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Department of Defense announces ABA coverage improvements for TRICARE

May 29, 2015

Washington, DC— TRICARE, the Department of Defense healthcare program, announced improvements to its coverage of applied behavior analysis (ABA) for beneficiaries with autism. The improvements were announced as amendments to the TRICARE Comprehensive Autism Care Demonstration (ACD).

The newly published federal register notice describes the changes, including aligning ABA cost shares with other outpatient services under the TRICARE Basic Program and having cost shares accrue to the annual family catastrophic cap.  ABA provider reimbursement rates will be based on “geographic practice cost indices.”

The notice states, “As a result of this adjustment, all TRICARE beneficiaries receiving ABA for ASD under the ACD will now be protected from excessive out of pocket costs by the applicable catastrophic cap based on their sponsor’s status and TRICARE plan under which covered.”

The ACD goals are to evaluate ABA under TRICARE and determine appropriate delivery models, cost sharing requirements, and provider reimbursement rates while increasing access to ABA services.

“This is a very positive step to ensure ABA services are affordable to military families,” said Karen Driscoll, Associate Director, Federal Government Affairs & Military Relations. “We applaud TRICARE and DoD leadership for listening and responding to the concerns from the community.”

All changes go into effect on October 1, 2015.

Read more on Tricare coverage of ABA HERE.