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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 an autism spectrum disorder.

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

Is your sponsor on active duty? You must register in the Extended Care Health Option (ECHO) to qualify for the Autism Care Demo.

Step 1: Get Diagnosed

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

Primary Care Physicians with the following specialties:

  • Family Practice
  • Internal Medicine
  • Pediatrics

We require testing Using the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) within one year to confirm the ASD diagnosis.

Specialized Diagnosing Providers who are board certified or board eligible in:

  • Behavioral Developmental 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 ask for a referral and authorization from your regional contractor or US Family Health Plan provider
  • You’ll get an authorization letter for ABA for one year.
  • A new referral and authorization is required each year

Step 3: Schedule an Appointment

You can schedule your appointment with the Board Certified Behavior Analyst (BCBA) listed in the authorization letter as soon as you get the letter.  >>Check the Status of Your Authorization

If you’d like to see a different BCBA than the one listed on your authorization letter, please contact your regional contractor.

Your behavior analyst 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 Board Certified Assistant Behavior Analysts (BCaBAs) or Behavioral Technicians 
  • Re-evaluate your child as needed

Your child’s individual treatment plan will say how much ABA they’ll get each week. The hours may be changed during re-evaluation.

Questions & Answers

How much ABA my child can get?

  • No age limits
  • No duration limits
  • Care is authorized for one year at a time

What can we expect during the course of treatment

  • Periodically: Re-evaluation and changes to the treatment plan
  • Every Six Months: Progress report
  • Every Year: New referral and authorization
  • Every Two Years: Medical Review to see if treatment is working

How much will we pay per appointment?

  • There’s no annual or lifetime dollar limit to the amount of ABA TRICARE may cover, if appropriate.
  • Your plan and type of provider determine how much you’ll pay.

If you see a BCBA with a Master’s degree or higher, you’ll pay the copayment or cost share for your plan:

  • Active duty family members with Prime: $0
  • Active duty family members with Standard/Extra (and TRICARE Reserve Select):
    • 15% in network
    • 20% out of network
  • Retired family members with Prime: $12
  • Retired family members with Standard/Extra (and TRICARE Retired Reserve):
    • 20% in network
    • 25% out of network
  • These amounts will apply to your annual catastrophic cap

If you see a BCaBA or a Behavior Technician:

  • You’ll pay a 10% cost share** for supervised ABA
  • This amount doesn’t count toward your annual catastrophic cap

**The monthly ECHO fees will satisfy the cost share for supervised ABA for active duty family members.

>>View More Questions & Answers

Last Updated 1/6/2015

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