Humana Military must receive completed outcome measures prior to issuing a treatment authorization. If your Applied Behavior Analysis (ABA) provider is unable to complete outcome measure scores, please contact us at (866) 323-7155 for further assistance.
Under the Autism Care Demonstration (ACD), TRICARE requires the following outcome measures for beneficiaries participating in the ACD:
Outcome measures can be performed by a TRICARE-authorized Autism Spectrum Disorder ASD-diagnosing providers. If your provider is unable to complete the measures, Humana Military has partnered with Rethink Autism Inc. to complete them with you remotely from any location in the TRICARE East Region.
Humana Military does not require a referral from the Primary Care Manager (PCM) or an ASD-diagnosing provider. In order to meet access to care standards, an authorization for outcome measures can be authorized to alternate preferred network provider.
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.
The Vineland-3 is used to aid in diagnosing and providing valuable information for developing both educational and treatment plans.
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 are required. The scores cannot be imbedded within the treatment plan or any other clinical documents.
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.
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.
The SRS-2 is a 65-item rating scale measuring deficits in social behavior associated with ASD.
The SRS-2 is used to identify social impairment and quantify level of severity.
The SRS-2 is categorized into age appropriate forms: preschool, school-aged male, school-aged female and adult. It 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 treatment plan or any other clinical documents.
The SRS-2 scores are standardized by comparing characteristics of a large sample population of people diagnosed with ASD, grouped by age and gender.
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.
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.
The PSI-4 is useful in designing a treatment plan, setting priorities for intervention or for follow up evaluation.
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 the treatment plan or any other clinical documents.
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 PSI-4 scores are not used for modification of the treatment plan but rather to support the individual family’s specific needs.
The PDDBI is an informant-based rating scale, designed to assist in the assessment (for problem behaviors, social, language and learning/memory skills) of children who have been diagnosed with Autism Spectrum Disorder (ASD). The PDDBI provides age-standardized scores for parent and teacher ratings. It is applicable for ages two through 18.5 years.
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 person falls within the spectrum of autism and the level of impact of symptoms.
Problem behaviors measured via the PDDBI include stereotyped behaviors, fears, aggression, social interaction deficits, and aberrant language associated with children with PDD having lower or high-functioning skills. Two forms for the teacher and parent consist of six domains (the extended forms measure 10 domains): Approach/Withdrawal Problems, Sensory/Perceptual Approach, Ritualisms/Resistance to Change, Social Pragmatic Problems, Semantic Pragmatic Problems, Arousal Regulation Problems (extended form), Specific Fears (extended form), Aggressiveness (extended form), Receptive/Expressive Social Communication Abilities, Social Approach Behaviors, Expressive Language, Learning, Memory, and Receptive Language (extended form). Each item is rated on a Likert scale, from “Never” to “Often/Typically.”
At baseline, only the PDDBI 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 be included. The ABA supervisor must complete the teacher form and cannot be delegated. 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 are required. The scores cannot be imbedded within the treatment plan or any other clinical documents.
The PDDBI scores are used to help develop the treatment plan and track progress.
The treatment plan 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.
The SIPA is a screening and diagnostic instrument that identifies areas of stress in parent adolescent interactions, allowing examination of the relationship of parenting stress to adolescent characteristics, parent characteristics, the quality of the adolescent-parent interactions, and stressful life circumstances. The SIPA is the upward age extension of the PSI-Fourth edition (PSI-4). It is applicable for ages 11-19 years.
The SIPA is used to provide a reliable way to measure stress and evaluate family dynamics specific to raising adolescents while showing progress over time. Understanding the origin of parental stress can assist the provider direct interventions to the beneficiaries.
The SIPA 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 the treatment plan or any other clinical documents.
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.
The SIPA scores are not used for modification of the treatment plan but rather to support the individual family’s specific needs.
