TRICARE families with special healthcare needs may need services beyond what is covered under TRICARE’s basic benefit. Learn more about your plan and the additional programs and services that may be available to assist you in getting the care you need.
TRICARE covers a full range of medical and specialty care services to address the needs of beneficiaries with Autism Spectrum Disorder (ASD). Coverage for eligible beneficiaries may include the following services:
* To receive TRICARE reimbursement for ABA, beneficiaries must be enrolled in TRICARE’s Autism Care Demonstration (ACD). ACD enrollment requires all beneficiaries to 1) receive an ASD diagnosis from their primary care manager or qualified ASD diagnosing provider and 2) get a referral from their provider and prior-authorization from Humana Military. Active Duty Family Member’s (only) must also enroll in their service’s Exceptional Family Member Program (EFMP) and register in TRICARE’s Extended Care Health Option (ECHO). Learn more
Learn more about your TRICARE basic program benefitActive Duty Family Members (ADFMs) may be eligible for additional programs and services such as:
EFMP assists Active Duty Family Members (ADFMs) with special healthcare services at present and new duty stations. The EFMP makes sure special needs are considered during assignments, and then helps ADFMs access assistance wherever they are.
EFMP services include:
To enroll in the EFMP, ADFMs must obtain paperwork from the EFMP medical point of contact at their local military treatment facility. Find your service branch’s EFMP representative by visiting the installation program directory.
Enrollment forms:
ECHO provides supplemental coverage to ADFMs beyond what is offered under the TRICARE Basic Program. ECHO services may include:
To receive the TRICARE ECHO benefit, beneficiaries must receive ASD diagnosis, enroll in the EFMP and register with Humana Military in the East Region. Learn more
Case management services are available to TRICARE beneficiaries with ASD to support self-management, shared decision making and knowledgeable use of medications. Case management services include:
To enroll in the case management program, talk to your provider about a referral or contact us at (800) 444-5445.
Children and adults with ASD may be eligible for government assistance for help covering the costs of basic living needs such as food, housing, and clothing. Learn about government programs and services including Social Security and Medicare.
