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Comprehensive Changes to the Autism Care Demonstration

The DHA Autism Care Demonstration (ACD) manual changes were published on March 23, 2021.

Since approval, a comprehensive review of the ACD occurred to evolve the program to a beneficiary-centric model. These changes aim to improve the quality of and access to care and services, and also improve the management and accountability of both the regional contractors and ABA providers.

  • By adopting these comprehensive changes, TRICARE is working to develop a more comprehensive ACD program that addresses the needs of all beneficiaries diagnosed with ASD.
  • The comprehensive changes to TRICARE's ACD towards a truly comprehensive program that integrates all potential services for the best possible outcomes tailored to the beneficiary.
  • The ACD program changes will:
    • Move the ACD to a beneficiary-centric model to help beneficiaries reach maximum potential
    • Empower parents to have a greater role in development of the comprehensive care plan for their children
    • For new beneficiaries to the program, incorporate all medically and psychologically necessary and appropriate services into one comprehensive care plan, coordinated by an Autism Services Navigator (ASN).
      • Regular case management services remain unaffected

What's Not Changing

  • The coverage for the diagnosis of ASD
  • Referral from an eligible TRICARE-authorized provider
  • Prior authorization for services
  • ABA provider completion of assessment and treatment plan

What's Changing:

  • Autism Services Navigator (ASN) for every new ACD participant. The ASN will:
    • develop a comprehensive care plan
    • improve care transition support
    • provide greater care coordination support
  • Connection to ASD resources
  • Outcome measures -- additional measures/changes of timelines
  • Increased parental involvement/support
  • Improved utilization management
  • Revision/addition of ABS category I CPT codes
  • Improved medical coordination via medical team conferences
  • Continued parental training via telehealth beyond COVID-19
  • Removal of confirmation diagnosis requirement

DHA Webinar Series: Comprehensive Changes to the Autism Care Demonstration

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ACD Manual Changes Q&As

These Q&As are follow up responses to questions submitted regarding the ACD policy changes published 3/23/2021. These Q&As are for informational purposes only.

File Description
Autism Care Demonstration Policy Changes: Questions & Answers - Set 1 Topics covered in Set 1 include: - Diagnostic requirements - Behavior Technicians in the School Change - Certain Community Settings
Autism Care Demonstration Policy Changes: Questions & Answers - Set 2 Topics covered in Set 2 include: - Behavior Technician Certification - Provider Certification Requirements - Participation Agreements - Restraints - Exclusions
Autism Care Demonstration Policy Changes: Questions & Answers - Set 3 Topics covered in Set 3 include: - Referrals and Authorizations - Parent Stress Measures - Sharing of Outcome Measures Reports - Access to Care - Outcome Measures – Referrals and Authorizations
Autism Care Demonstration Policy Changes: Question & Answers - Set 4 Topics covered in Set 4 include: - Provider Education - Audits - Autism Services Navigator (ASN) - Comprehensive Care Plan (CCP) - Reimbursements - Outcome Measures – General Questions - Documentation - Place of Service (PoS)
Autism Care Demonstration Policy Changes: Question & Answers - Set 5 Topics covered in Set 5 include: - CPT Codes - General - Concurrent Billing - CPT Code T1023 - Medical Team Conference (MTC) - CPT Code 97151 - CPT Code 97155 - CPT Code 97156 - CPT Code 97157/97158 - Clinical Necessity Reviews - ABA Discharge Summary

2021 ABA Maximum Allowed ACD Rates

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