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Autism Care Demonstration: Referral for Applied Behavior Analysis Services

After diagnosing a beneficiary with autism spectrum disorder (ASD), your provider will submit a referral to Health Net Federal Services, LLC (HNFS). We will verify it to:

  1. Ensure the referral meets all requirements per TRICARE policy and
  2. Confirm the beneficiary meets all ACD eligibility requirements.

Please allow 2–5 business days for HNFS to verify the referral requirements were met. 

For beneficiaries entering the Autism Care Demonstration (ACD) on or after Oct. 1, 2021: If the beneficiary’s initial ASD diagnosis occurred after age eight, or it has been two or more years since the original diagnosis and this is the first referral for ABA services under TRICARE, HNFS will need a one-time diagnostic evaluation from an ASD-diagnosing provider indicating a definitive ASD diagnosis (if not already on file). 

Key Facts About ABA Referrals

Referrals for ABA services under the ACD are:

Two-Year Referral Cycle

  • Within each two-year referral cycle, care is authorized in six-month periods. The first six-month authorization period begins once the initial assessment process is complete and treatment is authorized. 
  • Referral renewals are submitted by your TRICARE-authorized ASD diagnosing or referring provider once it is within six months prior to the end of the current two-year cycle. 
  • Referrals remain valid within the two-year timeline, even if you:
    • change providers,
    • get a second opinion,
    • move within the TRICARE West Region, or 
    • move to the TRICARE East Region.

We will provide you with the referral due date in writing to help you track when a new request for referral is required.

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