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Autism Care Demonstration

DSM-5 Diagnostic Checklist

TRICARE requires a completed DSM-5 Diagnostic Checklist for all beneficiaries in the Autism Care Demonstration (ACD). For beneficiaries new to the ACD as of Oct. 1, 2021, the checklist is required prior to enrollment and at each two-year referral renewal. For beneficiaries enrolled prior to Oct. 1, 2021, the checklist is required at their next referral cycle and each two-year referral renewal. The DSM-5 Diagnostic Checklist identifies the level of support required according to DSM-5 autism spectrum disorder (ASD) criteria. This form must be completed by TRICARE-authorized, ASD-diagnosing or referring providers only. Applied behavior analysis (ABA) providers are not permitted to complete this checklist.

  • Created: Nov 3, 2021
  • Modified: Nov 3, 2021
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Definitive Diagnosis Referring Provider Attestation

To help meet Oct. 1, 2021 Autism Care Demonstration (ACD) definitive diagnosis requirements and proactively prevent gaps in care, TRICARE-authorized ASD-referring and diagnosing providers have the option of submitting this form for beneficiares enrolled to the ACD prior to Oct. 1.

  • This attestation will fulfill both the DSM-5 Diagnostic Checklist and validated assessment tool eligibility requirements that take effect Oct. 1, 2021.
  • This form may ONLY be completed for beneficiaries enrolled to the ACD prior to Oct. 1.
  • Created: Nov 3, 2021
  • Modified: Nov 3, 2021
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