TRICARE, Your Military Health Plan

In This Section:

• Cancer Clinical Trials
• Questions to ask Your Doctor
• Costs
• Chiropractic Care
• Designated Locations
• Combat-Related Special Compensation Travel Benefit
• Before Traveling for Specialty Care
• Requesting Reimbursement
• Computer and Electronic Accomodations Program (CAP)
• Continued Health Care Benefit Program (CHCBP)
• Purchasing CHCBP Coverage
• Getting Care Through the CHCBP
• Filing CHCBP Claims
• Extended Care Health Option (ECHO)
• Who May Qualify
• Benefits
• Costs and Coverage Limits
• ECHO Home Health Care
• Autism Services Demonstration
• Foreign Force Member Health Care Option
• Line of Duty/Notice of Eligibility
• Pre-activation Benefit for National Guard and Reserve
• Medical Benefits
• Dental Benefits
• Transitional Assistance Management Program (TAMP)
• TRICARE Prime Options
• TRICARE Standard Options
• Dental Options
• Transitional Care for Service Related Conditions
• TRICARE Philippine Demonstration
• Philippine Demonstration Designated Areas
• Getting Care under the Demonstration
• Submitting a Waiver Request
• Health Care Costs under the Demonstration
• Filing Health Care Claims under the Demonstration
• TRICARE Plus
• Women, Infants and Children (WIC) Overseas
• Offices

Autism Services Demonstration

Autism spectrum disorders (ASDs) affect behaviors such as social interaction, the ability to communicate ideas and feelings, imagination and the establishment of relationships with others. Several treatments, therapies and interventions, known as Educational Interventions for Autism Spectrum Disorders (EIA), are available and they have been shown to reduce or eliminate specific problem behaviors and teach new skills to individuals with autism.

The Enhanced Access to Autism Services Demonstration allows eligible beneficiaries to have access to a greater range of these existing evidence-based EIA services through an expanded network of educational intervention providers.

Currently, the demonstration is only available in the 50 United States and the District of Columbia.

Eligibility
The demonstration is available to beneficiaries who are:

• Age 18 months and older
• Registered in the Extended Care Health Option (ECHO)
• Diagnosed with one of the following:
  • Autistic Disorder (AD)
  • Childhood Disintegrative Disorder (CDD)
  • Asperger's Syndrome (AS)
  • Pervasive Developmental Disorder Not Otherwise Specified (PDDNOS)

Note: If diagnosed before this demonstration began (March 15, 2008), children do not need to be re-diagnosed.

To begin services, work with your child's ECHO case manager to submit your child's Individualized Family Service Plan (IFSP) or Individualized Education Program (IEP) documentation to your regional contractor. If your child is home-schooled and your state does not require an IFSP or IEP, you must provide a letter from your child's primary care provider or specialized ASD provider verifying that the child's disability related to Autism results in dysfunction severe enough to require special education and other support services.

Lastly, ensure that your child's behavioral plan, developed by the EIA Supervisor, is sent to the medical provider who will oversee your child's autism care. To see if your child may qualify and to get started, please contact your regional contractor and discuss your options with your child's primary care provider.

Coverage
The demonstration covers EIA services that:

• Implement basic principles of Applied Behavior Analysis and target behaviors associated with the core deficits of ASD
• Focus on changing the child's behavior by observing and measuring the behavior in real-life environments
• Use scientific behavioral data to identify functional relationships between environmental events and behavior
• Gather behavioral data to track progress in reaching behavioral objectives identified in the Behavior Plan and periodically modifies the plan to adapt to the child's response to the intervention.
• Incorporate parent training so family members/caregivers can teach and support skills during typical family activities
• Require meetings between family members/caregivers and those designing and implementing the intervention program.

Educational Intervention Providers
This demonstration expands the definition of EIA Supervisors and adds a new provider class, EIA Tutors, both of which should increase the number of providers available to provide EIA services to participating beneficiaries. All EIA Supervisors must be participating TRICARE-authorized providers in order to render services within this demonstration.

If you are a provider and would like to learn how to participate in this demonstration, click here.

Costs and Coverage Limits
You must pay part of the monthly expenses for authorized benefits under this demonstration, just as you would with any other ECHO benefit.  You only pay the cost share if you receive covered autism services during the calendar month. Additionally, autism services apply towards your annual ECHO coverage limits.

• Learn more about ECHO costs and coverage limits

For Continued Services

1. Complete standardized testing of your child's verbal and non-verbal IQ in the first 12 months of receiving services under the Demonstration. Intelligence testing performed prior to the initiation of the Demonstration or performed by a local education authority or any tester that is or would be eligible as a TRICARE-authorized provider is acceptable in meeting this requirement.
2. If your child is unable to participate in intelligence testing, a letter from your primary care provider or Specialized ASD Provider is required to continue participation in the Demonstration every six months after the period described above.
3. Complete standardized testing of your child's language skills and adaptive behavior in the first 12 months of receiving services. Language skills and adaptive behavior testing completed within the 24 months prior to
   initiation of EIA services under the Demonstration meets this requirement.
4. Send behavioral plan and EIA Progress Report (developed by the EIA Supervisor) to the medical provider who is overseeing your child's autism care for review and approval every 6 months.
5. Submit documentation to your regional contractor every six months verifying yearly completion of classroom
   and practical training by at least one identified parent/caregiver. (Your ECHO case manager can
   provide more information on how to fulfill this requirement)

For More Information
If you are interested in the Autism Services Demonstration, please contact the Case Management Coordinator for your area.

Last Modified:May 22, 2012