Getting Started with the Autism Care Demonstration
TRICARE beneficiaries must meet specific qualifications in order to participate in the Autism Care Demonstration (ACD). Learn more on our ACD Eligibility page.
Before getting care under the ACD:
- TRICARE beneficiaries first need a definitive ASD diagnosis.
- After diagnosing a beneficiary with ASD, the provider must submit a referral or diagnostic evaluation to Health Net Federal Services, LLC (HNFS). This step is also referred to as a nomination for ACD services.
This initiates the process for ACD enrollment.
HNFS offers Autism Services Coordinators (non-clinical coordinators with experience with the ACD) who can help families with the pre-enrollment criteria.
Note: An Autism Services Coordinator is not the same as an Autism Services Navigator (ASN). Learn more about ASNs on our Autism Service Navigators page.
Autism Spectrum Disorder Diagnosis
The ASD diagnosis occurs under the TRICARE basic benefit. The diagnosis must be from a TRICARE-authorized primary care manager or specialist approved to diagnose ASD.
As of Oct. 1, 2021, approved ASD-diagnosing and referring provider types are:
|Primary Care Managers
- pediatric family medicine physicians
- pediatric nurse practitioners
- physicians board-certified or board-eligible in developmental-behavioral or neurodevelopmental pediatrics
- pediatric neurology or child psychiatry
- PhD clinical psychologists;
- specific board-certified doctors of nursing practice (DNPs)
Request for ACD Services
The ASD-diagnosing and referring provider must submit a request to HNFS. We will verify the request includes the following requirements:
- A referral or diagnostic evaluation stating ASD. We cannot accept a “provisional” diagnosis. The referral may or may not specify ABA services.
- The date of initial ASD diagnosis.
- A DSM-5 Diagnostic Checklist. This checklist is completed by a TRICARE-authorized ASD-diagnosing and referring provider, but it does not have to be completed by the provider who first diagnosed your child. A copy of the checklist is available at www.tricare-west.com. Note: ABA providers are not permitted to complete the DSM-5 Diagnostic Checklist.
- Results from one of the following assessment tools:
- Screening Tool for Autism in Toddlers and Young Children (STAT),
- Autism Diagnostic Observation Schedule-Second Edition (ADOS-2),
- Autism Diagnostic Interview-Revised (ADI-R),
- Childhood Autism Rating Scale-Second Edition (CARS-2),
- Gilliam Autism Rating Scale, Third Edition (GARS-3) (For this tool, the diagnosing and referring provider must also submit a diagnostic evaluation.)
Note! If not yet completed, one of HNFS' Autism Services Coordinators can help guide you through this requirement.
- For active duty family members only, registration in the Extended Care Health Option (ECHO). One of HNFS' Autism Services Coordinators can assist you with provisional ECHO registration process if not already registered. You will receive provisional registration into ECHO for up to 90 days. During the 90 days, your child can access the ECHO benefit and continue the process of initiating ABA services under the ACD. Please note:
- If you do not submit proof of Exceptional Family Member Program (EFMP) enrollment (or a waiver, when eligible) within the 90 days, your child will be disenrolled from ECHO and will no longer eligible for ABA services.
- If your child loses eligibility for ABA services between the expiration of the 90-day provisional period and registration into ECHO, the Autism Services Coordinator will support you for an additional 90 days. If after 180 days, ECHO registration has not been completed, your child will no longer be eligible for the ACD.
- Once ECHO registration is complete and ABA treatment has been authorized, the beneficiary's eligibility for the ACD will be reinstated. HNFS will not backdate the authorization to cover the dates of service between the expiration of the provisional ECHO status and registration. No services under the ACD should be rendered during this period.