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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). Please refer to TRICARE Operations Manual, Chapter 18, Section 4 for complete policy details.

To learn more, find past Defense Health Agency (DHA)-led presentations, and to sign up for email updates, visit www.health.mil/autism
 

Looking for providers? Search our ACD-specific directory:

 

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Eligibility and Diagnostic Criteria

Learn about ACD eligibility and diagnostic requirements.

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Benefits and Costs
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 assigned 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 over time.
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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 our comprehensive Treatment Plan Requirements guide.
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Clinical Necessity Reviews
Health Net Federal Services, LLC (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 provide ABA services to beneficiaries as part of the ACD.
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ABA Service Settings/Locations
ABA services may be rendered in a variety of settings/locations. 
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Billing (Current Procedural Terminology [CPT®] Codes and Claims Requirements)
Specific adaptive behavior services (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 and meet ACD requirements.
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Exclusions
Services excluded from the ACD are not reimbursable and will not be authorized. 
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Compliance & Audits
Providers must comply with medical documentation and billing practices. 
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Annual Provider Training

All autism corporate services providers (ACSPs) and ABA sole providers participating in the ACD are required to complete annual training.

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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 your TRICARE patients.
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Contact Us
Questions? HNFS' ACD team is standing by to assist.