News | June 14, 2022

Q&A: Understanding the Updated Autism Care Demonstration

By TRICARE Communications

Since 2014, the Comprehensive Autism Care Demonstration (ACD) has provided Applied Behavior Analysis (ABA) services to TRICARE beneficiaries diagnosed with Autism Spectrum Disorder (ASD). The ACD has gone through many updates over the years. The goal of these updates is to provide the best possible care to cover clinically necessary and appropriate ABA services for ASD. Also, ABA services are just one of many TRICARE benefits available to children with ASD.
 
“We understand that parents of children with ASD have concerns about their children’s ABA care,” said Dr. Krystyna Bienia, a clinical psychologist and senior policy analyst at the Defense Health Agency (DHA). “The goal of the recent ACD updates is to provide the most clinically appropriate care for children.”
 
However, sometimes policy updates can lead to misunderstandings. TRICARE is committed to helping parents understand the policy updates and clarifications to the ACD benefits. Here are answers to your questions about some of the ACD updates.
 
Q: Does the ACD allow the use of Behavior Technicians in school and community settings?
A: No. The ACD has never covered educational or support services in the school setting. This includes Behavior Technicians (BTs) working as supports, shadows, or aides. The 2021 policy update clarified that the ACD covers only clinically appropriate ABA services. This clarification of the role of BTs also applies to certain community settings, such as dentist appointments and sporting events. Your TRICARE contractor may authorize a board certified behavior analyst to provide targeted and time-limited ABA services for your child in the school setting. Keep in mind, these services must be clinically necessary for specific goals.
 
There are other options to address your child’s needs within the school setting. You should reach out to the team who put together your child’s Individual Education Program (IEP). If your child doesn’t have an IEP, contact your child’s school to start that process.
 
Clinical ABA treatment plans also include goals for parents. Your child will learn ABA techniques in the home or clinic environment. These mastered skills will help your child in a variety of settings.
 
Q: What support can we get if my child has multiple medical conditions, including ASD?
A: Each medical diagnosis is determined by a set of criteria. For your child to meet the diagnosis of ASD, they must meet this specific diagnostic criteria. Sometimes other medical conditions, such as epilepsy or a learning disability, can also be present. It’s important to understand that the ACD covers only ABA services as a treatment for ASD. This has always been true of the ACD. The 2021 policy updates clarified that no other conditions are covered.
 
But your child will still have support for other conditions through other TRICARE benefits. Your diagnosing provider usually makes recommendations for different specialties to treat or address these conditions. Your TRICARE contractor will work with you to find the right provider for your child’s health care. When everyone works together, the right care for your child can be identified. This ensures your child is seeing the right experts for the right conditions.
 
The ACD provides a trained professional to help you find care. Those who joined the ACD on or after Oct. 1, 2021 have an Autism Services Navigator (ASN). Did you join the ACD before that date? If so, you still have access to a case manager. Your ASN or case manager will work with you to figure out the best plan for you and your child.
 
Q: Why are more outcome measures required for the ACD?
A: TRICARE revised the outcome measures cycle in order to have more accurate and frequent data. This is both for your treating provider and TRICARE. These measures allow your providers and TRICARE to stay up to date about treatment successes or challenges. Your child now completes all measures before treatment starts. After that, your child completes the measures every six or 12 months. The timeline for each cycle depends on the measure. With more data, your provider can make better treatment decisions.
 
The DHA made several other revisions to improve the quality, timeliness, and data reporting requirements. For example, ASD diagnosing providers no longer have to write a referral when they can’t complete the outcome measures in a timely manner. By removing that requirement, the ACD allows for more provider types to be able to complete the measures without requiring a referral. Pre-authorization may still be required. This revision gives more flexibility to the families and providers working on your child’s care.
 
Rely on your case manager or ASN to help guide you through the assessment process so that it runs smoothly.
 
Q: What does the DHA do with the findings from the parent assessments?
A: The DHA uses the total scores of the parent assessments to evaluate whether the demonstration is addressing parent stress levels. The DHA never shares the data with your employer or any other health care providers except the treating providers. It handles and protects all information by following all privacy laws. This is the same as any other part of the patient’s medical record.
 
Helping families identify how stress may be affecting their daily lives is important. Your provider will work with you and your family to identify appropriate treatment goals. Also, your ASN can help identify resources to help your family.
 
Q: What additional ACD support is available for parents and families?
A: Your TRICARE contractor can help connect you to local and military installation services. This includes nonclinical support groups, where available. Some services may be available at military hospitals and clinics. You can find more ACD information and resources on your regional contractor’s website:  
  • West Region (Health Net Federal Services, LLC). To talk to an autism specialist, call 1-844-866-9378.
  • East Region (Humana Military). To talk to an autism specialist, call 1-800-444-5445.
  • Overseas Region (International SOS Government Services, Inc.). Call your TRICARE Overseas Program Regional Call Center to talk to someone.  
 
To get care through the ACD, you still must meet certain TRICARE requirements. As outlined in the TRICARE Autism Care Demonstration Fact Sheet, active duty service members must enroll their family member diagnosed with ASD in the Exceptional Family Member Program. They also need to register the child in the Extended Care Health Option. After enrollment, your child may be eligible to receive the extra benefits from these programs.
 
Have more questions about the ACD? Visit Autism Care Demonstration on the TRICARE website. You can also reach out to your TRICARE contractor, ASN, or case manager for help.
 
Would you like the latest TRICARE news sent to you by email? Visit the TRICARE Subscriptions page today, and create your personalized profile to get benefit updates, news, and more.
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