Autism Care Demonstration

A new TRICARE West Region contract is scheduled to start Jan. 1, 2025. With this, the West Region contractor will change from Health Net Federal Services, LLC (HNFS) to TriWest Healthcare Alliance (TriWest). HNFS is honored to provide exceptional service under the current West Region contract, and we will continue to do so throughout the remainder of our contract.

Read our West Region transition FAQs to learn more.

TRICARE’s Autism Care Demonstration (ACD) allows for clinically necessary and appropriate applied behavior analysis (ABA) services to be rendered to TRICARE-eligible beneficiaries diagnosed with autism spectrum disorder (ASD). Please refer to TRICARE Operations Manual, Chapter 18, Section 4 for complete policy details.

To learn more, find past Defense Health Agency (DHA)-led presentations, and to sign up for email updates, visit www.health.mil/autism.

Looking for providers? Search our ACD-specific directory:

Eligibility and Diagnostic Criteria

Learn about ACD eligibility and diagnostic requirements.

Benefits and Costs
Explore the services available to TRICARE beneficiaries.

Autism Services Navigators (ASNs)

Beneficiaries new to the ACD as of Oct. 1, 2021, are assigned an ASN.

Referrals for ABA Services

Referrals for ABA services are valid for two years.

Outcome Measures
Scores are used in treatment planning and evaluating progress over time.

Initial Authorizations: Assessments & First Treatment
Specific requirements must be met prior to treatment authorization.

Treatment Plan Requirements
Explore our comprehensive Treatment Plan Requirements guide.

Clinical Necessity Reviews
Health Net Federal Services, LLC (HNFS) performs clinical necessity reviews on all treatment authorization requests.

Subsequent Authorizations
Explore the requirements for ongoing care beyond initial referral and authorization.

Authorization Changes
Providers and beneficiaries can request changes to current authorizations.

Provider Types & Requirements
Providers must meet certain requirements to provide ABA services to beneficiaries as part of the ACD.

ABA Service Settings/Locations
ABA services may be rendered in a variety of settings/locations.

Billing (Current Procedural Terminology [CPT®] Codes and Claims Requirements)
Specific adaptive behavior services (ABS) CPT codes are authorized by TRICARE for reimbursement under the ACD.

Medical Documentation (Progress Notes)
Providers must maintain progress notes that align with the beneficiary's approved treatment plan and meet ACD requirements.

Exclusions
Services excluded from the ACD are not reimbursable and will not be authorized.

Compliance & Audits
Providers must comply with medical documentation and billing practices.

Annual Provider Training

All autism corporate services providers (ACSPs) and ABA sole providers participating in the ACD are required to complete annual training.

Provider Education Articles
Explore ABA-related news and updates.

Additional Resources
Comprehensive materials are available to providers and your TRICARE patients.

Contact Us
Questions? HNFS' ACD team is standing by to assist.