Bread Crumbs

Autism Care Demonstration Simplifies TRICARE ABA Benefits

6/16/2014

Starting this summer, a new Applied Behavior Analysis (ABA) policy will cover all TRICARE beneficiaries with autism spectrum disorder (ASD) under a single benefit. The Autism Care Demonstration (ACD) will start July 25, 2014 and will run until Dec. 31, 2018. All beneficiaries currently receiving ABA under TRICARE will transition seamlessly to the new benefit with no gap in coverage by Dec. 31, 2014.

Currently, TRICARE beneficiaries with ASD get ABA covered by one of three programs, depending on their sponsor’s duty status. The ACD combines these programs into a single benefit that will stay with beneficiaries if they move from active duty, retire or switch TRICARE plans. All ASD patients will have the same access to care, regardless of sponsor status or plan.

TRICARE worked with military families, autism experts and advocacy groups to develop this policy and address concerns with previous TRICARE ABA policies. The ACD complies with the most recent Behavior Analyst Certification Board guidelines for ABA coverage.

The ACD offers several enhancements to previous ABA TRICARE programs. There are no annual or lifetime caps on the amount of ABA TRICARE will cover, simpler guidelines for starting coverage once a child has an ASD diagnosis and consistent rules for what type of Board Certified Behavior Analysts (BCAB) can perform covered ABA. Further, the ACD’s testing, authorization and review policies are simpler and offer parents and providers greater flexibility.

The notice of the ACD was published in the Federal Register on June 16, 2014. TRICARE is still developing policy language to implement this program. For more information, and to subscribe to email updates on the ACD, visit www.tricare.mil/aba.

Last Updated 10/22/2014