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News | July 22, 2021

TRICARE Autism Care Demonstration Evolves

By TRICARE Communications

Do you have a child with a diagnosis of autism spectrum disorder (ASD)? TRICARE is revamping your access to health and support services. The Defense Health Agency (DHA) announced the TRICARE Autism Care Demonstration (ACD) policy changes in late March.
 
“These changes are based on several years of research and development,” said Dr. Krystyna Bienia, clinical psychologist and senior policy analyst at the DHA. “We used lessons learned during the demonstration, and also feedback from providers, advocates, and leading researchers. The updates will help children reach their full potential through clinically appropriate services.”
 
The DHA believes these changes will improve access to care and provide more support for parents and families. Here’s a closer look at some of these ACD changes and what they mean for you.
 
Increasing Parental and Family Involvement and Support
Often times, families don’t know where to go for services and support. The ACD program updates have changed that. Your TRICARE contractor will provide greater support to those in the ACD program. For example, your TRICARE contractor will help connect you to local and military installation services. This includes support groups, where available. They’ll also help link you to other services, such as parent-mediated programs. You’ll be able to find these services, as well as other ASD resources, on the contractor’s website. The goal is to have enhanced family support, combined with connections to clinical and non-clinical services, to help you get the support you need at the right time.
 
“Research shows that the best outcomes for children with ASD happens when families participate in the care,” said Dr. Bienia. “Supporting parents and having them take the lead in their child’s care is critical. Two ways to do that is by training parents in ABA techniques and involving them in the development of the comprehensive care plan.”
 
Some additional improvements coming this fall include:
  • Continued telehealth options (beyond the COVID-19 pandemic) for applied behavior analysis (ABA) parent training and guidance services
  • Autism Services Navigator for new ACD participants
  • Parental toolkit with comprehensive information about the ACD
 
ABA Services in the School and Community Settings
Some ACD changes clarify ABA services in the school and certain community settings. ABA services authorized under the ACD must:
  • Be clinically necessary and appropriate
  • Target the core symptoms of ASD
 
In the past, behavior technicians (BTs) providing services in the school setting were educational or support services, not clinical. In the policy update, TRICARE clarified that the ACD reimburses for only the active delivery of clinically appropriate ABA services. This means the ACD doesn’t cover educational or support services in the school setting, such as school supports, shadows, or aides. Your child’s Individualized Education Program, or IEP, should address their educational and academic needs.
 
Your TRICARE contractor may authorize board certified behavior analysts to provide focused and time-limited clinical ABA services for your child in the school setting. Keep in mind, services must be clinically necessary and appropriate for specific targets or goals. If you have authorizations that were approved before May 1 of this year, then they’ll continue through their authorization period. 
 
This clarification applies to certain community settings, as well. For example, an ABA provider who assists at a dental appointment or sporting event isn’t actively providing ABA services. These are non-medical engagements. In some cases, ABA providers may teach you ABA techniques to help with mastered skills in these types of environments. Keep in mind, there are certain community settings that may be clinically appropriate. It depends on the goals identified in your child’s treatment plan.
 
“These changes will help parents and families maintain the skills learned in the home or clinic setting to get the best outcomes,” said Dr. Bienia. “If you have questions about the changes, please reach out to your TRICARE regional contractor to learn more.”
 
Getting Care through the ACD
To get care through the ACD, you still must meet certain TRICARE requirements. If you’re an active duty service member, you must enroll your family member diagnosed with ASD in the Exceptional Family Member Program. You need to also register them in the Extended Care Health Option. You can read about these requirements in the Extended Care Health Option Fact Sheet. Retirees are also eligible for ACD services, but you pay different costs.
 
You still need to obtain a referral from a TRICARE-authorized provider and pre-authorization from the contractor for your ACD services. This applies to every TRICARE plan.
 
To learn more about the ACD program, visit Autism Care Demonstration. If you have questions, you can always reach out to your TRICARE contractor. And be sure to sign up for email updates, as ACD changes are being implemented throughout the year.
 
TRICARE will host a Chat with TRICARE about the Autism Care Demonstration on July 22 at 2 p.m. ET. Visit the TRICARE Facebook page to participate.
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