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
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
* You must complete the outcomes measures within one year of entry into the program and at the periodic ABA program review.
** You must complete it every two years thereafter. If the initial diagnosis is made by your Primary Care Manager (PCM), you must see a specialized ASD Diagnosing provider within one year of the initial referral.
Step 2: Get a Referral and Authorization
- This is required for everyone in all TRICARE plans.
- Your diagnosing provider will submit a referral for ABA services 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:
- schedule your appointment with the provider listed in the authorization letter. >>Check the Status of Your Authorization.
- If you’d like to see a different provider, contact your regional contractor.
Your authorized ABA supervisor will:
- Complete an ABA assessment
- Develop an individual treatment plan
- Work one-on-one with your childHelp 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
- You must complete outcomes measures at baseline within two years of entry into the program. And then again during each subsequent two year period. The specialized ASD diagnosing provider completes these outcome measures.
- You must also complete outcome measures at baseline and every six months. The authorized ABA supervisor completes this measure.
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, clinically necessary 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.
Last Updated 4/20/2018