Autism Services for TRICARE Beneficiaries

 
The Department of Defense Enhanced Access to Autism Services Demonstration tests the feasibility and advisability of permitting TRICARE reimbursement for educational interventions shown to positively impact the lives of autistic children. The demonstration allows reimbursements for applied behavioral analysis (ABA) rendered by providers (“tutors”) who are not otherwise eligible to be reimbursed by TRICARE for ABA services.
 
Primary care managers (PCMs) and network specialists caring for active duty family members can recommend children for enrollment in the demonstration program once eligibility is confirmed. The eligibility requirements include:

• Minimum age of 18 months
• Registered in the Extended Care Health Option (ECHO)
• Diagnosis of autism disorder, childhood disintegrative disorder,  Asperger’s syndrome or pervasive development disorder

Providers must contact Humana Military Healthcare Services, Inc. (Humana Military) to request authorizations and assignments to case managers. TRICARE beneficiaries cannot self refer for this program and must have their PCMs or specialists submit the information required for eligibility confirmation and placement in the program.
 
The beneficiary’s case manager will be responsible for assigning an authorized early-intervention services supervisor and tutor for home visits. For more information about this demonstration, the ECHO program, required forms or contact information for the Humana Military case manager in your area, visit our page on the Autism Demonstration.