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? You must enroll in the Exceptional Family Member Program (EFMP) and register in the Extended Care Health Option (ECHO) to qualify for the Autism Care Demo.
Follow the steps below to get started now:
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 Behavior 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 from now until September 30, 2015?
If you see a Board-Certified Behavior Analyst with a master’s degree or higher, you’ll pay the applicable copayment or cost-share for your plan (e.g. TRICARE Prime, TRICARE Standard):
- Active duty family members (ADFMs) with TRICARE Prime: $0
- ADFMs with TRICARE Standard and TRICARE Extra, as well as TRICARE Reserve Select beneficiaries:
- 15% with a network provider (Extra)
- 20% percent with a non-network provider
- Retired family members with TRICARE Prime: $12 Retired family members with TRICARE Standard and TRICARE Extra, as well as TRICARE Retired Reserve beneficiaries:
- 20% with a network provider (Extra)
- 25% with a non-network provider
- These amounts will apply to your annual catastrophic cap.
If you see a Board-Certified Assistant Behavior Analyst or a Behavior Technician:
- ADFMs pay the monthly ECHO fee only for any month in which supervised ABA is received*
- Non-ADFMs pay a 10% cost-share for supervised ABA
- These amounts do not apply to your catastrophic cap.
*ADFMs must enroll in EFMP and register for ECHO to participate in the Autism Care Demo (unless waived in specific situations).
How are my costs changing on October 1, 2015?
Beginning October 1, 2015:
- You'll only pay the outpatient cost shares and copays for your TRICARE plan, per appointment.
- The 10% cost share for tiered services will no longer apply for non-active duty family members
- All costs for all beneficiaries will apply to the annual catastrophic cap.
Please check back to this page for details as new program information is made available.
>>View More Questions & Answers
Watch the Video: Autism Care Demonstration