Autism Care Demonstration: The Importance of Discharge Summary Reports
Wednesday, September 28, 2022
As an applied behavior analysis (ABA) provider under the Autism Care Demonstration (ACD), you provide patients with expert, individualized care. Part of caring for ACD patients includes caring about their future after ACD treatment. A discharge summary report covers why a patient was discharged and next steps for patients and parents/caregivers once a patient’s ABA services end.
These reports may include information on referrals, second opinions and future treatment needs. They also include vital information on why a patient’s treatment ended. While not separately reimbursable, TRICARE requires ABA providers to create and submit discharge summary reports anytime they have a patient whose treatment ends.
Key Discharge Summary Report Information
Discharge summary reports not only help Health Net Federal Services, LLC (HNFS) clinical reviewers and parents/caregivers or future providers understand why treatment ended but also help them understand how a patient responded to treatment. As defined in the TRICARE Operations Manual (TOM), Chapter 18, Section 4, discharge summary reports must include:
- Transition timelines or summaries. A patient must receive, at a minimum, 45 days to transition from ACD treatment to discharge. This is referred to as the transition timeline. The ABA provider’s notes on this transition period must be included in the discharge summary report as statements of fact (for example, transition start date, transition end date) or narrative summary. Note: In the rare occurrence that the timeline was not met due to extraordinary circumstances, the ABA provider must provide an understandable explanation why the transition timeline was shorter than 45 days.
- Discharge date. Clearly identify the date the patient was discharged.
- Reason for discharge. Clearly and fully explain why the patient ended treatment. Reference TOM, Chapter 18, Section 4, paragraph 8.8 requirements in your explanation. These details not only help our clinical reviewers, other providers and parents/caregivers, but may help with future treatment recommendations, if needed. Other things affecting discharge that should be described include schedule or availability conflicts, lack of parent/caregiver desire, ABA provider staffing issues, changes to the patient’s ACD eligibility, etc.
- Signatures of parents/caregivers and ABA supervisor(s). Signatures for parents/caregivers and the ABA supervisor(s) must be included.
Refer to the "Step 2 – Clinical Necessity Review" section of our Clinical Necessity Reviews page for more information.
