Autism Awareness Month: TRICARE Covers ABA Therapy

  • Published
  • By Shari Lopatin
  • TriWest Healthcare Alliance
Today, autism in children has become more prevalent than childhood cancer, juvenile diabetes and pediatric AIDS combined, according to Autism Speaks, a national autism science and advocacy organization.

The Autism Speaks association defines autism as, "a group of complex developmental brain disorders." Today, about one in every 110 children is diagnosed with autism.

April is Autism Awareness Month and has been recognized as such by the Autism Society since the 1970s. Autism Awareness Month highlights the growing need for concern about autism and its potential treatments.

Many different types of treatment exist for an autistic individual. However, one of the more prominent techniques that has gained recent notoriety is applied behavior analysis, or ABA therapy. According to the National Institute of Child Health and Human Development, ABA may help reduce problem behaviors associated with autism and teach vital new skills.

As part of the growing recognition of ABA therapy, tricare now covers this type of treatment for eligible beneficiaries. It's part of tricare's Autism Services Demonstration, an enhanced benefit under the Extended Care Health Option. ECHO is tricare's benefit for individuals with disabilities.

How It Works

To be eligible for ECHO, families must first enroll into their service branch's exceptional family member program. Each service branch has a point of contact to help families enroll. After enrolling, families need a referral to register for ECHO, which can be obtained from a provider, or even a self-referral. After families are registered in ECHO, they can check their eligibility for the Autism Services Demonstration.

Children eligible for the Autism Services Demonstration must have a diagnosis consistent with the autism spectrum. In addition, they must have an active-duty sponsor, be living in the United States, be 18 months or older, and be enrolled in the ECHO program through their tricare regional contractor.

The tricare Autism Services Demonstration covers ABA treatment and other types of therapies that fall under the umbrella of "Educational Interventions for Autism Spectrum Disorders." The providers who implement these therapies must be tricare-authorized in order for the treatments to be covered. TriWest makes sure to take care of these providers, so they can take care of you -- their patients.

Each month, families pay a "cost share" for services they receive under ECHO. This monthly cost share depends on the sponsor's pay grade.

For more information on the Autism Services Demonstration, including specifics on cost shares,