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Information about Copayments and the Autism Care Demonstration

Wednesday, December 7, 2022

If your child receives services under TRICARE’s Autism Care Demonstration (ACD), you may have copayments. Copayment amounts will vary depending on your sponsor’s status and TRICARE plan. Amounts also will vary if you have other health insurance. Please review these frequently asked questions and answers about the ACD and copayments.

If I have more than one ABA appointment on the same day, will I owe multiple copayments?
For beneficiaries enrolled in the ACD, appointments to see providers can be several times a week or even daily. You will only pay one copayment for all applied behavior analysis (ABA) services your child receives on the same day.

Are there copayments for non-ABA services?
Your child may have ABA services and non-ABA services on the same day. Non-ABA services include those such as speech therapy and physical therapy appointments. If your child gets non-ABA services on the same day as ABA services, you will owe copayments for non-ABA services and a single copayment for any same-day ABA services.

Why was I charged a copayment for outcome measures when we didn’t see a provider?
For outcome measure appointments done using indirect methods, the beneficiary may not see the provider. Even though there isn’t a direct visit with the outcome measure provider, if your TRICARE plan requires a copayment, you will owe a copayment for these appointments unless other same-day ABA services occurred before the outcome measures appointment.

Why is someone other than my ABA provider charging me a copayment for outcome measures? 
While your ABA supervisor will execute the Pervasive Developmental Disorder Behavior Inventory, Health Net Federal Services, LLC (HNFS) may authorize the other required outcome measures to a provider from our preferred outcome measure provider network. We do this because not all ABA providers render the four outcome measures and to make sure outcome measures are completed within access-to-care standards. The other outcome measures include the:

  • Vineland Adaptive Behavior Scales, Third Edition; 
  • Social Responsiveness Scale, Second Edition; 
  • Parent Stress Index, Fourth Edition Short Form; and 
  • Stress Index for Parents of Adolescents.

What happens if I do not pay my copayment?
If you receive an invoice for a copayment, be sure to pay the amount due by the due date. If you don’t pay, your provider may send your account to a collection agency or even seek legal action.

Where can I go for more information on costs?
Visit www.tricare.mil/costs to view current out-of-pocket costs for TRICARE health plans.

Where can I go for more information on the ACD?
For more information on the ACD program and services, visit www.tricare.mil/ACD and our ACD web page.