Recently, the Defense Health Agency (DHA) announced a rewrite of the TRICARE Autism Care Demonstration (ACD) program that encompasses “significant changes to the ACD.” It will move the ACD from the current Applied Behavior Analysis (ABA)-centric model to one focused on the beneficiary and family. Without specific details, the DHA states these comprehensive changes will provide an opportunity to improve support to beneficiaries and their families by:

1. Providing more information about Autism Spectrum Disorder (ASD) and potential services;

2. Linking beneficiaries to the right care at the right time; and

3. Increasing services to eligible family members – especially parents.

DHA promotes the improvements as a “comprehensive approach that creates a beneficiary and parent-centered model of care and support that encompasses all the beneficiary’s and family’s needs.” The TRICARE manual change will incorporate all needed services – including but not limited to ABA services – into one treatment plan. DHA designed these changes “empowering parents to have a greater role in determining the most appropriate services for their child.”

Last year in a cost-saving measure, DHA revised the ACD to delete TRICARE reimbursement for supervision while simultaneously requiring unreimbursed supervision in accordance with the certification bodies. In short, DHA shifted the supervision costs to the providers. Based upon the limited information available, it appears this year’s cost saving measure will limit ABA services. Of course, we must wait until DHA rolls-out the new ACD TRICARE manual change for the details. Because this is a simple TRICARE manual change, no TRICARE beneficiary or parental input is required for the new program. DHA promised this TRICARE Manual change with the program re-write and updated policy guidance no later than Summer 2020.

See The Department of Defense Comprehensive Autism Care Demonstration Quarterly Report to Armed Services Committees, Third Quarter, Fiscal Year 2019, February 21, 2020. https://www.health.mil/Reference-Center/Congressional-Testimonies?refVector=001000000000000&refSrc=130