Autism Services Demonstration

The Enhanced Access to Autism Services Demonstration, effective for claims on or after March 15, 2008, is an enhancement to the ECHO program for those beneficiaries with certain diagnoses for autism spectrum disorders. This demonstration project allows reimbursement for behavioral-based tutoring services from providers including non-certified educational intervention service providers and tutors (and tutors-in-training) who provide applied behavior analysis (ABA) services.

Participation in the autism demonstration project is voluntary. Reimbursement for claims under the demonstration project may take up to 90 days for processing.

Authorized supervisors and companies will be required to direct and oversee these tutors who will provide hands-on work with children with autism. Tutors will be credentialed and specially trained to work with children with special needs.

All care submitted for reimbursement under the autism demonstration will require prior authorization. Cost-shares will still apply.

Visit TRICARE online to read more about the Autism Services Demonstration, Demonstration Eligibility and Demonstration Coverage and Costs.

You can find out more about the benefits under the autism demonstration project by calling your ECHO case manager or Donna McPherson, TriWest’s ECHO program manager, at 1-866-876-2384, ext. 48124.