Avoiding Gaps in Care: Key Submission Due Dates for the Autism Care Demonstration

Thursday, October 12, 2023

As an applied behavior analysis (ABA) or autism spectrum disorder (ASD) diagnosing and referring provider with the Autism Care Demonstration (ACD), Health Net Federal Services, LLC (HNFS) knows you have a busy schedule. To help you keep up to date with submission requirements for initial and ongoing ABA services, we are providing this refresher on key due dates.

ACD Submission Requirements for ABA Services

Definitive autism spectrum disorder (ASD) diagnosis – (One-time requirement) ASD diagnostic evaluation or referral

Submitted by the TRICARE-authorized ASD diagnosing and referring provider for initial referral to the ACD.
Include date of initial diagnosis.

Validated assessment tool (VAT) – (One-time requirement) STAT™, ADOS®-2, ADI-R®, CARS™-2, GARS-3

Submitted by the TRICARE-authorized ASD diagnosing and referring provider before enrollment period ends.
Submit diagnostic evaluation with documentation of diagnosing methods used to supplement the GARS-3 parent questionnaire (GARS-3 only).

DSM-5 Diagnostic Checklist – Identifies level of support required per DSM-5 ASD criteria

Submitted by the TRICARE-authorized ASD diagnosing and referring provider* before the enrollment period ends.
Submitted by the TRICARE-authorized ASD diagnosing and referring provider* at the end of each two-year referral cycle to continue ABA services. You may submit an updated checklist up to six months before the referral expires (does not apply to initial enrollment in the ACD).

*Does not have to be completed by the same provider who originally made the diagnosis

ABA referral – Valid for two years

Submit the initial ABA referral while HNFS confirms a beneficiary has met ACD eligibility requirements to prevent delays in care.
Submit referrals for continued ABA services no more than six months before the current two-year referral expires. Important: If we receive this more than six months before the current referral expires, we will cancel the request as a duplicate.
Must include diagnosis/comorbid diagnosis, symptom severity, and statement that the beneficiary requires ABA services.

PDDBI Parent and Teacher Forms – Due dates based on the date HNFS last received a valid and complete outcome measure

Required before HNFS can complete a benefit review for coverage of ABA services for treatment (only applies to PDDBI Parent Form; the PDDBI Teacher Form is not required for first treatment authorization).
Perform and submit PDDBI Parent and Teacher Forms within 90 days of every six-month due date.

Vineland-3, SRS-2, PSI-4-SF, SIPA – Due dates are based on the date HNFS last received a valid and complete outcome measure

PSI-4-SF/SIPA due every six months.*
Vineland-3 and SRS-2 due annually.*
Perform and submit within 90 days of their due dates while enrolled in the ACD.

*For new ACD beneficiaries only, these can be completed up to one year before starting ABA services.

Treatment plan – ABA providers must ensure all required elements have been included before submitting to HNFS for clinical review

Submit an initial treatment plan meeting requirements upon completion of the initial assessment.
Submit an updated treatment plan meeting requirements at least 30 days and no more than 60 days in advance of the current authorization’s expiration for reassessment.

Discharge summary – Must include information about reason for discharge, transition timeline and date of discharge; may include information on future treatment needs

One-time requirement.
Due when ABA services end.

HNFS will complete an initial review of all submitted requirements to verify they comply with TRICARE’s ACD policy. We will request additional information if needed and may pend and/or cancel a request until we receive the requested information.

When providers submit required documentation at the start of submission time periods (for example submitting a referral at the beginning of the six-month period before the referral cycle end date), this ensures HNFS can review and process information in a timely manner, maintaining continuity of care for our beneficiaries.

Learn more about ACD requirements by visiting our ACD page.