Autism Care Demonstration Discharge Summary Best Practices

Monday, May 1, 2023

Discharge summaries are an incredibly important part of the applied behavior analysis (ABA) treatment a beneficiary receives under the Autism Care Demonstration (ACD). Discharge summaries include essential information regarding the reasons a beneficiary’s treatment ended and can assist Health Net Federal Services, LLC (HNFS) with determining any current or upcoming support a beneficiary may need. This is vital to continuity of care. Please review the following question and answer refresher on discharge summary requirements.

What belongs in a discharge summary?

• Transition timelines: The beneficiary must be notified a minimum of 45 days before the last date of service. This timeline also must be presented in the summary report. Note: In the rare occurrence that the timeline was not met due to extraordinary circumstances, the ABA provider must provide an understandable explanation for why the transition timeline was less than 45 days.
• 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). Signatures for parents/caregivers and ABA supervisor(s).

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 Operations Manual, Chapter 18, Section 4, Paragraph 8.8.5 requires discharge summaries for all ACD beneficiaries when treatment terminates.

What happens if I did not include a discharge summary?

HNFS conducts frequent reviews of beneficiary health records to ensure that all program requirements have been met. This includes a historical review of required discharge summaries completed and processed by HNFS. When we find a record with a missing discharge summary, we ask the ABA provider to complete and submit the discharge summary in a timely manner to remain in compliance with TRICARE requirements. HNFS will continue to follow up with the ABA provider until we receive the requested discharge summary information. 

For additional information regarding ACD requirements, please visit our ACD page.