Autism Care Demonstration: Referral for Applied Behavior Analysis Services
After diagnosing a beneficiary with autism spectrum disorder (ASD), your provider will submit a referral to Health Net Federal Services, LLC (HNFS). We will verify the referral to:
- Ensure all TRICARE policy requirements have been met, and
- Confirm the beneficiary has met all Autism Care Demonstration (ACD) eligibility requirements.
Please allow two to five business days for HNFS to verify that referral requirements have been met.
For beneficiaries entering the ACD on or after Oct. 1, 2021: If the beneficiary’s initial ASD diagnosis occurred after age eight, or it has been two or more years since the original diagnosis and this is the first applied behavior analysis (ABA) services referral under TRICARE's ACD, we will need a copy (if we do not already have one on file) of the TRICARE-authorized diagnosing provider's diagnostic evaluation with definitive diagnosis of ASD.
Key Facts About ABA Referrals
Referrals for ABA services under the ACD are:
Two-Year Referral Cycle
- Within each two-year referral cycle, care is authorized in six-month periods. The first six-month authorization period will begin once the assessment process has been completed and treatment has been authorized.
- Referral renewals must be submitted by your TRICARE-authorized ASD diagnosing or referring provider within six months before the end of the current two-year cycle.
- Referrals remain valid within the two-year timeline, even if you:
- Change providers,
- Get a second opinion,
- Move within the TRICARE West Region, or
- Move to the TRICARE East Region or overseas.
We will provide a referral due date in writing to help track when a new request for referral will be required.
