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Demonstration Overview
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Autism Spectrum Disorders (ASD) affects human behaviors such as social interaction, communication, imagination and relationships. It is estimated that nearly 8,500 children of active duty service members have ASD. 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 delivered by paraprofessional providers.
The Demonstration will help the Department of Defense determine whether:
- There is increased access to these services
- The services are reaching those most likely to benefit from them
- The quality of those services is meeting a standard of care currently accepted by the professional community of providers
- Requirements are met for State licensure and certification where such exists
A number of EIA services, such as Applied Behavior Analysis (ABA), have been introduced to treat ASD. Currently ABA is the only EIA service accepted within the Military Health System (MHS) as having been shown to reduce or eliminate specific problem behaviors and teach new skills to children with ASD. ABA therapy is provided by TRICARE-authorized providers as a Special Education benefit under the Extended Care Health Option (ECHO).
This Demonstration will permit TRICARE reimbursement for EIA services delivered by paraprofessionals known as EIA Tutors. These paraprofessionals deliver care under the strict supervision of TRICARE-authorized licensed or certified providers.
Individual therapy is covered under the Demonstration; group EIA sessions are not a TRICARE benefit. The maximum benefit through both the Demonstration and the ECHO program may not exceed $36,000 per beneficiary per fiscal year beginning on October 1st of each year.
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