Through U.S. District Court order, TRICARE Management Activity (TMA) was ordered to cover Applied Behavior Analysis (ABA) therapy under TRICARE as a medical benefit for all eligible beneficiaries. This is an interim benefit in effect immediately until litigation is complete.

This interim ABA therapy benefit is separate from the Enhanced Access to Autism Services Demonstration available to active duty family members who qualify for the Extended Care Health Option (ECHO).

An interim policy is in place, but TMA is still working on details about the coverage and how to get ABA therapy services. Here's what we know so far:

• The coverage is retroactive to February 16, 2010 in the United States and February 16, 2008 overseas, in accordance with TRICARE filing deadlines and policy.
• Beneficiaries are asked to save their receipts for any care received that could potentially be reimbursed by TRICARE under this new benefit.
• ABA services under the TRICARE medical benefit will require a specific autism spectrum disorder (ASD) diagnosis rendered by a TRICARE authorized primary care provider or specialized ASD provider, as follows:
  • Primary care manager (PCM) under the TRICARE Prime or TRICARE Prime Remote programs;
  • TRICARE-authorized family practice, general medicine, internal medicine, and pediatric physicians under the TRICARE Standard and Extra program; or
  • Military treatment facility provider or team of providers or a network provider to whom a beneficiary is assigned for primary care services at the time of enrollment in TRICARE Prime.
  • Physician board-certified or board-eligible in behavioral developmental pediatrics, neuro-developmental pediatrics, pediatric neurology or child psychiatry; or
  • Ph.D. clinical psychologist working primarily with children

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