TRICARE and You – Autism Care Demonstration and applied behavior analysis therapy



Written by Cmdr. Paul Fawcett

TRICARE has introduced a new Autism Care Demonstration designed to provide applied behavior analysis (ABA) therapy for dependents diagnosed with autism spectrum disorder. A demonstration is a test or pilot program. The autism care demonstration will last until December 2018 when it will be evaluated for continuation.

What is ABA therapy?

ABA therapy uses behavior modification and positive reinforcement to reduce negative behaviors and increase self help skills, among other benefits. ABA therapy is a separately covered benefit from other potentially needed therapies such as speech therapy, occupational therapy or physical therapy, which are also covered benefits under TRICARE. ABA therapy is available if you are enrolled in TRICARE Prime, Standard, TRICARE for Life, TRICARE Young Adult, TRICARE Reserve Select or TRICARE Retired Reserve programs.

How Do I Access This Benefit?

In order to use this benefit, your dependent must have a diagnosis for Autism Spectrum Disorder from an approved provider. Once the diagnosis is made the medical provider will send a referral to the TRICARE contractor. You should then receive a referral letter in the mail with the name of an “ABA Supervisor” who is accepting patients. Your ABA supervisor will help you create a treatment plan and services can begin. The treatment plan will outline the service types needed and the number of hours of therapy needed.

How long does ABA Treatment Continue?

Depending on your child’s needs, however, every six months a reassessment will be made and the treatment plan will be updated. Every two years the ABA program will be reviewed to see if it is helping your dependent. There is no cap to the annual or lifetime amounts of ABA therapy that TRICARE will pay for.

What are my Out of pocket Costs for ABA Therapy?

Active duty members enrolled to TRICARE Prime have no out of pocket costs for ABA therapy. Members enrolled to TRICARE Standard or TRICARE Reserve Select pay 15% of allowable billed costs with a TRICARE network provider and 20% for a non network provider. Retired family members enrolled to TRICARE Prime pay $12 copays per visit.

Special needs program

Members who are seeking ABA services for their dependents must enroll in the Coast Guard Special Needs program. You can get more information about the Special Needs program from your District Work life Staff or from the Coast Guard Special Needs page.

For More information about the TRICARE Autism Demonstration or ABA therapy coverage, visit the TRICARE Autism Care Demonstration page.

Do you have more questions? Please leave a comment below!


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