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Autism Services Navigators

Autism Services Navigators (ASNs) oversee and/or collaborate with families, helping them navigate: 

  • Autism spectrum disorder (ASD) evaluation
  • Coordination and facilitation of care
  • Assessments throughout ACD care
  • Promotion of individualized options and services

The ASN’s role is that of a health care advocate; they do not perform clinical necessity reviews of treatment plans or make TRICARE coverage determinations. 

Eligible beneficiaries who decline the services of an ASN lose ACD program eligibility. 

What licensing or certification requirements must an Autism Services Navigator meet?

An ASN must have one of these licenses or certifications (Note: License or certification must be current):

  • Registered Nurse (Note: Must have case management experience)
  • Clinical psychologist
  • Licensed clinical social worker (LCSW)
  • Other licensed mental health professional (Note: Must be certified in case management)

In which clinical areas must an Autism Services Navigator have experience? 

  • ASD
  • Mental/behavioral health
  • Pediatrics

Are there additional areas in which an Autism Services Navigator must have experience? 

  • Health care environment
  • Care management 

Who is eligible to receive the services of an Autism Services Navigator? 

As of Oct. 1, 2021, Health Net Federal Services, LLC (HNFS) assigns an ASN to a beneficiary who is new to the Autism Care Demonstration (ACD) once the beneficiary has met enrollment criteria. The assigned ASN will then serve as the primary health care advocate for the beneficiary and the beneficiary’s family, helping navigate ACD benefits and resources.

What is the process for being assigned an Autism Services Navigator? 

To reduce any potential gaps in care, HNFS introduces the ASN concept during the pre-enrollment phase. This ensures beneficiaries enrolled in the ACD understand the requirements of the program, the role of an ASN and steps for getting care once enrolled. 

Prior to HNFS authorizing applied behavior analysis (ABA) services and within three business days of a beneficiary’s enrollment, TRICARE requires ASNs to contact assigned beneficiaries to:

  • Make an introduction.
  • Confirm their contact information.
  • Educate on an ASN’s role.
  • Explain what the beneficiary/family can expect with care coordination.
  • Conduct an initial intake evaluation.
  • Begin the process for developing the beneficiary's Comprehensive Care Plan (CCP). 

Comprehensive Care Plan

For beneficiaries assigned an ASN, the ASN will work with the family to develop a written CCP that is specific to the needs of the beneficiary and their family. CCPs complement, but do not replace, treatment plans developed by ABA providers. 

What are the requirements of a Comprehensive Care Plan? 

Written CCPs must be in place within 90 calendar days of an ASN being assigned to the family and must be updated every six months (including updated outcome measures). 

CCPs cover:

  • Care and services related to diagnosing ASD 
  • Timelines for transition (e.g., permanent change of station)
  • Discharge planning
  • Transition planning
  • Outcome measure results

The ASN will let a beneficiary’s parents/caregivers, primary care manager (PCM) and/or referring provider know once the beneficiary’s CCP has been completed and share the CCP with these providers prior to the beneficiary starting ABA services under the ACD. 

Important: ABA services may be suspended if the beneficiary’s CCP is not completed within applicable timelines. 

How does the Autism Services Navigator coordinate care?

An ASN functions as a single point of contact for a beneficiary/beneficiary’s family, other health care providers and military hospitals and clinics (if applicable). 

Coordination efforts cover:

  • ABA and medical services (e.g., physical therapy, occupational therapy, etc.)
  • Extended Health Care Options (ECHO) services
  • Exceptional Family Member Program (EFMP) services
  • CCP-related services
  • Treatment goals and CCP goals that are complementary and meet a beneficiary’s needs
  • Medical team conference meetings and documentation

How does the Autism Services Navigator promote continuity of care?

An ASN works to ensure a beneficiary has treatment continuity of care for events such as moving or provider unavailability. Once a beneficiary’s family or a health care provider has notified HNFS of a permanent change of station or transition:

  • For at least one month up to and one month after moving to another region, a beneficiary shall be covered by two ASNs (one for the previous region and one for the new region). These ASNs will communicate with each other to ensure smooth transfer of services.
  • Within 10 calendar days of having been notified of a beneficiary relocating, the ASN in the previous region will send all of the beneficiary’s ACD-related documentation to the ASN in the new region.
  • The ASN in the new region will work with the beneficiary’s family to make sure no required information is missing and that all ACD program requirements continue to be met.

 

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