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News | March 16, 2023

TRICARE Pilots and Demonstrations: How You Benefit

By TRICARE Communications

TRICARE develops pilots and demonstrations to test new medical services, treatments, and approaches. These include initiatives for autism care, childbirth support, and low back pain. Certain groups have the chance to benefit from these services during an evaluation period. Results from these programs may inform future benefit changes.
 
“The goal of these pilots and demonstrations is to support better health outcomes, enhance health care experiences, and reduce costs over time,” said Erica Ferron, a management and program analyst with the TRICARE Health Plan. “This is an important process to ensure that TRICARE keeps finding new ways to improve your health care coverage.”
 
Here’s a look at three programs that are underway. You should consider which ones may be helpful for you or a family member. Keep in mind, not everyone is eligible for these programs. Also, the end times of these programs vary.
 
1. Low Back Pain and Physical Therapy Demonstration
The Low Back Pain and Physical Therapy Demonstration addresses the ongoing issue of low back pain many individuals face. The purpose is to see if those whose low back pain may be treated or managed by physical therapy will try it if the first few physical therapy visits are free. The demonstration waives your cost-shares for up to three covered physical therapy sessions. After the third covered session, you’ll pay regular cost-shares and copayments.
 
To be eligible for the demonstration:                                    
  • You must have a primary diagnosis of low back pain.
  • You must have a referral from a TRICARE-authorized provider for physical therapy services to treat your low back pain.
  • You must live in and receive physical therapy services in one of the ten states the demonstration is available in:
    • Arizona
    • California
    • Colorado
    • Florida
    • Georgia
    • Kentucky
    • North Carolina
    • Ohio
    • Tennessee
    • Virginia
 
The demonstration runs through Dec. 31, 2023.
 
2. Childbirth and Breastfeeding Support Demonstration
Under the Childbirth and Breastfeeding Support Demonstration, TRICARE covers the services of three types of maternal health providers:
  • Certified non-medical labor doulas
  • Certified lactation consultants
  • Certified lactation counselors
 
The goal is to evaluate the impact of these providers on birthing parents and infants.
 
The demonstration is only for those who are enrolled in TRICARE Prime or TRICARE Select in the U.S. Be sure to review the eligibility details.
 
Most beneficiaries who give birth in the Military Health System will receive a voluntary survey. This is regardless of your eligibility for or participation in the demonstration. The survey gives you a chance to share your experiences with giving birth. The goal is to help TRICARE improve its maternity care and benefit.
 
The demonstration will run stateside until Dec. 31, 2026. It will expand to overseas on Jan. 1, 2025.
 
3. Autism Care Demonstration
Under the Autism Care Demonstration (ACD), TRICARE covers clinically necessary and developmentally appropriate applied behavior analysis (ABA) services. These services are meant to treat the core symptoms of autism spectrum disorder (ASD). The goal of the ACD is to analyze and evaluate the quality, efficiency, convenience, and cost-effectiveness of authorized ABA services.
 
For your child to qualify for the ACD:
  • You must enroll your child in a TRICARE health plan.
  • An approved provider must diagnose your child with ASD.
  • Your child must receive a referral to the ACD for ABA services.
 
If you’re an active duty service member, you must enroll your child in the Exceptional Family Member Program. You must also register your child in the Extended Care Health Option, as outlined in the TRICARE Autism Care Demonstration Fact Sheet.
 
The ACD is authorized to run through the end of 2028.
 
For more on these pilots and demonstrations, as well as other TRICARE initiatives, check out Special Programs. Not sure if TRICARE covers a specific service? Go to Covered Services and use the search tool. Or contact your TRICARE regional contractor to help you with health care coverage questions.
 
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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