Autism Care Demonstration: 2021 Rate Update

Thursday, April 15, 2021

The Defense Health Agency (DHA) recently posted updated applied behavior analysis (ABA) rates at www.health.mil/rates. Please note the two new sets of rates:

• ABA maximum allowed amounts effective May 1, 2021

• Maximum allowed amounts for other Autism Care Demonstration (ACD) services, effective Aug. 1, 2021

The May 1 rates reflect DHA’s annual ABA rate update. The August 1 rates reflect upcoming changes to the ACD.

As a reminder, the balance billing provision for non-network providers does not apply to ABA rates. TRICARE-authorized providers agree to accept the TRICARE maximum allowable charge, minus applicable beneficiary copayments, cost-shares and deductibles, as payment in full. 

Policy changes to TRICARE’s Autism Care Demonstration

DHA has authorized policy changes to the ACD program. These changes will expand the ACD into a more comprehensive program that offers integrated services and additional support for TRICARE families.

Changes to the program are being implemented in phases, with all changes to be in effect by Jan. 1, 2022. We encourage you to attend DHA’s ACD webinar series. Find information and recordings of past webinars at www.health.mil/autism. We also recommend you subscribe to DHA’s GovDelivery ACD group to receive ACD updates. Go to: https://public.govdelivery.com/accounts/USMHS/subscriber/new.

We are working with DHA to develop materials and resources, including expanded web content that will be available to providers and beneficiaries as implementation dates approach.