How it works

Step 1: Receive Autism Spectrum Disorder (ASD) diagnosis

Diagnosis must come from an approved ASD-diagnosing Primary Care Manager (PCM) or specialist.

Approved PCM and specialists types:

• PCM - pediatrician
• PCM - pediatric family medicine physicians
• PCM - pediatric nurse practitioner
• Board-certified developmental pediatrician
• Board-certified neurodevelopmental pediatrician
• Pediatric neurologist
• Pediatric child psychologist
• PhD clinical psychologist
• Specific board-certified Doctors of Nursing Practice (DPN)

Step 2: Get a referral and pre-authorization

Your child must get a referral to the ACD and a pre-authorization for all Applied Behavior Analysis (ABA) services. This is required for all TRICARE plans, including incidents where TRICARE is considered secondary (Other Health Insurance [OHI]).

• The diagnosing provider will submit a referral for authorization
• Your child will receive an authorization notice for six months of ABA services
• A new referral from your ASD-diagnosing provider is required every two years
• For beneficiaries enrolled on or after Oct. 1, 2021, Humana Military will assign an outreach coordinator who can assist with eligibility to the ACD

Are you requesting ABA services for the first time?

• Humana Military will send an authorization notice which covers your child’s ABA assessment
• Your child’s provider will complete the ABA assessment and then develop a treatment plan
• Your child will receive an authorization notice for six months of ABA services (reauthorization is required every six months from your child’s provider)
• ABA services are only available in locations with Board Certified Behavior Analysts (BCBA)

Step 3: Complete outcome measures

You and your child’s provider team must complete four baseline outcome measures before your child can get ABA services. This will help monitor your child’s progress.

You must complete the four outcome measures every six months or every 12 months (depending on the measure). If you need assistance in finding a provider to complete the outcome measures, please contact us at (866) 323-7155.

Step 4: Schedule an appointment

When you get your child’s authorization notice, schedule their ABA assessment with the provider listed in the authorization. If you would like to request a different provider, please call (866) 323-7155.

Your ABA supervisor’s role

• Plans, delivers and supervises your child’s ABA treatment program
• Helps you to develop goals for your participation in your child’s ABA treatment plan
• Updates your child’s treatment plan prior to your child’s next authorization period

Step 5: Work with your Autism Services Navigator (ASN)

TRICARE will assign your child an ASN if they are enrolled on or after Oct. 1 2021. Your child’s ASN acts as their primary clinical advocate.

The ASN will work with you to develop your child’s Comprehensive Care Plan (CCP).

Your child’s CCP will:

• Set goals and track timelines for outcome measures and authorization dates
• Connect you with clinical and non-clinical resources
• Provide discharge, moving or transition support