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
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.
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