In a recent webinar entitled “TRICARE® Autism Care Demonstration” participants were provided an overview of Applied Behavior Analysis (ABA), in addition to advice for service providers and military families on how best to assist beneficiaries under the Autism Care Demonstration (ACD).
Question: What training are you requiring pediatricians providing services at military medical facilities to heave in terms of understanding Applied Behavior Analysis (ABA) and the challenged of the referral system?
Advice: Pediatricians are educated in the diagnosis of Autism Spectrum Disorder (ASD) as part of their medical educational training. Pediatrician state licensure includes the scope of practice to diagnose ASD. The education and training of developmental pediatricians and behavioral-developmental pediatricians includes specialized education and training on the diagnosis and treatment of developmental disorders, to include ASD. This is why the Autism Care Demonstration (ACD) diagnosing provider within two years of diagnosis by a Primary Care Manager (pediatricians, family medicine and internal medicine physicians). Specialized ASD diagnosing providers under TRICARE includes developmental pediatricians, doctoral level licensed clinical psychologists, child psychiatrists, child neurologist and doctors of nursing practice meeting certain criteria.
Question: Would you please give more detail and clarify what is involved in the 2-year review?
Advice: Every two years from the initial authorization, the Managed Care Support Contractors (MCSC) conduct a clinical review to review clinical necessity for continued ABA services under the ACD. The clinical review takes into account the beneficiary’s current ASD status and treatment needs, to include progress towards meeting ABA treatment objectives and goals, referring provider input and parent/caregiver input. Outcome measures will be required at baseline and every two years as part of the ‘every two-year review’ once the revised ACD policy goes into effect in January 2017. Three outcome measures will be required: Autism Diagnostic Observation Schedule 2nd edition (ADOS-2), the appropriate Wechsler Intelligence Scale, and the Vineland 3 which is a global measure of functioning.
Expert: Theresa A. Hart, RNC MS, Nurse Consultant/Program Manager, Perinatal, Pediatrics and Special Medical Programs Defense Health Agency Clinical Support Division
This blog series provides advice from subject matter experts on issues surrounding military caregiving for service providers and families. We take questions and concerns from military helping professionals and families and provide the necessary feedback from credible experts in the field of study. Whether you are a provider or a caregiver, what questions do you have? We want to hear from you.
This MFLN-Military Caregiving concentration blog post was published on January 6, 2017.