Autism Care Demonstration

The TRICARE Comprehensive Autism Care Demonstration (ACD) covers applied behavior analysis (ABA) services. Under the ACD, ABA services are authorized to target the core symptoms of autism spectrum disorder (ASD).

The ACD began on July 25, 2014. It will continue is currently authorized to run through Dec. 31, 2023.

Does your child qualify for the ACD?

To qualify for the ACD, your child must be:

• Enrolled in a TRICARE health plan.
• Diagnosed with ASD by an approved provider.

Are you an active duty service member (ADSM)?

If you’re an ADSM with a child diagnosed with ASD, you must be enrolled in your service branch’s Exceptional Family Member Program. Your child also must be enrolled in the Extended Care Health Option.

How the ACD Works

Follow the steps below to get started.

Step 1: Get Diagnosed

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

• Family practice
• Internal medicine
• Pediatrics

A Specialized ASD Diagnosing Provider in the following specialties:

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

Step 2: Get a Referral and Pre-Authorization

• Your child must get a referral to the ACD and a pre-authorization for all ABA services. This is required for all TRICARE plans.
• Your child’s diagnosing provider will submit a referral to your regional contractor* or US Family Health Plan (USFHP) provider for authorization.
• Your child will get an authorization letter for six months of ABA services.
  • A new referral from your ASD diagnosing provider is required every two years.

Are you requesting ABA services for the first time?

• You’ll get an authorization letter for your child from your regional contractor or USFHP provider. This authorization covers your child’s ABA assessment.
• Your provider will complete your child’s ABA assessment. Then, your provider will develop your child’s treatment plan.
• You’ll get an authorization letter for six months of ABA services. Your child’s provider will request reauthorization every six months.

*ABA services are only available in locations with board certified behavior analysts.

Step 3: Complete Outcome Measures

• You and your child’s provider team must complete four baseline outcome measures before your child can get ABA services. This will help monitor your child’s progress. The four measures are the:
  • Pervasive Developmental Disorder Behavior Inventory
  • Vineland Adaptive Behavior Scales
  • Social Responsiveness Scale
  • Parent Stress Index or Stress Index for Parents of Adolescents
• You must complete the four outcome measures every six months or every 12 months. The frequency depends on the measure.

Step 4: Schedule an Appointment

When you get your child’s authorization letter:

• Schedule your child’s ABA assessment appointment. Your child’s authorization letter gives you the provider’s contact information. >>Check your authorization status.
• If you’d like to see a different provider, contact your:
  • Regional contractor
  • USFHP designated provider

Your authorized ABA supervisor:

• Oversees your child’s ABA treatment program.
• Helps you to develop goals. These goals are for your participation in your child’s ABA treatment plan.
• Updates your child’s treatment plan. This will be done before your child’s next authorization period.

Step 5: Work with your Autism Services Navigator (ASN)

Starting Oct. 1, 2021, TRICARE will assign your child an ASN. Your child will only get an ASN if you’re new to the ACD. Your child’s ASN acts as the primary care coordinator.

You and your child’s ASN will develop your child’s comprehensive care plan (CCP). Your child’s CCP will:

• Set goals.
• Track timelines. These timelines include for both outcome measures and authorization dates.
• Connect you with:
  • Clinical resources
  • Non-clinical resources
• Provide discharge, moving, or transition support.

Note: You won’t have an ASN if you’re enrolled in the USFHP or if you live overseas.

Upcoming Changes to the Autism Care Demonstration

Changes to the ACD began on May 1, 2021. All of the changes to the ACD changes will start by Jan. 1, 2022.

May 2021

	Coverage before May 1, 2021	Coverage on or after May 1, 2021
Extended Care Health Option	Are you an active duty service member? Your child must be enrolled in: Your service branch’s Exceptional Family Member Program. The Extended Care Health Option.	Your child’s eligibility and enrollment requirements won’t change. Your child will have a 90-day provisional period, not a 180-day provisional period.
Applied Behavior Analysis (ABA) Services Policy Update	Behavior Technicians (BTs) in School Settings Any authorized ABA services that are active will continue until your child’s next authorization period.	Clarification on authorized BT services BTs in the school setting are prohibited. What ABA service may be authorized? Board certified behavior analyst (BCBA) ABA services that are: Clinically necessary Appropriate You must have pre-authorization for any BCBA ABA services. Your contractor must approve any goals. The goals must be focused and time-limited.

Aug. 2021

	Coverage before Aug. 1, 2021	Coverage on or after Aug. 1, 2021
Family Resources	Contractor specific, not available.	You and your family can access clinical and non-clinical resources, including: Contractor-identified local resources Parent-mediated programs Applied behavior analysis (ABA) services for parents, such as: Telehealth ABA group sessions

Oct. 2021

	Coverage before Oct. 1, 2021	Coverage on or after Oct. 1, 2021
Diagnosis Follow-ups	Did you enroll your child in the Autism Care Demonstration (ACD) before Oct. 1, 2021? You don’t have to get a new authorization until your next two-year referral appointment. An approved ACD diagnosing provider must make your child’s next referral.	Will you reach your two-year referral on or after Oct. 1 2021? You don’t have to get the updated documentation until your next two-year review date. If your child’s first autism spectrum disorder (ASD) diagnosis comes on or after age 8, the diagnosis must come from a specialized ASD diagnosing provider. Was your child diagnosed more than two years before you requested applied behavior analysis services? You must get an updated diagnostic assessment for them.