timeline was not met due to extraordinary circumstances, ABA providers must provide an understandable explanation as to why.
  
  
• Discharge date: The date (MM/DD/YYYY) the beneficiary was discharged from ABA treatment.
  
  
• Reason for discharge: A clear, detailed explanation for why treatment ended. Acceptable discharge reasons include: 
  • ABA treatment plan goals were met, and ABA services are no longer needed.
  • No measurable progress was made toward meeting treatment plan goals after successive progress review periods and repeat treatment plan modifications.
  • Treatment plan gains were neither generalizable nor durable over time and gains did not transfer to the larger community setting after successive progress review periods and repeat treatment plan modifications.
  • The patient could no longer participate in ABA services (due to medical problems, family problems or other factors prohibiting participation).
     
• Signatures of parents/caregivers and ABA supervisor(s). Please include all required signatures.

Do I get reimbursed for discharge summaries?  

ABA providers are not reimbursed for creating discharge summaries. They are contractually required and considered a best practice for beneficiaries ending ABA treatment.

When am I required to create a discharge summary?

TRICARE requires a discharge summary from the ABA provider at termination of services. 

What happens if I did not include a discharge summary?

HNFS conducts frequent reviews of beneficiary health records to ensure all program requirements have been met. If a record is missing a discharge summary, we will ask the ABA provider to complete and submit the discharge summary in a timely manner to remain in compliance with TRICARE. We will follow up with the ABA provider until the discharge summary is received. 

Find additional information regarding ACD requirements on our website.