Parents of austic children have new opportunities for care through updates made to TRICARE’s Autism Care Demonstration (ACD) program, which went into effect January 1, 2022. These improvements help TRICARE better address the needs of family members with Autism Spectrum Disorder (ASD) and give parents more input in developing the care plan for their child. Parent training is an important new focus of the ACD and providers must now start parent training within 30 days of the initial authorization period.

Autism Services Navigators were assigned to new beneficiaries beginning October 1, 2021. “New” is defined as: those not currently receiving Applied Behavior Analysis (ABA) services under the ACD or those with a gap in ABA services of greater than 12 months.

The Role of an Autism Services Navigator (ASN)

• Serves as a primary healthcare advocate for the beneficiary and family.
• Help the family navigate the benefits and resources available through the ACD.
• Collaborates with all stakeholders for the beneficiary.
• Oversees assessment, planning, facilitation, care coordination and evaluation.

The ASN must have clinical experience in: pediatrics, behavioral health (BH), and/or ASD; a healthcare environment; and proven care management experience.

They must hold a current, valid, unrestricted license which include:

• Registered Nurse (RN) with case management (CM) experience
• Clinical Psychologist
• Licensed Clinical Social Worker other licensed mental health professionals who possess a certification in CM

An ASN is applicable to beneficiaries enrolled in Health Net Federal Services and Humana Government Business. Those currently enrolled in the ACD and receiving ABA services, but moving from one region to another will NOT count as a “new” beneficiary.

Note: TRICARE Overseas Program, U.S. Family Health Plans, and TRICARE for Life are NOT required to provide the ASN.

Things to Expect from an ASN

For the beneficiary/family, the ASN will:

• Make first contact with the beneficiary/family once a referral to the ACD or ABA services has been placed
• Develop a CCP
• Coordinate medical and BH services, MTF services, ECHO services, respite services, ABA services, parent-medicated programs, etc.
• Ensure all services work in collaboration to achieve the optimal outcome
• Coordinate and participate in medical team conferences
• Facilitate continuity of care when a beneficiary moves, sponsor retires, or a treating provider becomes unavailable
• Identify and facilitate connections with local level resources
• Provide educational resources about ASD Things to expect from an ASN 10

For treating providers, the ASN will:

• Share the CCP
• Be the central point of contact for that beneficiary/family
• Coordinate and participate in medical team conferences
• Share outcome measures data with the team of treating providers

What Is a Comprehensive Care Plan (CCP)?

A plan that is developed and maintained by the ASN and allows for a more consistent and beneficiary-centric approach.

The CCP will:

• Identify all care and services for each new beneficiary in the ACD
• Document outcome measures and timelines
• Document PCS timelines (where applicable)
• Develop a discharge/transition plan

The CCP is updated every six months, in line with the continued authorization of ABA services. After a referral is submitted and the ASN makes contact, a CCP will begin development, including but not limited to:

• Intake
• Review of services (current and recommended)
• Incorporation of all outcome measures
• IEP (if available)

The CCP must be completed within 90 days.

Referrals to approved services will be authorized; however, if the CCP is not completed within 90 days due to family/beneficiary non-compliance, ABA services will be put on hold until the CCP is completed.

Learn more in the TRICARE Newsroom: TRICARE Comprehensive Autism Care Demonstration Program

*The ASN role starteds October 1, 2010/1/21 and is available to new beneficiaries entering the program after that date. However, current beneficiaries may access contractor-care/case management services, MTF case management services, or EFMP** care coordination/case management services. 8*EFMP is a Service-owned program (not medical) that has 3three purposes: identification/enrollment, assignment coordination, support to help families identify services/programs. These services are outside of Private Sector Care/the TRICARE benefit. The ASN will be specific to the TRICARE benefit and will be someone that can help the families connect all the pieces. The scope of collaboration, advocacy, and oversight is more comprehensive than the EFMP coordinator.