Within provider self-service, providers can access beneficiaries’ care management profiles with information and resources on their current enrolled program(s).

Check out the care management dashboard!

Referral for ABA Services

To enroll in the ACD and obtain ABA services, beneficiaries need a:

  • Referral from an approved ASD-diagnosing provider or diagnosing specialists which includes:
    • An ASD diagnosis with the severity level
    • Date of initial ASD diagnosis
    • Request for ABA services
    • For beneficiaries, eight years or older and first diagnosed with ASD, a referral from a specialized ASD-diagnosing provider evaluation is required.
  • A completed DHA Diagnostic Statistical Manual (DSM)-5 checklist,  indicating the severity level of ASD symptoms
  • Results from a validated assessment tool
    • Screening Tool for Autism in Toddlers and Young Children (STAT)
    • Autism Diagnostic Observation Schedule-Second Edition (ADOS-2)
    • Autism Diagnostic Interview-Revised (ADI- R)
    • Childhood Autism Rating Scale-Second Edition (CARS-2)
    • Gilliam Autism Rating Scale, Third Edition (GARS-3). 
      • Completion of the GARS alone is not sufficient for diagnostic documentation. A diagnostic evaluation must be submitted in addition to the GARS-3.
    • For beneficiaries younger than age 12 months, the authorized ASD diagnosing / referring provider may choose an appropriate age-based tool to complete the VAT requirement
  • Enrollment in the Exceptional Family Member program (EFMP) and the Extended Care Health Option (ECHO) if the beneficiary is a dependent of an ADSM 
  • Acceptance of Autism Service Navigator (ASN) services

For a list of approved TRICARE ASD-diagnosing providers, review TOM Ch. 18 Sec. 3 paragraph 11.13.  

Registered providers should use provider self-service to submit all referrals and authorization requests. 
Providers who do not have a provider self-service account should register for an account to submit referral and authorization requests online. 

Humana Military will authorize an initial assessment for outcome measures for Treatment Plan (TP) development upon receipt of all necessary documents. Failure to provide necessary clinical information may result in delays, terminations of authorized care and denials for pended claims.

Initial ABA services request

During the initial assessment with an authorized ABA supervisor, target ASD symptoms are identified, and a TP is developed.

After the initial assessment is complete, ABA supervisors must submit a new authorization request containing:

  • A TP
  • Parenting Stress Index Fourth Edition (PSI-4) short form or Stress Index for Parents of Adolescents (SIPA)
  • Pervasive Developmental Disorder Behavior Inventory (PDDBI) parent form
  • Social Responsiveness Scale Second Edition (SRS-2) parent form
  • Vineland Third Edition (Vineland-3) parent and teacher/interview form

If the ABA supervisor cannot complete the required outcome measures, please notify Humana Military at (866) 323-7155 to ensure completion of these outcome measures.

ABA services must be pre-authorized before services begin. Humana Military does not accept retrospective referrals and will not backdate late submissions. Providers can submit requests for ongoing treatment up to 60 days in advance. However, submitting requests less than 30 days before the current authorization expires may result in non-reimbursement for ABA services. 

Continuing ABA services

TPs are reviewed for clinical necessity every six months to allow reassessment and document progress in improving core deficits. Prior to the expiration of each six-month authorization period, the authorized ABA supervisor must submit a new request for re-authorization of ABA services for the next six months from Humana Military. Providers must submit updated TPs and required outcome measures for review.

Every two years, a valid referral from an approved ASD-diagnosing provider or specialist must be submitted with the ASD diagnosis, level of support and approved DHA DSM-5 checklist. A two-year referral may be accepted up to six months in advance of its respective due date. 

Outcome measures timeline - what to expect the first two years