Benefits available with Autism Spectrum Disorder (ASD)

What's covered

Basic benefit covered services:

• Medical team conference with interdisciplinary team of healthcare professionals
• Occupational Therapy (OT)
• Pharmacotherapies
• Physical Therapy (PT)
• Psychotherapies
• Psychological testing
• Respite care
• Speech Therapy (ST)

Autism Care Demonstration (ACD) covered services:

• Autism services coordination via the Autism Services Navigator (ASN) for beneficiaries enrolled on or after Oct. 1, 2021
• Applied Behavior Analysis (ABA) services

TRICARE eligibility

To enroll in the ACD, beneficiaries must meet the following:

• Must be enrolled in an eligible TRICARE plan
• Active Duty Family Members (ADFM) must register for the Extended Care Health Option (ECHO)
• Must also be diagnosed with ASD to receive services under the ACD program (diagnosis must be from a TRICARE-authorized Primary Care Manager (PCM) or specialist approved to diagnose ASD)

Approved PCMs:

• Pediatricians
• Pediatric family medicine physicians
• Pediatric nurse practitioners

Approved specialists:

• Board-certified developmental pediatrician
• Board-certified neurodevelopmental pediatrician
• Pediatric neurologist
• Pediatric child psychologist
• PhD clinical psychologist
• Specific board-certified Doctors of Nursing Practice (DPN)