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Autism Care Demonstration

TRICARE’s Autism Care Demonstration (ACD) allows for clinically necessary and appropriate applied behavior analysis (ABA) services to be rendered to TRICARE-eligible beneficiaries diagnosed with autism spectrum disorder (ASD). The demonstration, which began in July of 2014, is currently scheduled to continue through Dec. 31, 2023. Please refer to TRICARE Operations Manual, Chapter 18, Section 4 for complete policy details.

The Defense Health Agency (DHA) published changes to the ACD that has been implemented in phases in 2021. To learn more and to sign up for email updates, visit www.health.mil/autism

 

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Eligibility and Diagnostic Criteria

Learn about ACD eligibiity and diagnostic requirements.

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Overview & Benefits
Explore the services available to TRICARE beneficiaries.
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Autism Services Navigators (ASNs)

Beneficiaries new to the ACD as of Oct. 1, 2021, are eligible for an ASN.

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Referrals for ABA Services

Referrals for ABA services are valid for two years. 

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Outcome Measures
Scores are used in treatment planning and evaluating progress.
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Initial Authorizations: Assessments & First Treatment
Specific requirements must be met prior to treatment authorization.
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Treatment Plan Requirements
Explore this comprehensive guide to treatment plan requirements.
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Clinical Necessity Reviews
HNFS performs clinical necessity reviews on all treatment authorization requests.
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Subsequent Authorizations
Explore the requirements for ongoing care beyond initial referral and authorization.
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Authorization Changes
Providers and beneficiaries can request changes to current authorizations.
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Provider Types & Requirements
Providers must meet certain requirements to support beneficiaires through the ACD.
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ABA Service Locations
ABA services are rendered in a variety of locations. 
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Billing (CPT Codes and Claims Requirements)
Specific ABS CPT® codes are authorized by TRICARE for reimbursement under the ACD.
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Medical Documentation (Progress Notes)
Providers must maintain progress notes that align with the beneficiary's approved treatment plan.
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Exclusions
Services excluded from the ACD are not reimburseable and will not be authorized. 
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Compliance & Audits
Providers must comply with medical documentation and billing practices. 
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Provider Education Articles
Explore ABA-related news and updates.
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Additional Resources
Comprehensive materials are available to providers and beneficiaries.
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Contact Us
Questions? HNFS' ACD team is standing by to assist.