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Outcome Measures

Health Net Federal Services, LLC (HNFS) must receive completed outcome measure scores before we can authorize treatment. If we have not received outcome measure scores from your applied behavior analysis (ABA) provider, we may contact you to coordinate their completion. We will work with you to help  resolve any barriers you have to getting these completed.

Outcome Measure Tools

Outcome measures help providers develop treatment plans and evaluate patient improvements (or regression). Under the Autism Care Demonstration (ACD), TRICARE requires the following outcome measures for beneficiaries participating in the ACD based on their age: 

  • Pervasive Developmental Disorder Behavior Inventory (PDDBI), 
  • Vineland Adaptive Behavior Scales, 3rd Edition (Vineland-3), 
  • Social Responsiveness Scale, Second Edition (SRS-2), and either, 
  • Parenting Stress Index, Fourth Edition, Short Form (PSI-4) or Stress Index for Parents of Adolescents (SIPA).

HNFS cannot authorize initial or ongoing ABA services until these required outcome measures are complete.

The name of the person completing all outcome measures and their relationship to the beneficiary must be indicated on all forms. 

Notes about the PSI-4 and SIPA: Research has shown that parents’ stress levels can impact the child and the child’s environment, which may affect their symptoms. The PSI-4 and SIPA are standardized, reliable measures of stress and family dynamics that help to identify where additional support resources may benefit both the family and the beneficiary. 

The PSI-4 and the SIPA stress indexes and scores are not factors for treatment planning or coverage determination. 

Who Can Perform Outcome Measures

The PDDBI must be executed by the responsible ABA supervisor conducting the assessment or reassessment. HNFS may authorize the additional four outcome measures to providers in our preferred outcome measure network. These providers have been identified as being capable of performing all four outcome measures (Vineland-3, SRS-2, PSI-4, SIPA) for any beneficiary within access-to-care standards. 
 

Key Facts about outcome measure authorizations

  • For the Vineland-3, SRS-2, PSI-4, and SIPA, your child may be authorized to an ABA provider who is not his or her treating provider. 
  • HNFS can authorize outcome measures directly to ABA providers without a referral from your child’s primary care manager or ASD-diagnosing provider. 
  • Outcome measure authorizations are separate from initial assessment/treatment authorizations. 
  • The outcome measures are all parent reports based on answering questions in a survey format. Your child does not need to be present or participate in the completion of the outcome measures.
  • HNFS’ preferred outcome measure network of providers can complete these with you remotely (via email or postal mail) from any location in the TRICARE West Region.
     

When Are Outcome Measures Required?

HNFS must receive scores for all applicable outcome measures before we can authorize ABA treatment. Outcome measures must be performed at the following intervals: 

Outcome Measure Baseline (prior to treatment authorization) Every Six Months Every Year
Parent PDDBI X X  
Teacher PDDBI   X  
Vineland-3 X   X
SRS-2 X   X
PSI-4 Short Form (age based) X X  
SIPA (age based) X X  

 

  • Baseline data is before the first treatment authorization. For beneficiaries new to the ACD only, we can accept the Vineland-3, SRS-2, SIPA, and PSI-4 scores for up to one year prior to the start of treatment.
  • Every six months/every year renewal dates are based on the date we receive the specific measure. 
  • The PSI-4 and SIPA have overlapping age ranges. The PSI-4 is appropriate for ages 1.5 up to 12 years and the SIPA is appropriate for ages 11–19 years. For beneficiaries aged 11 years old at the time of authorization/reauthorization, either measure will be accepted. For beneficiaries aged 12 years or older, they will complete the SIPA. 
  • Important: Outcome measures are completed within 90 days of their due date. If we receive outcome measure results too soon, you may need to repeat them within this time frame.

Outcome Measure Renewals

As of May 1, 2021, beneficiaries new to the ACD start on a one-year cycle for the Vineland-3 and SRS-2. Existing ACD beneficiaries have been transitioned from their current cycle to the new one-year cycle and were notified of their new dates. 

Future renewal periods will be based on the date the outcome measures are received by HNFS. This means each outcome measure may have its own chronological timeline based on date we received a valid and complete measure. 

How to Submit Scores

  • Civilian providers submit outcome measure scores to HNFS through our online authorization submission tool.
  • Beneficiaries and military hospitals or clinics can submit outcome measure scores via fax to 1-877-910-0945.


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