Responsibilities

• At least 18 months of age
• Enrolled in the Extended Care Home Option (ECHO)
• Diagnosis is made by a TRICARE authorized Primary Care Manager who is a board-certified physician or a TRICARE authorized PhD clinical psychologist working primarily with children.
• Diagnosed with:
  • Autistic Disorder
  • Childhood Disintegrative Disorder
  • Asperger’s Syndrome
  • Pervasive Developmental Disorder Not Otherwise Specified
• Provide HMHS with the beneficiary’s Individualized Family Service Plan (IFSP) or the Individualized Education Program (IEP) documenting that the beneficiary is receiving Early Intervention Services or Special Education, respectively.  If the child is home schooled or enrolled in a private school and not required by State law to have an IEP, the PCM or Specialized ASD Provider must certify to HMHS that the child requires participation in the Demonstration.

In order for care to be authorized a Behavior Plan (BP) must be submitted to the Case Manager and must include:

• Beneficiary’s name, DOB, date Functional Behavioral Assessment and Analysis was completed, sponsor’s Social Security Number (SSN), name of referring provider; and
• Background and history that clearly demonstrates the condition, diagnosis, family history, length of time the beneficiary has been receiving EIA services and identification of any services/therapies being received through community resources; and
• How the EIA Supervisor will coordinate EIA services with available community services; and
• Goals that provide a detailed description of the targeted skills and behaviors that will be addressed through EIA sessions and the objectives that will be measured; and
• Administration of any diagnostic tests to assess skill acquisition or behavior modification; and
• Frequency and method of assessing progress; and
• Extent of parental training to implement and reinforce skills and behaviors and to provide support for implementing strategies within a specified setting.

After the initial authorization of EIA services, ongoing care must also be authorized.  At lease every six months, or as specified by the Case Manager, an updated BP with an EIA Progress Report (EPR) must be submitted that includes:

• Beneficiary’s name, DOB, inclusive dates of the evaluation period, sponsor’s SSN, name of referring provider; and
• Summary of progress; and
• Summary of challenges to meet goals and objectives; and
• Parent/caregiver participation in implementing the BP during the evaluation period; and
• Detailed review/update of all BP elements; and
• Dates of the plan being updated; and
• Number of EIA hours of service to be provided each month by the EIA Supervisor and the EIA Tutor.

EIA Supervisors are responsible to ensure the BP is being administered by the Tutor in an effective manner.  To confirm that the quality of services provided by EIA Tutors meet the minimum evidence-based standards as indicated by the current BACB Task List, the BACB Professional Disciplinary Standards, the BACB Guidelines for Responsible Conduct for Behavior Analysts, and Current BACB rules and regulations, the EIA Supervisors must provide no less than two hours of supervision per month for each beneficiary seen by a contracted or employed Tutor.

Providers must ensure ongoing compliance with all participation requirements and report to HMHS within 30 days of notification of any BACB sanctions for any violations or loss of BACB certification.

At intervals specified by HMHS, EIA Supervisors must cooperate with participation criteria compliance and quality of care and service audits.

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