Humana Military must receive completed outcome measures prior to issuing a treatment authorization. All outcome meausres may be completed no earlier than 90 days to their respective due date per TRICARE Operations Manual (TOM) Ch. 18, Sec. 4, Para. 8.6.4.7. If the Applied Behavior Analysis (ABA) provider is unable to complete outcome measure scores, please contact us at (866) 323-7155 for further assistance. TRICARE requires the submittal of scores and related data points (signature of the respondent and their relationship to the beneficiary) from the outcome measures outlined below.
Outcome measures can be performed by TRICARE-authorized ASD-diagnosing providers or, when authorized by Humana Military, ABA providers (Board Certified Behavior Analyst (BCBA) or BCBA-D) who can administer the Vineland-3, SRS-2 and PSI-4-SF/SIPA.
If the ABA provider is unable to complete the outcome measures, please contact Humana Military at (866) 323-7155.
Humana Military does not require a referral from the Primary Care Manager (PCM) or an ASD-diagnosing provider. Alternate providers are able to complete outcome measures under the basic benefits – requirements apply according to the specialty of the provider completing the measures. Humana Military communicates with providers ensuring all requirements are met within a timely manner. Please ensure all contact information is up to date.
Please contact Humana Military at (866) 323-7155 or log into provider self-service to update any provider information necessary.
What is the Vineland-3?
The Vineland-3 is a valid and reliable measure of adaptive behavior for individuals diagnosed with intellectual disabilities and developmental disabilities (to include ASD). The Vineland-3 consists of an interview, a parental/caregiver, and teacher rater forms. It is applicable for ages birth to 90 years.
Why is the Vineland-3 used?
The Vineland-3 is used to aid in diagnosing and providing valuable information for developing educational and TPs.
What are the Vineland-3 submission requirements?
The Parent/Caregiver and Teacher forms must be completed at baseline and annually thereafter. The provider must submit all composite scores for communication, daily living, socialization, motor skills, adaptive behavior, composite score and both maladaptive behavior composite scores (internalizing and externalizing) using either manual or publisher scoring. The full publisher print report or hand-scored protocols that includes T-scores are required. The scores cannot be imbedded within the TP or any other clinical documents. The name of the person completing the form and their relation to the beneficiary must match and be included on all forms.
How do providers use the Vineland-3 scores?
The Vineland-3 converts all raw scores into standard scores or T-scores generating five major domain composite scores: communication, daily living skills, socialization, adaptive behavior composite, and motor (for beneficiaries under nine years old). The scores are calculated into a percentile rank. A percentile rank is the percentage of individuals in the individual's normative age group who scored the same or lower than the individual.
When do Vineland-3 scores indicate the need for modification of the TP?
The TP may need to be modified during the annual review if the beneficiary has made limited progress, has shown signs of regression, or met targeted goals.
What is the SRS-2?
The SRS-2 is a 65-item rating scale measuring deficits in social behavior associated with ASD. It is applicable for ages 2 ½ through 99 years.
Why is the SRS-2 used?
The SRS-2 is used to identify social impairment and level of severity.
What are the SRS-2 submission requirements?
The SRS-2 is categorized into age appropriate forms: preschool, school-aged male, school-aged female and adult. The Parent Form must be completed at baseline and annually thereafter. The full publisher print report or hand-scored protocols are required. The scores cannot be imbedded within the TP or any other clinical documents. The name of the person completing the form and their relation to the beneficiary must match and be included on all forms.
How do providers use the SRS-2 scores?
The SRS-2 scores are standardized by comparing characteristics of a large sample population of people diagnosed with ASD, grouped by age and gender.
When do SRS-2 scores indicate the need for modification of the treatment plan?
The treatment plan may need to be modified during the annual review if the beneficiary has made limited progress, has shown signs of regression, or met targeted goals.
What is the PSI-4?
The PSI-4 is a measure used for screening/triaging, and evaluating the parenting system and identifying issues that may lead to problems in the child’s or parent’s behavior. It focuses on three major domains of stress: child characteristics, parent characteristics, and situational/demographic life stress. The PSI-4 is commonly administered in medical centers, outpatient therapy settings, and pediatric practices. Applicable for ages birth through 12 years old.
Why is the PSI-4 used?
The PSI-4 is useful in designing a TP, setting priorities for intervention or for follow up evaluation.
What are the PSI-4 submission requirements?
The PSI-4 must be completed at baseline and every six months thereafter. Only the short form is required. The full publisher print report or hand-scored protocols are required. The scores cannot be imbedded within theTP or any other clinical documents. The name of the person completing the form and their relation to the beneficiary must match and be included on all forms.
How do providers use the PSI-4 scores?
The PSI-4 is designed to provide an indication of the overall level of parenting stress that an individual is experiencing. It is not intended to diagnose dysfunction in the parent-child relationship, or to be a screening tool of parental mental health problems. The intent of the PSI is to identify potential resources for the beneficiary and family.
When do PSI-4 scores indicate the need for modification of the TP?
The PSI-4 scores are not used for modification of the TP but rather to support the individual family’s specific needs.
What is the PDDBI?
The PDDBI is an informant-based rating scale, designed to assist in the assessment (of problem behaviors, social, language and learning/memory skills) in children who have been diagnosed with (ASD). The PDDBI provides age-standardized scores for parent and teacher ratings. It is applicable for ages two through 18.5 years.
Why is the PDDBI used?
TRICARE has selected the PDDBI as it focuses on the core deficits of ASD based on the DSM-5 criteria. This measure allows for an understanding of where a individual falls within the spectrum of autism and the level of impact of their symptoms.
Problem behaviors measured include stereotyped behaviors, fears, aggression, social interaction deficits, and aberrant language associated with children with Pervasive Developmental Disorder (PDD) having lower or high-functioning skills. Each item is rated on a Likert scale, from “Never” to “Often/Typically. The standard teacher and parent forms consist of six domains and the extended forms measures 10 domains:
Each item is rated on a Likert scale, from “Never” to “Often/Typically.”
What are the PDDBI submission requirements?
At baseline, only the parent form is required. Each authorization request thereafter will require both the parent and the teacher form. The name of the person completing the form and their relation to the beneficiary must match and be included on all forms
The ABA supervisor is required to complete the teacher form. The Domain/Composite Score Summary Table including all domains must be included, as well as the composite T-scores and the total autism composite score. The full publisher print report or hand-scored protocols must be submitted. The scores cannot be imbedded within the TP or any other clinical documents.
How do ABA providers use PDDBI scores?
The PDDBI scores are used to help develop the TP and track progress.
When do PDDBI scores indicate the need for modification of the TP?
The TP may need to be modified during the six-month review if the beneficiary has made limited progress, has shown signs of regression, or met targeted goals.
What is the SIPA?
The SIPA is a screening and diagnostic instrument that identifies stress areas within parent-adolescent interactions. It facilitates an in-depth analysis of the correlation between parenting stress and various factors, including adolescent characteristics, parental attributes, the quality of interactions between parents and adolescents and external stressful life circumstances. The SIPA is the upward age extension of the PSI-Third Edition (PSI-3). It is applicable for ages 11 – 19 years.
Why is the SIPA used?
The demands and stress for caring for a family member diagnosed with ASD may increase stress levels. The SIPA measures stress and evaluates family dynamics with adolescents and these stressors over time. It is a used to identify resources to assist the beneficiary and their family.
What are the SIPA submission requirements?
The SIPA is completed at baseline and every six months thereafter. Only the short form is required. The full publisher print report or hand-scored protocols are required. The scores cannot be imbedded within theTP or any other clinical documents. The name of the person completing the form and their relation to the beneficiary must match and be included on all forms.
How do providers use the SIPA scores?
The SIPA is designed to provide an indication of the overall level of parenting stress that an individual is experiencing. It is not intended to diagnose dysfunction in the parent-child relationship, or to be a screening tool of parental mental health problems it is to identify potential resources for the beneficiary and family.
When do SIPA scores indicate the need for modification of the treatment plan?
The SIPA scores are not used for modification of the TP but rather to support the needs of the beneficiary and family.