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ABA Service Settings

TRICARE allows applied behavior analysis (ABA) services to be rendered in various settings, as clinically appropriate. Regardless of the setting, authorized ABA services must:

  • Target the core symptoms of autism spectrum disorder (ASD) 
  • Not be an excluded service under the Autism Care Demonstration (ACD)

Part of the clinical necessity review process includes determining the appropriate location where ABA services may be rendered for the beneficiary. 
 

Home

  • The home is the beneficiary's residence.  
  • Services can be by all ABA provider types (as authorized per the treatment plan).
  • The ABA provider must render active delivery of ABA services that target the core symptoms of ASD.  
  • See "School Settings" for home schooling information.
     

Clinics/Centers

  • A clinic (center) is the outpatient ABA clinic or center.
  • Services can be by all ABA provider types (as authorized per the treatment plan).
  • The ABA provider must render active delivery of ABA services that target the core symptoms of ASD.  
     

Daycare (non-preschool)

  • A daycare is a daycare center, child development center or after-school program.
  • Services may be by all ABA provider types (as authorized per the treatment plan).
  • The ABA provider must render active delivery of ABA services that target the core symptoms of ASD.  
  • ABA providers may not function as support aides or observers during care routines or activities (e.g., lunch, group activities, arts and crafts, etc.). 
     

School Settings

  • A school is a preschool, public school, private school or home school.
  • Services may be administered by ABA supervisors (as authorized per the treatment plan).
  • The ABA supervisor must render active delivery of ABA services that target the core symptoms of ASD.   
  • The services must be focused and time-limited. 
  • ABA services performed by behavior technicians (BTs) or assistant behavior analysts in a school setting are not allowed. 
  • The ABA supervisor may not function as a support aide or observer during care routines or activities (e.g., lunch, group activities, arts and crafts, etc.). 
  • A current Individualized Education Program (IEP) is required. ABA services may not duplicate IEP services.
  • Academic or educational goals are not covered under the ACD in any setting, including the school setting. 
  • If your child is homeschooled, authorized ABA services must be rendered outside of home-schooling hours. Home-schooling hours cannot overlap ABA services. 
  • Daycare centers/child development centers/after-school programs are not considered school settings under the ACD. (See “Daycare” section.)
     

Community settings

Community settings are any location not part of a home, center/clinic or school setting. Community settings include grocery stores, parks, restaurants, medical offices, or events such as youth sports or local community events. 

  • Services may be by all ABA provider types (as authorized per the treatment plan).
  • The ABA provider must render active delivery of ABA services that target the core symptoms of ASD.  
  • The services must be focused and time-limited.
  • Specific exclusions apply to sporting events, camps and medical appointments for the beneficiary or other family members.
  • Exclusions also apply to ABA services rendered during other medical appointments (doctor visits, physical therapy, etc.), to include another family member's appointments.
  • Because community settings often do not allow for frequent/repeated treatment opportunities and often target areas not specific to an ASD diagnosis, we use the clinical necessity review process to determine whether a community setting is clinically appropriate, provider types, units, etc. 
     

Telemedicine

Telemedicine is the use of secure video conferencing to provide active delivery of ABA services to beneficiaries at home.

  • Audio-only services are not allowed. 
  • Only the following services are allowed via telehealth when authorized:
    • parent/caregiver guidance by the ABA supervisor or assistant behavior analyst
    • medical conferences by the ABA supervisor
  • The ABA supervisor or assistant behavior analyst must render active delivery of ABA services that target the core symptoms of ASD.  
  • Behavior technicians may not provide services via telehealth.  
  • Outcome measures are not allowed via telehealth, but may be rendered via an indirect methods (see “Indirect” section). 
     

Indirect

  • Indirect refers to telephone (no video), email and U.S. postal mail (report writing, reviewing records, etc.).
  • Outcome measures may be performed by TRICARE-authorized ASD-diagnosing providers or, when authorized by HNFS, ABA supervisors via indirect methods.

 

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