The Enhanced Access to Autism Services Demonstration will test the feasibility and advisability of permitting TRICARE reimbursement for Educational Interventions for Autism Spectrum Disorders (EIA) services (defined as behavior modification interventions of specified characteristics) delivered by paraprofessional providers. The Demonstration will enable the Department of Defense to determine if there is increased access to these services; the services are reaching those most likely to benefit from them; and the quality of those services.
Eligibility
Active duty service member’s beneficiaries with a diagnosis of Autistic Disorder (AD), Pervasive Developmental Disorder Not Otherwise Specified (PDDNOS), Asperger’s Disorder (AS), or Childhood Disintegrative Disorder (CDD) and confirmed by an Autism Spectrum Disorders (ASD) specialist are eligible for the demonstration. All participants must be registered or in the process of registering in the Extended Care Health Option (ECHO) program. Diagnostic testing, defined below, is required if the diagnosis is made by a provider who is not an ASD specialist. For children 18 months through 8 years of age standardized testing of language skills and adaptive behavior is required.
The child must be receiving special education with developmental, corrective, and supportive services as may be required to assist a child with a disability to benefit from special education documented in an Individualized Education Plan (IEP) or Individualized Family Service Plan (IFSP).
If the child is homeschooled and not required by state law to have an IEP or IFSP the child’s PCP or Specialized Autism Spectrum Disorder Provider must certify that the child’s disability related to ASD results in dysfunctions severe enough to require special education and other supportive services.
