Autism Care Demonstration
Accolade is currently partnered with TRICARE® West Region contractor, Health Net Federal Services to provide Autism Services Navigation to eligible beneficiaries
Does your child qualify for the ACD?
To qualify for the ACD, your child must be:
Enrolled in a TRICARE® health plan
Diagnosed with ASD by an approved TRICARE® provider
Are you an active duty service member (ADSM)?
ADSMs with a child diagnosed with ASD must enroll in your service branch’s Exceptional Family Member Program. Your child must also enroll in the Extended Care Health Option (ECHO).
Step 1: Get Diagnosed
Eligible beneficiaries must have an autism spectrum disorder (ASD) (F84.0) diagnosis by a TRICARE-authorized primary care manager (PCM) or specialized ASD-diagnosing provider.
Diagnosis occurs under the TRICARE® basic benefit. TRICARE® beneficiaries nominated for the ACD must have their TRICARE-authorized ASD-diagnosing and referring provider submit either a referral or diagnostic evaluation stating a diagnosis of ASD using DSM-5 criteria to initiate the process for enrollment into the ACD. For definitive diagnosis requirements, please visit https://www.tricare-west.com/content/hnfs/home/tw/prov/autism-care-demonstration/eligibility.html.
Step 2: Get a Referral and a Authorization
After Health Net Federal Services, LLC (HNFS) has confirmed a beneficiary has met all initial eligibility and definitive diagnosis requirements for the Autism Care Demonstration (ACD), if not already received, the TRICARE-authorized primary care manager (PCM) or specialized ASD-diagnosing provider must submit an ABA referral to HNFS.
ABA referral requests must contain the following:
co-morbid diagnosis (if applicable)
symptom severity level/level of support (1-mild, 2-moderate, 3-severe)
statement the beneficiary needs ABA services
For more information, visit https://www.tricare-west.com/content/hnfs/home/tw/prov/autism-care-demonstration/referral.html.
Step 3: Complete ACD registration process with HNFS
For initial assessment and first treatment steps, visit https://www.tricare-west.com/content/hnfs/home/tw/prov/autism-care-demonstration/aba_auth_details.html
Step 4: Compete outcome measures
All beneficiaries must have complete, valid outcome measure scores in order for HNFS to process treatment authorization requests. TRICARE® requires the submittal of scores and related data points (signature of the respondent and their relationship to the beneficiary) from the following outcome measures:
Pervasive Developmental Disorder Behavior Inventory (PDDBI, 1.5 years–18.5 years)
Vineland Adaptive Behavior Scales, 3rd Edition (Vineland-3, 0 years–99 years)
Social Responsiveness Scale, Second Edition (SRS-2, 2.5 years –99 years), and
Parenting Stress Index, Fourth Edition, Short Form (PSI-4-SF, 0 years–12 years) or
Stress Index for Parents of Adolescents (SIPA, 11 years–19 years and 11 months)
For more information, visit https://www.tricare-west.com/content/hnfs/home/tw/prov/autism-care-demonstration/outcome_measures.html
Step 5: Connect with Accolade Autism Service Navigator
The Autism Service Navigator will be assigned after the enrollment criteria has been met. The ASN will serve as a primary health care advocate for the beneficiary and the family. For more information, visit https://www.tricare-west.com/content/hnfs/home/tw/prov/autism-care-demonstration/autism-services-navigator.html