A. There are two parts to your question.
1. Under the basic TRICARE benefit, your child needs to have a 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 or 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; and
• 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.
Note: 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 Board Certified Behavior Analyst. 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, Vineland II, – 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.
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