Autism Care Demonstration: Applied Behavior Analysis Provider Types and Requirements
Overview
Education and certification requirements to become a provider for the Autism Care Demonstration (ACD) are outlined in TRICARE Operations Manual (TOM), Chapter 18, Section 4.
Due to the TRICARE contract transition, please note:
- For provider groups who are directly credentialed by Health Net Federal Services:
- With exception to Registered Behavior Technicians® (RBT), we are no longer accepting new practitioner additions or new facility locations. (If you are an ABA supervisor or assistant behavior analyst, please email ACDNetwork@hnfs if you have questions.)
- Through Dec. 15, 2024, HNFS will continue to certify new RBTs in support of TRICARE's Autism Care Demonstration.
- For provider groups who have a delegated credentialing agreement: We will continue to accept new practitioner additions submitted to us on rosters through Dec. 31, 2024.
Provider Types
Under the ACD, TRICARE beneficiaries receive applied behavior analysis (ABA) services provided solely by TRICARE-authorized ABA supervisors (Board Certified Behavior Analysts® [BCBA®], BCBA – Doctoral® [BCBA-D®], licensed behavior analysts [LBA], or clinical psychologists).
Under the tiered-delivery model, the authorized ABA supervisor receives support from:
- Board Certified Assistant Behavior Analysts® (BCaBA®),
- Qualified Autism Service Practitioner – Supervisors (QASP-S®),
- Licensed assistant behavior analysts (LABA), and/or
- Behavior technicians (BT), including:
- Registered Behavior Technicians® (RBT®)
- Applied Behavior Analysis Technicians® (ABAT®)
- Board Certified Autism Technicians (BCAT)
- State-certified BTs where applicable
Assistant behavior analysts and BTs work one-on-one with the beneficiary to implement the treatment plan designed, monitored and supervised by the authorized ABA supervisor.
An assistant behavior analyst and/or BT working within the scope of his or her training may assist the authorized ABA supervisor in various roles and responsibilities as determined appropriate by the TOM and the authorized ABA supervisor with an ABA scope of practice. Assistant behavior analysts and BTs must work under the supervision of an authorized ABA supervisor.
Note: Supervisors providing ABA services in a state that has a behavior analyst state license or certification must be licensed or certified in that state. BCaBAs providing ABA services in a state that offers an assistant behavior analyst license or certification must be licensed or certified in that state. BTs providing services in a state that offers certification must be certified in that state.
Credentialing Versus Certification
ABA providers subject to credentialing: BCBAs, BCBA-Ds, LBAs, BCaBAs, QASPs, and LABAs. It can take HNFS up to 60 days from the receipt of a complete packet to credential a network ABA provider (BCBA, BCBA-D, BCaBA, QASP, LABA, or LBA) based upon the accuracy of the information provided.
- Please include copies of the criminal history background check (CHBC) – with county, state, federal, and sex-offender check – and current basic life support (BLS)/cardiopulmonary resuscitation (CPR) certifications with roster submissions.
- Use our Check Credentialing Status tool to check credentialing status online.
ABA providers subject to certification: To participate as ACD providers, BTs are subject to a certification process.
- When adding BTs to be certified, ABA provider groups must submit copies of a BT's CHBC and current BLS/CPR documentation with the roster submission.
- BT certification takes up to 10 days from the receipt of a complete request.
Provider Requirements
Please refer to our ACD Provider Roster page for network provider instructions on submitting rosters and required documentation to HNFS.
| Provider Type |
Certification |
Requirement |
|---|
| All ABA providers |
BLS or CPR
|
HNFS must collect copies of BLS/CPR certification from all ABA providers.
All ABA providers must complete BLS or CPR-equivalent certification as demonstrated by completion of a 100% in-person or hybrid course of a web-based instruction component and live component to demonstrate skills on a dummy.
ABA supervisors and assistant behavior analysts: HNFS will collect certification copies with roster submissions when new providers are added and during the recredentialing process if copies are not on file.
BTs: HNFS will collect certification copies with roster submissions when new BTs are added or during the recertification process if copies are not on file.
Non-network providers must submit proof of completion of BLS or CPR certification. (Refer to the "Proof of Certification..." section below.)
|
| All ABA providers |
CHBC |
HNFS must collect copies of CHBCs from all ABA providers. CHBCs must include current federal, state, and county criminal and sex offender reports for all locations resided or worked in during the previous 10 years.
ABA supervisors and assistant behavior analysts: HNFS will collect CHBC copies with roster submissions when new providers are added or during the
recredentialing process if copies are not on file.
BTs: HNFS will collect CHBC copies with roster submissions when new BTs are added or during the recertification process if copies are not on file.
Sole ABA providers: HNFS will run the background checks for all sole ABA providers.
|
| All ABA providers |
National Provider Identifier (NPI) |
All ABA providers must have an NPI.
Verify your NPI record is up to date by visiting https://npiregistry.cms.hhs.gov.
|
BTs
(Must be under the supervision of an authorized ABA supervisor) |
BT certification |
To provide services as a TRICARE-authorized provider, BTs must be certified by one of the following (Important: BTs providing services in a state that offers certification must be certified in that state.):
Non-network providers should send proof of certification such as the certificate number or registration number from one of the agencies identified above. (Refer to the "Proof of Certification ..." section below.)
|
Proof of Certification Requirements for Non-Network Providers
Non-network providers must submit proof of completion upon completing BLS, CPR or BT certification.
Fax or mail a completed ACD BLS/CPR Requirement Form - Non-Network Providers to PGBA, LLC:
- Fax: 1-844-730-1373
- Mail: TRICARE West – Provider Data Management
PO Box 202106
Florence, SC 29502-2106
