What is the TRICARE Autism Demonstration?
Autism spectrum disorders (ASD) may affect social interactions, the ability to communicate ideas and feelings, imagination and the establishment of relationships with others. Several treatments, therapies and interventions, known as Educational Interventions for
Autism Spectrum Disorders (EIA), are available and have been known to reduce or eliminate specific problem behaviors and teach new skills to individuals with autism.
These EIA services are not covered under basic TRICARE coverage (TRICARE Prime, TRICARE Standard and Extra, etc.), and only partially covered through the Extended Care Health Option (ECHO). The Enhanced Access to Autism Services Demonstration allows eligible beneficiaries to have access to a greater range of existing evidence-based EIA services through an expanded network of educational intervention providers.
Requirements are defined in Chapter 20, Section 10, of the TRICARE Operations Manual, which can be found
online.
The Enhanced Access to Autism Services Demonstration began March 15, 2008 and is only available in the 50 United States and the District of Columbia.
What is the basic coverage that will be reimbursed?
Under the Enhanced Access to Autism Demonstration, TRICARE covers Educational Interventions for Autism Spectrum Disorders (EIA), services that:
implement basic principles of Applied Behavior Analysis and target behaviors associated with the core deficits of ASD
focus on changing the child's behavior by observing and measuring the behavior in real-life environments
use scientific behavioral data to identify functional relationships between environmental events and behavior
gather behavioral data to track progress in reaching behavioral objectives identified in the Behavior Plan and periodically modifies the plan to adapt to the child's response to the intervention
incorporate parent training so family members/caregivers and those designing and implementing the intervention program.
Educational Intervention Providers
This demonstration expands the definition of EIA Supervisors and adds a new provider class, EIA Tutors, which should increase the number of providers available to provide EIA services to participating beneficiaries. Tutors must be contracted or directly employed by an authorized EIA Supervisor and be authorized by HMHS prior to providing services.
How do I sign up to be a participating provider?
How will I be reimbursed?
Please see Article 3 of the Participation Agreement.
How will I receive a referral?
A TRICARE beneficiary must have their PCM or ASD Specialist submit information necessary to allow the Managed Care Support Contractor to confirm eligibility. Referrals and clinical information may be faxed to the market ECHO Case Manager.
| Southwest Market |
GulfSouth Market |
Southeast Market |
| Fax: (210) 228-614-4692 |
Fax: (228) 385-5138 |
Fax: (706) 854-8604 |
| (TX excluding the El Paso area, Louisiana west of the Mississippi River, AR, OK) |
(LA east of the Mississippi River, FL panhandle, TN, MS, AL) |
(GA, SC, FL excluding the panhandle) |
