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Autism Care Demonstration

The TRICARE Comprehensive Autism Care Demonstration (Autism Care Demo) covers applied behavior analysis (ABA) for all TRICARE beneficiaries diagnosed with autism spectrum disorder (ASD).

  • The demonstration started on July 25, 2014.
  • It will end on December 31, 2018.

Is your sponsor on active duty? To qualify, you must register in the Extended Care Health Option (ECHO). You only pay the ECHO monthly fee for ECHO services other than ABA.

Follow the steps below to get started:

Step 1: Get Diagnosed

Your child must by diagnosed by an approved diagnosing provider, which includes either:

A Primary Care Physician with the following specialties:

  • Family practice
  • Internal medicine
  • Pediatrics

We require either testing or evaluation by a specialized ASD diagnosing provider within one year to confirm the ASD diagnosis.

A Specialized ASD Diagnosing Provider who is board certified or board eligible in:

  • Developmental Behavioral Pediatrics
  • Neurodevelopmental Pediatrics
  • Pediatric Neurology
  • Adult or Child Psychiatry
  • Licensed Clinical Psychology, doctoral level

We don’t require more testing to confirm the ASD diagnosis.

Step 2: Get a Referral and Authorization

  • This is required for everyone in all TRICARE plans
  • Your diagnosing provider will submit a referral to your regional contractor or US Family Health Plan provider for authorization
  • You’ll get an authorization letter for ABA for six months.
  • A new referral and authorization is required every six months.

Step 3: Schedule an Appointment

When you get your authorization letter:

Your authorized ABA supervisor will:

  • Complete an ABA evaluation
  • Develop an individual treatment plan
  • Work one-on-one with your child
  • Help parents and caregivers
  • Supervise services provided by assistant behavior analysts and behavior technicians 
  • Re-evaluate your child as needed

Questions & Answers

How much ABA my child can get?

  • No age limits
  • No duration limits
  • Care is authorized for six months at a time

What can we expect during the course of treatment?

  • Periodically: Re-evaluation and changes to the treatment plan
  • Every Six Months: New referral and authorization
  • Every Two Years: Clinical necessity review to see if treatment is working

How much will we pay per appointment?

Your TRICARE plan determines how much you'll pay for all ABA services:

  • TRICARE Prime
    • Active duty family members: $0
    • Retired service members and families: $12
  • TRICARE Standard and Extra
    • Active duty family members:
      • 15% in network
      • 20% out of network
    • Retired family members:
      • 20% in network
      • 25% out of network
  • TRICARE Reserve Select
    • 15% in network
    • 20% out of network
  • TRICARE Retired Reserve
    • 20% in network
    • 25% out of network

These amounts will apply to your annual catastrophic cap. There’s no annual or lifetime dollar limit to the amount of ABA services TRICARE may cover, if appropriate. Learn more about your plan’s costs.

>>View More Questions & Answers

Watch the Video: Autism Care Demonstration

Last Updated 9/29/2015

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