Health & Safety

January 31, 2014

Ask the Doc

doctor
Q.“Our sponsor is no longer on active duty. What do we need to do to get Applied Behavior Analysis for our child who may have an Autism Spectrum Disorder?”

A. “There are two parts to your question.
1. Under the basic TRICARE benefit, your child needs to have an Autism Spectrum Disorder diagnosed by a TRICARE-authorized primary care manager, provider or Autism Spectrum Disorder Specialist, who is either a physician board-certified or board-eligible in behavioral developmental pediatrics, neurodevelopmental pediatrics, pediatric neurology, child psychiatry or a Ph.D. clinical psychologist working primarily with children. The services under the basic benefit include:
• An initial assessment.
• Development of a treatment plan.
• One-on-one ABA interventions with an eligible beneficiary.
• Training of immediate family members to provide services in accordance with the treatment plan.
• The TRICARE basic benefit only covers delivery of ABA by a masters-level Board-Certified Behavior Analyst or doctoral-level Board Certified Behavior Analyst-Doctoral.
Individuals certified by the BACB as a Board Certified Assistant Behavior Analyst are not TRICARE authorized ABA providers under the TRICARE Basic Program.
2. Under the ABA Pilot, effective July 25, 2013, your child can receive additional ABA reinforcement services from either a bachelors-level Board Certified Assistant Behavior Analyst or a paraprofessional ABA Tutor under the supervision of a TRICARE authorized ABA provider licensed/certified by a State or by the Behavioral Analyst Certification Board as a BCBA. Requirements under the ABA Pilot include:
• Your child must be diagnosed with a qualifying ASD disorder by a TRICARE-authorized physician Primary Care Manager primary care provider or specialized ASD provider. Nurse Practitioners and Physician Assistants aren’t authorized ASD-diagnosing providers for ABA services under the ABA pilot.
• You child’s must have specific standardized psychometric tests done. The Autism Diagnostic Observation Schedule and Vineland Adaptive Behavioral Scale are required for your child to support ABA under the TRICARE basic benefit and ABA Pilot. The Vineland Schedule is required every six months for your child to continue reinforcement services under the ABA Pilot. You must be referred and get prior-authorization before receiving ABA initial and continuing ABA reinforcement under the Pilot.
Note:
On March 1, the CONUS Nurse Advice Line will provide 24 hour a day and 7 day a week nurse triage, advice and Military Treatment Facility appointing to the continental United States, Alaska and Hawaii. The NAL goals are to recapture care to the MTF, to reduce unnecessary Emergency Departments and Urgent Care utilization, to improve the patient’s continuous healthcare relationship with his or her MTF and PCM and to maximize patient satisfaction.
• MTF enrollees calling the NAL will gain immediate access to advice from registered nurses 24 hours a day and 7 days a week using standard triage protocols.
• NAL RNs will advise MTF enrollees on the most clinically appropriate level of care ranging from emergency to self-care.
• NAL will provide a parent or care-giver the option of a follow-up call if self-care is advised for any pediatric patients.
• NAL will inform PCM of any enrollee call to the NAL via a Telephone-Consult in Your electronic Health Record.”

TRICARE military benefits health plan service centers will end administrative walk-in services in the U.S. April 1. The closure of the TRICARE service center will not affect health care or TRICARE benefits. Customers may visit www.tricare.mil or call 1-877-988-9378 for TRICARE service.

Send your questions to askthedoc@nellis.af.mil.




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