Service settings

TRICARE allows clinically-appropriate Applied Behavior Analysis (ABA) services to be rendered in various settings. ABA services must target the core symptoms of Autism Spectrum Disorder (ASD) and not be an excluded service under the Autism Care Demonstration (ACD). The clinical review process will be used to determine the appropriate location of ABA services.

Various service settings allowed

Home:

• Considered the beneficiary’s residence
• The ABA provider must render active delivery of ABA services that target the core symptoms of ASD

Clinic:

• The ABA clinic
• The ABA provider must render active delivery of ABA services that target the core symptoms of ASD
• Services may be conducted by all ABA provider types

Daycare:

• A daycare is a daycare center, child development center or after-school program (not pre-school)
• The ABA provider must render active delivery of ABA services that target the core symptoms of ASD
• ABA providers may not function as support aides or observers during care routines or activities (lunch, group activities, arts and crafts, etc)
• Services may be conducted by all ABA provider types
• Not affiliated with an educational setting

School setting:

• A school is a preschool, public school, private school or home school
• Services may be administered by the ABA supervisor
• The ABA provider must render active delivery of ABA services that target the core symptoms of ASD
• ABA services performed by Behavior Technicians (BT) or assistant behavior analysts in a school setting are NOT allowed
• The ABA supervisor may not function as a support aide or observer during care routines or activities
• A current Individualized Education Program (IEP) or equivalent is required; ABA services may not duplicate IEP services
• Academic or education goals are not covered under the ACD in any setting and should not be included within the Treatment Plan (TP)
• ABA services must be rendered outside of home-schooling hours and cannot overlap with ABA services
• A daycare center is not considered a school setting
• Is affiliated with an educational setting

Community setting:

• Community settings include parks, restaurants, grocery stores, community events, doctor appointments, or any setting that is not part of a home, clinic or school setting
• Services may be conducted by all ABA provider types
• ABA services must be focused and time-limited
• Only community settings that are clinically necessary and appropriate, as determined by clinical review, may be approved; specific exclusions apply to sporting events, camps and medical appointments
• Approval of an appropriate community setting is dependent upon the goals identified in the Treatment Plan (TP); these goals must be clinically appropriate and target the core symptoms of ASD
• Parent training is not allowed in community settings

Telemedicine:

• Only available for parent training after the first initial six months of treatment