TRICARE’s Autism Care Demonstration Enhances Benefits

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Starting this summer, a new Applied Behavior Analysis (ABA) policy will cover all TRICARE beneficiaries with autism spectrum disorder (ASD) under a single benefit. We appreciate that the Defense Health Agency listened to military families, autism experts and advocacy groups – including our Association – to develop this enhanced policy. 

The new TRICARE Autism Care Demonstration (ACD) technically kicked off on July 25, but beneficiaries will transition to the new benefit through the end of the year. TRICARE has not yet published policy details but they have stated that the ACD will include the following improvements to ABA coverage:

  • No annual or lifetime caps on the amount of ABA TRICARE will cover
  • Simpler guidelines for starting coverage once a child has an ASD diagnosis
  • A consolidated, single benefit that provides all TRICARE beneficiaries with the same access to care regardless of sponsor status and stays with them as they retire or switch TRICARE plans
  • Coverage of the tiered service delivery model including BCaBAs and ABA Technicians as well as BCBA/BCBA-D direct services

TRICARE is still developing policy language to implement this program. The ACD will run through December 31, 2018.  

Please note that TRICARE has extended the ABA Pilot, originally set to expire on July 24, 2014, through December 31, 2014 to give families time to transition to the ACD. This ensures that beneficiaries currently covered by the ABA pilot will not suffer a gap in coverage.

We continue to monitor this policy as well as a FY2015 National Defense Authorization Act amendment that would require TRICARE to improve ABA benefits, reduce restrictions on access to care, and make the treatment available to all children with developmental disabilities, not just autism.

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