TRICARE covers Applied Behavior Analysis (ABA) from Board-Certified Behavior Analysts (BCBA) or Board-Certified Behavior Analyst-Doctorate (BCBA-D) for all TRICARE eligible beneficiaries who are diagnosed with an Autism Spectrum Disorder (ASD). The Comprehensive Autism Care Demonstration (CACD) supports one-to-one services and tiered delivery services, depending on the unique needs of the beneficiary.
Supervisors must first become TRICARE certified and hold the BCBA or BCBA-D certification or license as required by state. In states that do not provide licensing or certification, the behavior analyst must be certified by the Behavior Analyst Certification Board (BACB).
All ABA providers must meet the qualifications as outlined on the CACD program applications, and the application process must be completed prior to providing services through the program.
CACD program applications are separate from TRICARE Certification (PGBA) and ValueOptions Federal Services Network participation.
TRICARE policy includes reimbursement information. See TRICARE Operations Manual 6010.56-M Chapter 18, Section 18 for details. The CACD has no caps for annual or lifetime payments or age limits for treatment.
Responsibilities for ABA providers include treatment planning and follow-up.
ABA supervisors and/or BCBAs and BCBA-Ds are responsible for completing the initial assessment, writing the treatment plan, ensuring the treatment plan is being administered by the behavior technician in an effective manner, and writing the updated progress note and updated treatment plan. BCaBAs, under the direction of the BCBA, can assist in clinical support and case management activities, to include assisting in the supervision of BTs and providing treatment guidance to family members/caregivers.
Behavior technicians must meet the minimum evidence-based standards as indicated by the current BACB Guidelines for Responsible Conduct for Behavior Analysts and Current BACB rules and regulations.
To confirm the quality of services provided by behavior technicians, ABA supervisors must provide no less than 5 percent and no more than 20 percent of hours with beneficiaries under supervision per month for each beneficiary seen by a contracted or employed behavior technician or BCaBA. When supervision in excess of 20 percent is indicated, the ABA provider should work with the Managed Care Support Contractor.
Additionally, providers must ensure ongoing compliance with all participation requirements and report to ValueOptions Federal Services within 30 days of notification of any BACB sanctions for any violations or loss of BACB certification.
At intervals specified by ValueOptions Federal Services, CACD supervisors must cooperate with participation criteria compliance, quality of care and service audits. Scroll down to Related Links to find audit forms.
Finally, psychometric testing is required. New beneficiaries diagnosed by a P-PCM must complete either the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) or a diagnostic evaluation from a specialized ASD diagnosing provider within one year of admission to the CACD.
All current beneficiaries who receive ABA services will be deemed to have met all diagnosis, referral and assessment requirements.
Information about the CACD is current as of the time it is published. Visit TRICARE.mil/aba for the latest policy requirements.Related links: