ABA therapy with TRICARE
We accept TRICARE at both of our Alexandria clinics, on the Route 1 corridor near Fort Belvoir. Like any insurance, TRICARE needs a referral and authorization before ABA starts. Here’s how it works and where to begin.
What TRICARE covers
TRICARE covers ABA through a program called the Autism Care Demonstration (ACD), which is separate from the regular TRICARE medical benefit. It covers qualifying family members of active duty service members, retirees, and certain National Guard and Reserve members. To qualify, your child must be:
- Enrolled in a TRICARE health plan
- Diagnosed with autism spectrum disorder (ASD) by an approved provider
Like any insurance, TRICARE needs a referral and pre-authorization before ABA services start. TRICARE says every TRICARE plan requires this.
On cost, you pay your plan's copayment or cost-share for ABA, with one copayment for all ABA services on the same day. Your exact costs depend on your plan, so check with your regional contractor.
How to get started
Here's the general sequence, based on TRICARE's own steps:
- Get a diagnosis from a TRICARE-approved diagnosing provider, such as your child's pediatrician, a developmental behavioral pediatrician or a licensed clinical psychologist.
- If you're active duty, start EFMP and ECHO enrollment. Enroll in your service branch's Exceptional Family Member Program and TRICARE's Extended Care Health Option. Don't wait on these.
- Get a referral. Your child's diagnosing provider sends a referral to your regional contractor.
- Get the first authorization. For families new to ABA, the first authorization covers your child's ABA assessment.
- Complete the assessment. We assess your child, write a treatment plan, and complete the baseline outcome measures TRICARE asks for.
- Get the treatment authorization. Once it's approved, therapy can begin.
Once ABA is approved
- Regular reauthorizations. ABA is authorized for a set period at a time, and we request reauthorization before it ends.
- A new referral from time to time. Your child needs an updated referral and documentation for ABA to continue.
- Parent goals. Your child's BCBA helps you set goals for your own part in your child's treatment plan.
- An autism services navigator. TRICARE assigns most families a navigator, who coordinates care with you.
Moving on PCS orders?
Don't disenroll before you move, and talk with your regional contractor and case manager early: you can request referrals for your new duty station before you go. Ask both your current and new contractors how your authorization will carry over, and bring your child's diagnosis, treatment plan and recent progress reports to your new provider. If you're moving to the Alexandria area, call us early and we'll plan around your timeline.
Questions to ask your regional contractor
Virginia is in TRICARE’s East Region, served by Humana Military. Have your sponsor’s information and your child’s diagnosis paperwork handy, and write down the date, the name of the person you spoke with, and any reference number.
- Is my child enrolled in the Autism Care Demonstration, or what do we need to do to enroll?
- Did my child’s diagnosis come from an approved diagnosing provider?
- Has a referral been received? What’s the status of our authorization?
- Is the ABA provider we’re considering authorized under the ACD?
- Which steps apply to our family (EFMP, ECHO), and are they complete?
- When is our next reauthorization, and when is our next referral due?
- Who is our autism services navigator, and how do we reach them?
- What will our copayment be under our current plan?
Write the answers down and bring them to us. We’ll go through them together.
Let’s figure it out together
When you reach out, your first conversation is with an experienced member of our leadership team. We’ll listen, answer your questions, and talk through where you are in the process. Coverage depends on your specific plan, so we check your benefits first.
This page is general information, not insurance or legal advice. TRICARE program rules change; tricare.mil and your regional contractor have the final word.
Not sure yet? That’s what the first call is for.
Ask about insurance, schedules, or what a day would look like for your child. No pressure and no commitment.