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.
Beginning October 1, 2015, cost shares and copays will apply to your catastrophic cap. This will reduce out- of-pocket expenses for many ABA therapy beneficiaries.
Watch the Video: Autism Care Demonstration
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
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:
- 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 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.
For all ABA services (BCBA, BCaBA, BT), 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
>>View More Questions & Answers