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Definitive Diagnosis Referring Provider Attestation

To help meet Oct. 1, 2021 Autism Care Demonstration (ACD) definitive diagnosis requirements and proactively prevent gaps in care, TRICARE-authorized ASD-referring and diagnosing providers have the option of submitting this form for beneficiares enrolled to the ACD prior to Oct. 1.

  • This attestation will fulfill both the DSM-5 Diagnostic Checklist and validated assessment tool eligibility requirements that take effect Oct. 1, 2021.
  • This form may ONLY be completed for beneficiaries enrolled to the ACD prior to Oct. 1.
  • Created: Aug 1, 2022
  • Modified: Nov 3, 2021
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