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Autism Care Demonstration Update: 2020 Rates; COVID-19 Impacts to ABA

Monday, March 30, 2020

The Defense Health Agency will soon post updated applied behavior analysis (ABA) rates at www.health.mil/rates. These rates, which are updated annually, are effective for dates of service on or after May 1, 2020. As a reminder, the balance billing provision for non-network providers does not apply to ABA rates. TRICARE-authorized providers agree to accept the TRICARE maximum allowable charge, minus applicable beneficiary copayments, cost-shares and deductibles, as payment in full. 

Please also review the latest ABA updates that have occurred in response to the COVID-19 pandemic: 

  • Expanded telehealth. The Defense Health Agency (DHA) has expanded telemedicine options allowed under TRICARE’s Autism Care Demonstration. In addition to outcome measures, ABA supervisors and assistant behavior analysts may now provide parent/caregiver guidance via telehealth. This exception is in place during the emergency period of March 31–May 31, 2020. Specific exclusions apply. Continue to submit reauthorization requests 30 days prior to current authorizations expiring, even if care is not being rendered. Providers are responsible for understanding TRICARE’s policy revision and how to manage authorizations during this emergency period. For more information, visit our benefits Benefits A–Z and find additional FAQs at www.health.mil/autism

  • Outcome measures: We recognize beneficiaries scheduled for outcome measure testing (Vineland-3 and SRS-2) may have had appointments delayed or canceled. We continue to work with beneficiaries to resolve testing concerns to ensure authorizations aren’t affected. ASD-diagnosing providers can submit referral requests to HNFS for beneficiaries to complete outcome measure testing (Vineland-3 and SRS-2) via local network ABA providers during this time. Telehealth appointments are allowed. 

  • Pearson VUE test centers closing. The Behavior Analyst Certification Board (BACB) announced Pearson VUE test centers for behavior technicians (BTs) are closed through April 16, 2020. TRICARE policy regarding BT certification remains in effect. Behavior technicians (RBTs, ABATs, BCATs) must be certified by an approved agency in order to provide services as a TRICARE-authorized provider. 

  • Individual Education Plans (IEPs). An IEP is required for TRICARE beneficiaries who receive ABA services in a school setting. With recent school closures, your TRICARE patients may have moved to a home environment. During this time, IEPs will not be required to reauthorize care as long as that care remains in a home setting. Please clearly document the location of services in the treatment plan.

  • Basic life support (BLS)/cardiopulmonary resuscitation (CPR). New individual providers must continue to obtain BLS/CPR certifications per current TRICARE policy. No exceptions will be made. If you are due for recertification, certifying bodies (American Red Cross, American Heart Association, etc.) have posted recommendations on how to recertify in the current environment on their websites. 

Find the latest information on the COVID-19 outbreak at www.cdc.gov/COVID19 and additional provider resources on our Coronavirus web page. Subscribe for ongoing ABA updates at www.health.mil

Contact HNFS’ Autism Care Demonstration (ACD) Customer Service team at 1-844-866-WEST (1-844-866-9378), option 1, then option 5 (after the prompts) to:

  • Get information about TRICARE’s ACD program, including benefit, referral and authorization guidelines.
  • Verify network effective dates (example, “Why is my BT not showing in the XpressClaim system?”).
  • Ask about the credentialing/certification process. (Please allow 45 business days before asking about status).