Autism Care Demonstration
Once families have enrolled in EFMP and ECHO, they can use the Autism Care Demonstration (ACD) benefit. ACD is a program under TRICARE that allows families to access ABA services for their children with autism. Currently, children need to have an autism diagnosis given by a diagnosing specialist (see a full list of qualifying providers here) to qualify for ABA services. If a general physician or Primary Care Manager gave the initial autism diagnosis, the child can start ABA services, but needs to have a diagnosis from a qualified specialist within a year of beginning ABA. This deadline is sometimes flexible if there are no specialized diagnosing providers in the area or if a child is on a waitlist for evaluation.
To find an ABA provider, the child’s PCM can refer him/her to a local preferred ABA provider, or families can search for ABA providers using the Provider Directories on the Health Net Federal Services (HNFS) or Humana Military websites and request a referral from their child’s doctor. Note that the ACD is available overseas in limited locations – families should contact their regional call center for more information.
To continue ABA services once care has started, TRICARE currently requires three outcome measure tests to be administered regularly. These tests are not diagnostic and are meant to measure progress or lack thereof. These tests are the Vineland III, the SRS-2, and the PDDBI, and they can be administered by a psychologist or by the ABA provider. If TRICARE uses these test results to reduce or cut ABA services without the ABA provider’s agreement that a reduction would be best, families should email the Defense Health Agency for support at DHA.ACD@mail.mil.
Families can also email this contact if they are experiencing other TRICARE issues that are keeping them from receiving ABA services for their children on the spectrum.