TRICARE beneficiaries

ASD benefits and progams

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.

Autism CoE
Providers

TRICARE benefits and programs

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:

  • Occupational therapy
  • Physical therapy
  • Physician services
  • Psychological services
  • Psychological testing
  • Prescription drugs
  • Speech therapy
  • Applied Behavior Analysis (ABA)*

* To receive TRICARE reimbursement for ABA, beneficiaries must be enrolled in TRICARE’s Comprehensive Autism Care Demonstration (CACD). CACD 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 benefit

Active Duty Family Members (ADFMs) may be eligible for additional programs and services such as:

Exceptional Family Member Program (EFMP)

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:

  • Offer information about local services and programs, including childcare and relocation assistance
  • Help you apply for benefits and entitlements
  • Connect you with other families with special needs

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:

  • DD Form 2792, Family Member Medical Summary: The service member or adult family member completes the first page to document medical needs. The family member's physician or other qualified medical professional completes the rest.
  • DD Form 2792-1, Special Education/Early Intervention Summary: The sponsor or legal guardian completes items one through seven of the first page to document educational needs. School or early intervention program personnel complete the remainder of the form. A copy of the individualized education program or individual family service plan pairs with the form.
Learn more about the EFMP

Extended Care Health Option (ECHO)

ECHO provides supplemental coverage to ADFMs beyond what is offered under the TRICARE Basic Program. ECHO services may include:

  • Training
  • Rehabilitation
  • Special education
  • Assistive technology devices
  • Institutional care (may include transport to and from)
  • Home health care
  • Respite care for the primary caregiver
  • Case management and care coordination

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

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:

  • Referrals to local or state-funded resources
  • Educational tools and resources focused on the beneficiary’s needs
  • Care coordination
  • Development of individualized care plan to include goals and the different types of care and services to meet the beneficiary’s needs

To enroll in the case management program, talk to your provider about a referral or contact us at 1-800-444-5445.