See What's Covered
Search the A-Z list for a list of covered services. Your coverage and out-of-pocket costs may vary based on who you are and your health plan option.
Applied Behavior Analysis
TRICARE covers applied behavior analysis (ABA) from Board-Certified Behavior Analysts for all TRICARE-eligible beneficiaries who are diagnosed with an Autism Spectrum Disorder.
Covered ABA under the basic TRICARE benefit includes:
- Functional behavioral assessment and analysis/Initial Behavioral Plan
- ABA services to the beneficiary
- Updated ABA Treatment Plan
- ABA interventions to family member/caregivers
In addition, TRICARE continues to provide all necessary treatment for Autism Spectrum Disorders, such as psychometric testing, physician services, psychological services, speech therapy, occupational therapy, physical therapy and prescriptions.
Qualifying for Applied Behavior Analysis under the Basic TRICARE Benefit Interim Policy
To qualify for ABA under the interim ABA policy, beneficiaries must be diagnosed with an Autism Spectrum Disorder by a TRICARE-authorized primary care provider or specialized Autism Spectrum Disorder provider, which includes:
- Any primary care manager if enrolled in TRICARE Prime, TRICARE Prime Remote, TRICARE Young Adult-Prime, or the US Family Health Plan
- TRICARE-authorized family practice, general medicine, internal medicine, and pediatric physicians if using TRICARE Standard and Extra, TRICARE Reserve Select or TRICARE Young Adult-Standard
- Physician board-certified or board-eligible in developmental pediatrics, neurodevelopmental pediatrics, pediatric neurology or child psychiatry
- Ph.D. or Psy.D. clinical psychologist working primarily with children
Approved ABA Providers
Only the following types of providers (working under the supervision of the referring provider) are authorized to provide ABA under the interim policy. TRICARE-authorized providers who:
- Have a current State license to provide ABA services; or
- Are currently State-certified as an Applied Behavioral Analyst; or
- Where such State license or certification is not available, are certified by the Behavioral Analyst Certification Board as a Board Certified Behavior Analyst
Individuals certified by the Behavioral Analyst Certification Board as a Board Certified Assistant Behavior Analyst are not TRICARE-authorized ABA providers under the basic TRICARE benefit.
TRICARE covers ABA reinforcement services provided by ABA Tutors in two ways:
- Active duty family membersBeneficiaries whose sponsors are currently serving on active duty in a uniformed service, including the U.S. Army, U.S. Air Force, U.S. Navy, U.S. Marine Corps, U.S. Coast Guard, Commissioned Corps of the U.S. Public Health Service, and Commissioned Corps of the National Oceanic and Atmospheric Association. Also included are beneficiaries whose sponsors are members of the National Guard and Reserves during the time the sponsor is called or ordered to active service for more than 30 consecutive days. continue to qualify for ABA reinforcement under the Extended Care Health Option (ECHO) Autism Demonstration. Active duty family members will continue to receive the same ABA reinforcement services under the ECHO Autism Demonstration as they are getting now without changes to the program. >>Learn More about the ECHO Autism Demonstration
- On July 25, 2013, a new ABA Pilot offering ABA reinforcement began for all non-active duty family membersBeneficiaries whose sponsors are not serving on active duty in a uniformed service, including sponsors who are: retired; survivors of deceased service members; Medal of Honor recipients no longer serving on active duty; and National Guard and Reserve members who are not currently serving on active duty for more than 30 consecutive days. . For the first time, this new benefit will offer non-active duty family members ABA reinforcement services similar to those offered to active duty family members under the ECHO Autism Demonstration.
The ABA Pilot for non-active duty family members offers ABA reinforcement. To qualify for ABA reinforcement, you must first qualify for ABA under the basic TRICARE benefit and then meet additional requirements for the pilot. If you choose to receive ABA reinforcement for your non-active duty family member under the ABA Pilot, your family member must meet the additional ABA Pilot requirements to continue receiving regular ABA under the basic TRICARE benefit. Non-active duty family members can continue to get ABA under the existing interim Basic Program guidance only if they choose not to take part in the pilot to receive ABA reinforcement. >>Learn More about the ABA Pilot
ABA Under Basic TRICARE Benefit
- Your health plan option determines out-of-pocket costs. >>View Costs by Plan
- No annual limitation on ABA, however, you will only pay up to your catastrophic cap for all services, including ABA
- Active duty families: $1,000
- Guard/Reserve families: $1,000
- Retired families: $3,000
ABA Reinforcement Under the ECHO Autism Demonstration or ABA Pilot
- TRICARE will cost share up to $36,000 annually for care under the ECHO Autism Demonstration or ABA Pilot
- For the ECHO Autism Demonstration, ECHO cost shares apply and ABA reinforcement is part of all ECHO services.
- For the ABA Pilot, a 10% cost share applies for non-active duty family members, which doesn’t count toward the TRICARE Standard deductible or the family’s catastrophic cap. Few, if any beneficiaries, will likely exceed the $36,000 annual cap applicable to ABA reinforcement.