Post on 23-Jan-2021
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https://learn.extension.org/events/2825
TRICARE® Autism Care Demonstration
This material is based upon work supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, and the Office of Family
Readiness Policy, U.S. Department of Defense under Award Number 2015-48770-24368.
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MFLN Intro
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Today’s Presenters
Richard Hart
Senior Health Policy Analyst
Health Plan Execution and Operations
Defense Health Agency (DHA)
Dori Rogut,
M.S., PMHNP, BC
Senior Policy Analyst
Behavioral Health Benefits and Standards
Clinical Support Division, Condition-Based
Specialty Care
Defense Health Agency (DHA)
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Guidelines
Protected Health Information (PHI), Protected Individual Information (PII): in your questions, to protect the patient, please do not bring up or refer to any patient specific information. This is designed to protect each patient.
This webinar is specific to the ACD benefit not designed to problem solve individual cases.
Resources for individual cases are provided by the Managed Care Support Contractor- see last slide for contact information.
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Autism Care Demonstration(ACD)
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The ACD is administered by the regional Managed Care Support Contractor (Health Net, Humana, United Military and Veterans).
What is Autism Spectrum Disorder (ASD)?
•ASD affects essential human behaviors such as:
•Social interaction
•Communication
• Imagination
•Relationships
• It also includes restricted repetitive behaviors, interests and activities.
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What are the covered services for ASD?
• TRICARE covers:
• Occupational therapy
• Physical therapy
• Health care provider services
• Psychological services
• Psychological testing
• Prescription drugs
• Speech therapy
• Applied behavior analysis (ABA) under the ACD
• Autism Care Demonstration runs from July 25, 2014 through December 31, 2018.
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What is Applied Behavior Analysis (ABA)?
• ABA is a covered benefit that:
• Applies behavior modification principles
• Helps develop skills
• Decreases negative behaviors
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Questions?
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Eligibility
• ABA services are covered for all qualifying dependents of:
• Active duty service members (ADSMs)
• Retired service members
• Certain National Guard and Reserve members
• There are no age limits
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Active Duty Service Members
• ADSMs who are seeking ABA services for family members must:
• Sign up for their service’s Exceptional Family Member Program (EFMP)
• Register their family members in the Extended Care Health Option (ECHO)
• ABA does not count against the yearly cap for ECHO benefits. ABA is provided under the Autism Care Demonstration, which places no cap on ABA coverage.
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What does the ACD cost?
• For all ABA services, you pay the copayment or cost-share for your TRICARE program:• ADFMs with TRICARE Prime: $0
• ADFMs with TRICARE Standard and TRICARE Extra, as well as TRICARE Reserve Select members:
• 15% with a network provider*
• 20% with a non-network provider*
• Retired family members with TRICARE Prime: $12
• Retired family members with TRICARE Extra and TRICARE Standard, as well as TRICARE Retired Reserve members:
• 20% with a network provider*
• 25% with a non-network provider*
These amounts apply to the yearly TRICARE catastrophic cap.
*After the yearly deductible is met. 12
Questions?
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How to Best Assist Beneficiaries Access Care under the ACD
DO: ∎ Ask parents/caregivers if their child has
received a diagnosis of Autism Spectrum Disorder and a referral to the ACD.
∎ Ask the parents/caregivers if they received the authorization letter for the ACD from the regional contractor.
∎ Review the regional contractor letter with the parents/caregivers and assist them to make the appointment with the provider listed on the authorization letter.
∎ Assist by calling the regional contractor DIRECTLY if the beneficiary cannot get an appointment with the provider listed on the authorization letter within the 28 day access standards.
DON’T: ∎ Give parents/caregivers a list of ABA
providers in your area and tell them to call to multiple ABA provider practices to get their child on a “Wait List.”
A wait list is defined by TRICARE® to mean that there is an authorization letter for the ACD and the provider listed on the authorization cannot see the beneficiary within the 28 day access standard for specialty care.
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Who provides ABA?
• TRICARE-authorized ABA providers:
• Authorized ABA supervisors
• Assistant behavior analysts (working under the supervision of an authorized ABA supervisor)
• Behavior technicians (working under the supervision of an authorized ABA supervisor)
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What types of services are available?
• A child's authorized ABA supervisor will:
• Complete an initial ABA assessment
• Develop an individual treatment plan
• Work with the child to provide ABA services
• Help parents, and other caregivers
• Reevaluate the child and update the individual treatment plan every six months
• The treatment plan dictates the types of services and number of hours of ABA needed each week.
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Questions?
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Ongoing ABA requirements
• Every six months:
• A reassessment progress report and treatment plan update
• Every two years:
• A periodic ABA program review
• A new referral and reauthorization
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Is the ACD available overseas?
• Overseas, in very limited locations and circumstances, a child may be able to get ABA services:
• ABA services are only authorized in countries that have behavior analysts who are certified by the Behavior Analyst Certification Board.
• The ABA benefit is not available in overseas countries where there are no board-certified behavior analysts within the TRICARE specialty care access standards.
• Tiered model services (assistant behavior analysts and behavior technicians) are not covered overseas.
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ACD Points of Contact
∎ The Regional TRICARE® Contractors have ABA-trained representatives available to help assist family members/caregivers to access timely ABA services. The Regional Contractor phone numbers are:
Humana/ValueOptions (South Region): ABA Customer Service
1-866-323-7155
HealthNet (North Region): (ask to speak with their Autism specialists)
1-877-874-2273
UnitedHealthcare (West Region) ECHO/Autism Line
1-855-874-6800
International SOS (Overseas)
1-877-451-8659
∎ Also see: http://www.tricare.mil/Plans/SpecialPrograms/ACD
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Questions?
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» The MFLNMC Concentration Area offers 1.0 CEU credit from the National Association of Social Workers (NASW) to licensed professionals. Also certificates of completion are available for those interested in receiving training hours.
» To receive a CEU credit OR certificate of completion, please complete the evaluation found at: https://vte.co1.qualtrics.com/SE/?SID=SV_6s7ucEnt4qmTB8p
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» Title: Chronic Illness: Empowering Families in the Journey (Part 1)
» Time: 11:00 a.m. - 12:30 p.m. ET
» Date: Thursday, January 19, 2017
» Location: https://learn.extension.org/events/2899
For more information on MFLNMC go to:
https://blogs.extension.org/militaryfamilies/military-caregiving/
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MFLN Intro
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26This material is based upon work supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, and the Office of Family
Readiness Policy, U.S. Department of Defense under Award Number 2015-48770-24368.
» Slide 3, Image: Richard Hart, DHA. Photo Credit: Richard Hart
» Slide 3, Image: Dori Rogut, DHA. Photo Credit: Dori Rogut
» Images from slides (9, 13, 17, and 21) are purchased from iStockphoto by Texas
A&M AgriLife Extension Service and the Military Families Learning Network
(MFLN), under Member ID: 8085767.
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