Getting Care

Follow the steps below to get started:

Step 1: Get Diagnosed

Your child must by diagnosed by an approved diagnosing provider, which includes either:

A Primary Care Physician in the following specialtiesA branch of medicine or surgery that a doctor specializes in.:

  • Family practice
  • Internal medicine
  • Pediatrics

A Specialized ASD Diagnosing Provider in the following specialties:

  • Board Certified or Board Eligible physicians in the following disciplines:
  • Licensed Clinical Psychology, doctoral level
  • Doctors of Nursing Practice, meeting certain criteria
    • Developmental Behavioral Pediatrics
    • Neurodevelopmental Pediatrics
    • Pediatric Neurology
    • Adult or Child Psychiatry

Note: All beneficiaries must complete the outcomes measures within two years of entry into the program and every two years after that.

Step 2: Get a Referral and Authorization

  • This is required for everyone in all TRICARE plans.
  • Your diagnosing provider will submit a referral to your regional contractor or US Family Health Plan provider for authorization.
  • You’ll get an authorization letter to cover six months of ABA services from an authorized ABA supervisor.
  • Your authorized ABA supervisor will request continuation of ABA services every six months.
  • You’ll get a new authorization letter for the next six months of ABA services from your regional contractor.
    • A new referral from your primary care physician or ASD diagnosing provider is required every two years.

Step 3: Schedule an Appointment

When you get your authorization letter:

Your authorized ABA supervisor 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 assistant behavior analysts and behavior technicians 
  • Re-evaluate your child as needed

Step 4: Schedule an Appointment for Any Special Testing

  • All beneficiaries must complete outcomes measures within two years of entry into the program and then again during each subsequent two year period.

Questions & Answers

How much ABA my child can get?

  • No age limits
  • No duration limits
  • ABA services are authorized for six months at a time
  • Weekly hours are based on the individual needs of the child

What can we expect during the course of ABA services?

  • Periodically: Re-evaluation and changes to the treatment plan
  • Every Six Months: Authorized ABA supervisor will request continuation of ABA services
  • Every Two Years: New referral from your primary care physician or ASD diagnosing provider followed by a new authorization for the next six months of ABA services.

How much will we pay per appointment?

Your TRICARE plan determines how much you'll pay for all ABA services.

These amounts will apply to your annual catastrophic cap. There’s no annual or lifetime dollar limit to the amount of ABA services TRICARE may cover, if appropriate. Learn more about your plan’s costs.

>>View More Questions & Answers

Last Updated 2/15/2017

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