TRICARE Clarifies Applied Behavior Analysis (ABA) Policies
TRICARE Management Activity (TMA) held a briefing to clarify Applied Behavior Analysis (ABA) policies across the TRICARE Basic (Medical) program, the Extended Care Health Option (ECHO) Demonstration, and the new Autism Pilot program for non-active duty family members (NADFMs.)
No new policy changes were announced. However, in response to beneficiary concerns that online TRICARE manuals still reflect the June 25 policy changes that were subsequently reversed, TMA repeatedly stated that the current online versions are incorrect and it will take time to complete the revisions. TMA assured briefing participants that Managed Care Support Coordinators have been directed via a formal letter to make no change in delivery of ABA under the TRICARE Basic Program or ECHO Autism Demonstration.
Non-active duty family members who desire ABA reinforcement services can access care under the new Autism Pilot program. The referral and authorization process outlined in the June 25 TRICARE policy manual will apply to the Autism Pilot program only. During the briefing, TMA officials stated that one of the Autism Pilot objectives is to test the feasibility of expanding these additional requirements to all TRICARE ABA therapy beneficiaries.
To recap, the current TRICARE policies for accessing ABA are as follows:
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- There is no change for active duty family members receiving ABA for Autism Spectrum Disorder (ASD) under the TRICARE Basic program. TRICARE Basic requires that ABA be delivered by Board Certified Behavior Analysts (BCBAs.)
- There is no change for active duty family members enrolled in the ECHO Autism Demonstration who are receiving ABA reinforcement from Board Certified Assistant Behavior Analysts (BCaBAs) or ABA Tutors. There is no change in out-of-pocket costs for active duty family members utilizing the ECHO ABA Demo.
- There is no change for non-active duty family members (i.e., retiree dependents and participants in TRICARE Reserve Select, TRICARE Retired Reserve, TRICARE Young Adult and the Continued Health Care Benefit Program) currently receiving ABA under the TRICARE Basic program.
- Non-active duty family members can access ABA reinforcement via the Pilot program. To receive ABA under the Pilot, NADFM beneficiaries must first receive an Autism Spectrum Disorder (ASD) diagnosis from a TRICARE-authorized physician Primary Care Manager (PCM) or specialized ASD provider. The diagnosing physician will then provide a referral for an ABA assessment. The ABA assessment must be performed by a BCBA and must include two standardized baseline tests, the ADOS-2 and the Vineland Behavioral Scale. Once the initial assessment is completed and a treatment plan is developed, the diagnosing physician can submit a referral for ABA treatment. All ABA therapy, including the initial assessment, requires prior authorization from a TRICARE regional contractor. Since the pilot is currently set to run for only one year, there is no procedure for obtaining a reauthorization.
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