News | March 30, 2021

DHA Improves TRICARE Comprehensive Autism Care Demonstration Program

By TRICARE Communications

Do you have a family member with a diagnosis of autism spectrum disorder (ASD)? If so, they’ll soon have expanded access to health and support services. The Defense Health Agency (DHA) has authorized policy changes to the TRICARE Comprehensive Autism Care Demonstration (ACD) program. These changes will expand the ACD into a more comprehensive program. It will offer integrated services and additional support that fit your family’s needs.
 
“We remain committed to addressing the needs of those beneficiaries diagnosed with ASD and their families,” said Dr. Krystyna Bienia, clinical psychologist and senior policy analyst at the DHA. “There isn’t a ‘one size fits all’ approach when it comes to ASD care. We want our beneficiaries to have options, and these improvements should help connect families with the right services at the right time.”
 
The ACD will continue to cover applied behavior analysis (ABA) services for beneficiaries diagnosed with ASD. But the improvements will combine all available services into one comprehensive care plan. This ensures that you have access to the most appropriate services for your individual needs. Changes to the program begin to take effect on May 1, 2021. And there will be a roll out plan for all changes to be in effect by Jan. 1, 2022.
 
If you’re interested in participating in the ACD—or currently enrolled—here’s what you need to know about these coming updates.
 
What will change:
  • You’ll be able to receive parental guidance and trainings via telehealth beyond the national emergency due to the pandemic.
  • If you’re a parent of a child with ASD, you’ll have greater involvement in the development of his or her care plan.
  • There will no longer be a confirmation of diagnosis requirement to get continued care. In most cases, this means you aren’t required to follow up with a specialist after your TRICARE approved diagnosing provider determines a diagnosis of ASD. You’ll have continued access to care through the ACD. It’s still recommended that you make an appointment with the specialist even though it isn’t required. Doing so will ensure you get a more thorough diagnostic evaluation. It will also help you consider all of your clinical and non-clinical options.
  • For those who join the ACD on or after Oct. 1, 2021, TRICARE will assign an autism services navigator (ASN) to work with you to develop a comprehensive care plan and coordinate your care. Your ASN can connect you to additional ASD resources.
  • Your provider will be able to bill for group services, should they be clinically appropriate.
  • There will be an additional outcome measure as part of the program. The frequency of measures are changing (at baseline and from 2 years to 1 year). You won’t have to go back to a specialist to obtain these measures.
 
What won’t change:
  • Previously accessible case management services will remain available.
  • You still need a referral and pre-authorization from a TRICARE-authorized provider (diagnosing provider and ABA provider) to receive services.
  • Your ABA provider must conduct an ABA assessment and develop an individual ABA treatment plan.
  • You’ll need to complete outcome measures.
 
Keep in mind, you must follow TRICARE’s requirements to get care through the ACD.
 
Are you an active duty family member (ADFM)? If so, make sure you’re enrolled in the programs you need to access care through the ACD. As outlined in the Extended Care Health Option Fact Sheet, Extended Care Health Option registration and enrollment in the Exceptional Family Member Program are required for ADFMs to qualify for ACD and ABA services.
 
As you and your family learn more about your ACD coverage, remember that your TRICARE contractor is there to help. You can reach out to them if you have questions about costs or covered services.
 
To learn more about the ACD program, visit Autism Care Demonstration. To stay up to date on these and other changes, be sure to sign up to get TRICARE updates via email. Take command of your health and get the care you need.
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