New Autism Demonstration Expands Opportunities for ABA Providers

FALLS CHURCH, Va.—The Department of Defense (DoD) and TRICARE, the DoD’s health entitlement program for more than 9.2 million beneficiaries, have announced a demonstration project to care for military dependents diagnosed with Autism Spectrum Disorders (ASD).

            The Enhanced Access to Autism Services Demonstration, which went into effect March 15, allows reimbursement for educational intervention services, such as Applied Behavior Analysis (ABA), delivered by paraprofessional providers.  ABA is a systematized process of collecting data on a child’s behaviors and using a variety of behavioral conditioning techniques to teach and reinforce desired behaviors while extinguishing harmful or undesired behaviors.  Time-limited, focused ABA methods have been shown to improve communication abilities, reduce or eliminate specific problem behaviors and teach new skills to some individuals with autism.  
  
            “We think this demonstration project will address some of the concerns families had—their inability to locate authorized ABA providers. However, we will only be successful if providers come forward to support our uniformed service families,” said Army Maj. Gen. Elder Granger, deputy director, TRICARE Management Activity.  
 
            TRICARE is in need of ABA professionals, or supervisors, and paraprofessionals, or tutors, to provide services that will enhance the effectiveness of academic instruction and provide training in life skills (language, communication, self help, activities of daily living, etc.) 

            The DoD has been a leader in providing coverage for health and special education services for children with autism. TRICARE is one of the very few health plans providing coverage for special education services.  In recent years, the per month special needs benefit for qualifying family members under TRICARE’s Extended Care Health Option (ECHO) was increased from $1,000 to $2,500; however, TRICARE beneficiaries still find it difficult to obtain services from authorized ABA providers. 

            TRICARE authorized providers are currently limited to those recognized by the Behavior Analyst Certification Board (BACB).  However, the professionalization of the field remains in its infancy and the number of BACB-certified behavior analysts is limited.  These certified professionals are for the most part providing behavior analysis evaluation and intervention planning services rather than the one-on-one technical intervention that is the actual tool effecting behavior change in autistic children.  This new field has yet to define the provider class that delivers the one-on-one technical services to children.  ABA tutors will increasingly be asked to provide services to the many children being diagnosed with ASD.

            “It is our intent that the provider qualifications set forth for the demonstration be in place only as a temporary bridge until national standards are established by an appropriate nationally recognized certifying body for ABA providers,” said Granger. “In the meantime, as a health care provider, we must take action on behalf of the children of our service men and women by allowing trained, supervised paraprofessionals to provide hands-on intervention services.” 

            TRICARE’s three Managed Care Support Contractors are building a referral network of ABA providers who will agree to be reimbursed for TRICARE-eligible beneficiaries referred for care. Providers wanting more information may contact: 

TRICARE North Region – Health Net Federal Services—(877) 874-2273
TRICARE North region provides health care services and support in Connecticut, Delaware, the District of Columbia, Illinois, Indiana, the Rock Island Arsenal area of Iowa, Kentucky, Maine, Maryland, Massachusetts, Michigan, the St. Louis area of Missouri, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, the Fort Campbell area of Tennessee, Vermont, Virginia, West Virginia and Wisconsin.

TRICARE South Region - Humana Military Healthcare Services—(800) 444-5445
TRICARE South region provides health care services and support in Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, Oklahoma, South Carolina, most of Tennessee and the eastern portion of Texas.

TRICARE West Region - TriWest Healthcare Alliance—(888) 874-9378
TRICARE West region provides health care services and support in Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa (except for the Rock Island Arsenal area), Kansas, Minnesota, Missouri (except for the St. Louis area), Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Dakota, the extreme western portion of Texas, Utah, Washington and Wyoming.

About TRICARE Management Activity and the Military Health System
TRICARE Management Activity, the Defense Department activity that administers the health care plan for the Uniformed Services, retirees and their families, serves more than 9.2 million eligible beneficiaries worldwide in the Military Health System (MHS).  The mission of the MHS is to enhance the Department of Defense and national security by providing health support for the full range of military operations.  The MHS provides quality medical care through a network of providers, military treatment facilities, medical clinics, and dental clinics worldwide. For more about the MHS go to www.health.mil.