Enhanced Access to Autism Services Demonstration

The Enhanced Access to Autism Services Demonstration allows eligible beneficiaries to have access to a greater range of existing evidence-based Educational Interventions for Autism Spectrum Disorders (EIA) services through an expanded network of educational intervention providers.

Currently, the demonstration is only available in the United States and the District of Columbia.

Eligibility

The demonstration is available to ECHO-registered beneficiaries, age 18 months and older who are diagnosed with one of the following:

• Autistic Disorder (AD)
• Rett’s Syndrome
• Childhood Disintegrative Disorder (CDD)
• Asperger's Syndrome (AS)
• Pervasive Developmental Disorder Not Otherwise Specified (PDDNOS)

If diagnosed before this demonstration began (March 15, 2008), children do not need to be re-diagnosed. To begin services:

• Submit your child's Individualized Family Service Plan (IFSP) or Individualized Education Program (IEP) documentation to your regional contractor.
• If your child is home-schooled and your state does not require an IFSP or IEP, provide a letter from your child's primary care provider or specialized ASD provider verifying that the child's disability related to Autism results in dysfunction severe enough to require special education and other support services.
• Send your child's behavioral plan to the medical provider who will oversee your child's autism care.

To see if your child may qualify and to get started, please contact your regional contractor and discuss your options with your child's primary care provider.

Benefits

The demonstration covers EIA services that:

• Implement basic principles of Applied Behavior Analysis and target behaviors associated with the core deficits of ASD
• Focus on changing the child's behavior by observing and measuring the behavior in real-life environments
• Use scientific behavioral data to identify functional relationships between environmental events and behavior
• Gather behavioral data to track progress in reaching behavioral objectives identified in the Behavior Plan and periodically modifies the plan to adapt to the child's response to the intervention.
• Incorporate parent training so family members/caregivers can teach and support skills during typical family activities
• Require meetings between family members/caregivers and those designing and implementing the intervention program.

Educational Intervention Providers

This demonstration expands the definition of EIA Supervisors and adds a new provider class, EIA Tutors, both of which should increase the number of providers available to provide EIA services to participating beneficiaries. All EIA Supervisors must be participating TRICARE-authorized providers in order to render services within this demonstration.

Costs and Coverage Limits

You must pay part of the monthly expenses for authorized benefits under this demonstration, just as you would with any other ECHO benefit.  You only pay the cost share if you receive covered autism services during the calendar month. Additionally, autism services apply towards your annual ECHO coverage limits.

For Continued Services

• Complete standardized testing of your child's verbal and non-verbal IQ in the first 12 months of receiving services under the Demonstration. Intelligence testing performed prior to the initiation of the Demonstration or performed by a local education authority or any tester that is or would be eligible as a TRICARE-authorized provider is acceptable in meeting this requirement.
• If your child is unable to participate in intelligence testing, a letter from your primary care provider or Specialized ASD Provider is required to continue participation in the Demonstration every six months after the period described above.
• Complete standardized testing of your child's language skills and adaptive behavior in the first 12 months of receiving services. Language skills and adaptive behavior testing completed within the 24 months prior to initiation of EIA services under the Demonstration meets this requirement.
• Send behavioral plan and EIA Progress Report (developed by the EIA Supervisor) to the medical provider who is overseeing your child's autism care for review and approval every 6 months.
• Submit documentation to your regional contractor every six months verifying yearly completion of classroom
  and practical training by at least one identified parent/caregiver. (Your ECHO case manager can provide more information on how to fulfill this requirement)