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Applied Behavior Analysis

Covered by TRICARE?Limits
Yes

TRICARE covers Applied Behavior Analysis (ABA) through a combination of benefits:

  • Basic TRICARE coverage (for everyone with Autism Spectrum Disorder)
  • The Extended Care Health Option Autism Demonstration (for active duty family members) 
  • The Applied Behavior Analysis Pilot (for non-active duty family members

Federal Register Notice creates the new TRICARE Comprehensive Autism Care Demonstration (Autism Care Demo) that will:

  • Replace these three ABA benefits
  • Cover ABA for all beneficiaries with Autism Spectrum Disorder
  • Keep most of the current rules
  • Be available in the United States and U.S. territories, with some limited availability overseas

We are now finalizing policy language to implement new Autism Care Demo.

  • Details will be announced when the policy is finalized.
  • Requests that meet the criteria will be processed retroactive to the July 25th.
  • You should save any receipts for services covered by this policy.

If your child is getting ABA or related services now:

  • You don’t need to do anything
  • You’ll be moved automatically to the new program
  • There will be no changes to your current treatment plan

Current ABA Coverage

TRICARE covers the following services under the basic ABA benefit. But, they must be provided by TRICARE-authorized Board-Certified Behavior Analysts.

  • Functional behavioral assessment and analysis
  • Initial ABA Treatment Plan
  • ABA services
  • Updated ABA Treatment Plan
  • ABA interventions to family member or caregivers

We also cover other care you may need for Autism Spectrum Disorders:

ABA Tiered-Model Services

Tiered-model ABA services are provided by Board Certified Assistant Behavior Analysts (BCaBAs) and ABA Tutors.* BcaBAs and ABA tutors:

  • Must be supervised by a Board-Certified Behavior Analyst.
  • Provide direct one-on-one ABA services in the home, school or community setting.

Currently, how you get these tiered model services depends on who you are:

*ABA Tutors are called Behavior Technicians under the new Autism Care Demo.

Costs for ABA Services

Benefit Costs Caps
Basic TRICARE Coverage Your out-of-pocket costs depend on your TRICARE plan.
  • No annual limit on ABA.
  • You’ll only pay up to your catastrophic cap for all services, including ABA
ECHO Autism Demonstration You’ll pay part of the monthly costs for authorized services, just like other ECHO benefits. 
  • TRICARE pays up to $36,000 annually in cost shares. 
  • This amount doesn't count toward your annual catastrophic cap.
ABA Pilot You pay a 10% cost share.  
  • This doesn’t count toward your TRICARE Standard deductible or your family’s catastrophic cap.
  • TRICARE pays up to $36,000 annually in cost shares.

Last Updated 10/2/2014

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