Health & Safety

March 17, 2017

Ask the Doc

99th Medical Group

Q. I’m confused about TRICARE’s new requirement for testing to be done as part of a two-year review process for Applied Behavior Analysis (ABA) coverage. I understand my child needs to get testing done before TRICARE authorizes care for another two years. My child’s authorization ended in January 2017. Does he have to wait for the testing to be done before he can continue ABA services?

A. TRICARE will continue to cover your child’s ABA services as it moves to the new two-year review requirement. DHA knows it may be difficult in some areas to get appointments with specialized ASD diagnosing providers who can do the required resting.
• If your child’s testing and two-year review were approved before Dec. 31, 2016, you now have two years to get the testing done before your authorization ends.
• If your child’s two-year review is due between Jan. 1, 2017, and March 31, 2017, your ABA provider may ask your regional contractor to extend your child’s current ABA authorization. The provider needs to note your child can’t get an appointment with a specialized ASD diagnosing provider before the current authorization ends.
• If your child’s two-year review is due after March 31, 2017 (beginning April 1, 2017), you have to complete and submit the results of the required testing as part of the two-year review to get an authorization for two more years of ABA.
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