TRICARE enhances autism services coverage

By Brian Smith: TriWest Healthcare Alliance

Active duty military families now have access to expanded services for autistic children under TRICARE. A new set of behavioral and educational benefits — the Enhanced Access to Autism Services Demonstration benefit — allows eligible beneficiaries to see a new category of providers as part of the Extended Care Health Option (ECHO) program.

Educational interventions for autism spectrum disorders (EIA) aim to reduce problem behaviors and teach new skills to autistic children. The demonstration allows reimbursement for applied behavior analysis (ABA) services performed by tutors under close supervision. TriWest Healthcare Alliance is working throughout the 21-state TRICARE West Region to certify providers who can deliver these services.

Eligibility

When a child is eligible, an ECHO case manager is assigned. That case manager will be able to assist with questions about the benefit and with enrollment into TriWest’s ECHO program. Beneficiaries eligible for the Autism Services Demonstration must meet the following criteria:

• A TRICARE-eligible dependent of an active duty service member

• Age 18 months or older

• Registered or registering for TRICARE’s ECHO program through TriWest

• Living within the 21 states of the TRICARE West Region

• Diagnosed by a TRICARE-authorized primary care manager or specialized provider with one of the following:

• Autistic Disorder

• Asperger’s Syndrome

• Childhood Disintegrative Disorder

• Pervasive Developmental Disorder Not Otherwise Specified

Supervisors and tutors

Supervisors, under the demonstration, are individuals certified by the Behavior Analyst Certification Board (BACB) or licensed by their state to render ABA services. These supervisors oversee tutors who deliver one-on-one ABA services. The supervisor will work with the family and the eligible child to develop a behavior plan and keep track of the child’s progress. The behavior plan includes the child’s goals and objectives and any recommendations for continued service. The supervisor will work with TriWest to make sure the proper authorizations are in place.

A interactive directory of local, contracted EIA supervisors is available through the ECHO section of www.triwest.com (www.triwest.com/beneficiary/echo). More ECHO Autism Services Demonstration benefit and contact information is available online.

Information:

• TRICARE Autism Demonstration Project: www.tricare.mil/mybenefit/autism

• TriWest Healthcare Alliance ECHO Program: http://www.triwest.com/beneficiary/echo

• TriWest ECHO Program Manager: 1-866-876-2384, ext. 48124

• Exceptional Family Member Program: www.militaryhomefront.dod.mil/efm