Update on TRICARE and ABA Services for Military Families | Organization for Autism Research

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In December 2012, The OARacle (the monthly e-newsletter of the Organization for Autism Research) reported on legal and Congressional action that enabled TRICARE to cover Applied Behavior Analysis (ABA) services – the most researched and arguably most efficacious behavioral intervention – for military children affected by autism under its basic coverage program.  Regarded as a major victory for more than 23,000 service members and their families, this mandate is now being implemented through a pilot program.

TRICARE recently began a pilot program that provides non-active duty families access to evidence-based autism treatments.

TRICARE recently began a pilot program that provides non-active duty families access to evidence-based autism treatments.Dependents of active duty service members are already eligible for ABA services through the TRICARE basic program or, more commonly, its Extended Health Care Options (ECHO) program.  The purpose of the ABA pilot program is to extend these benefits (up to $36,000 in coverage) to family members of military personnel that are not on active duty, including retirees.  To be eligible for the program, dependents must have:

  • An autism spectrum disorder diagnosis from a physician
  • A referral from the diagnosing physician to a Board Certified Behavior Analyst (BCBA)
  • Authorization from a regional contractor that describes why ABA is appropriate
  • An initial ABA assessment to determine baseline measures and reassessment after 180 days

Though generally in favor of this change, advocacy groups such as Autism Speaks had expressed concern that the new program would negatively affect or limit the services that TRICARE currently covers for children of active duty service members.  TRICARE responded in late July with a letter to its regional contractors stating that no changes will be made.  While this provided a sense of relief, there is still debate about other policies as written: the types of tests required for eligibility, timeliness of access to services, length of coverage, etc.

This ABA pilot program will be in place for one year and end in late July of 2014.  Extension of the program, however, will require passage of new legislation and subsequent budget language at the federal level.  Visit the TRICARE Web site for more detailed information about the ABA pilot program.

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