Autism Care Demonstration – Meeting Minimum Parent/Caregiver Training Requirements
Wednesday, May 31, 2023
Providers helping patients under TRICARE’s Autism Care Demonstration (ACD) are in an excellent position to engage parents and caregivers in their children’s ABA treatment. To encourage family involvement, TRICARE requires parents or caregivers to participate in a minimum of six training sessions during each six-month authorized treatment period. These sessions are billed as at least one unit of Current Procedural Terminology (CPT®) code 97156 or 97157. Careful and proactive scheduling can help ensure ABA providers and parents/caregivers meet this requirement. If the six-session minimum has not been met for two or more consecutive authorizations, TRICARE policy prohibits regional contractors from reauthorizing subsequent care.
Documenting Training Sessions
ABA providers must submit reauthorizations 60 to 30 days before an authorized treatment period ends and attach an updated treatment plan that documents parent/caregiver training, including future sessions.
What do I do if minimum parent/caregiver training requirements weren’t met?
ABA providers must:
- Provide detailed explanations for unmet requirements.
- Offer solutions for preventing missed requirements in the future (for example: reminders, overschedule appointments by average rate of cancellation, 15-minute CPT code 97156 session after rendering CPT code 97155 session, etc.).
- Reschedule missed/canceled trainings whenever possible.
- Let parents/caregivers and ABA supervisor teams know continued ABA treatment authorizations may not be approved if training requirements haven’t been met.
- Be able to use other ABA supervisors who are credentialed with TRICARE and familiar with the beneficiary’s program.
- Design a flexible training schedule with rescheduling capabilities.
- Bring in other caregiver-qualifying family members such as grandparents or siblings over the age of 18, as clinically appropriate. Refer to TRICARE Operations Manual, Chapter 18, Section 4, Paragraph 11.21.1 for requirements on who qualifies as a caregiver.
Consultation Request
If an ABA provider fails to meet minimum training requirements, include explanations with proposed plans of action, or provide training session details in the treatment plan, Health Net Federal Services, LLC (HNFS) will request a consultation with that provider. HNFS also will contact ABA providers if training recommendations do not increase or if goals do not become more complex over time. During these consultations, we may discuss:
- Developing a long-term plan to meet minimum requirements and prepare families for eventual discharge from treatment.
- Increasing generalization and parent/caregiver ability to use treatment techniques to maintain gains outside of treatment.
Resources and Support
We offer comprehensive information about parent/caregiver training requirements on our Initial Authorizations and Subsequent Authorizations pages. We also offer printable treatment plan requirements guides on our Resources page. ABA providers and parents/caregivers also may contact our dedicated ACD customer service line to discuss parent/caregiver training requirements.
