TRICARE families with special healthcare needs may require/be interested in services beyond what is covered under TRICARE’s basic benefit. Discover programs and services available to assist 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 occupational therapy, physical therapy, physician services, psychological services, psychological testing, prescription drugs, speech therapy, autism services coordination, medical team conference with interdisciplinary team of healthcare professionals and Applied Behavior Analysis (ABA). To receive TRICARE reimbursement for ABA, beneficiaries must be enrolled in TRICARE’s Autism Care Demonstration (ACD).
ACD enrollment requires all beneficiaries to:
Active Duty Family Members (ADFM) 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
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 healthcare, respite care for the primary caregiver, case management and care coordination.
To receive the TRICARE ECHO benefit, beneficiaries must receive an ASD diagnosis, enroll in the EFMP and register with Humana Military in the East Region.Find out more about ECHO
The EFMP makes sure special needs are considered during assignments and helps ADFMs access assistance wherever they are. The EFMP offers information about local services and programs, including childcare and relocation assistance, helps you apply for benefits and entitlements, and connects 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 hospital or clinic.Visit EFMP & Me for more information
Case management services are available to TRICARE ASD beneficiaries. 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 (800) 444-5445.