Autism Awareness Month: Tricare covers ABA therapy

  • Published
  • By Shari Lopatin
  • TriWest Healthcare Alliance
MINOT AIR FORCE BASE, N.D. --  Today, autism in children has become more prevalent than childhood cancer, juvenile diabetes and pediatric AIDS -- combined.

That's according to Autism Speaks, a national autism science and advocacy organization. The association defines autism as a group of complex developmental brain disorders. Today, approximately one in every 110 children is diagnosed with autism.

April is Autism Awareness Month, which has been celebrated by the Autism Society since the 1970s. Autism Awareness Month highlights the growing need to further understand autism and the potential treatments.

Many different types of treatments exist for an autistic individual. However, one of the more prominent techniques, which recently gained notoriety, is applied behavior analysis. According to the National Institute of Child Health and Human Development, ABA may help reduce problem behaviors associated with autism as well as teach new skills.

As part of the growing recognition of ABA therapy, Tricare now covers this type of treatment for eligible beneficiaries. It's part of Tricare's Autism Services Demonstration, an enhanced benefit under the Extended Care Health Option program. ECHO is Tricare's benefit for individuals with disabilities.

To be eligible for ECHO, a family must first enroll in the service branch's Exceptional Family Member Program. Each service branch has a point of contact to help families enroll. After enrolling, the family needs a referral to register for ECHO, which can be obtained from a provider, or even a self-referral. After a family gets registered in ECHO, they can check their eligibility for the autism services demonstration.

Children eligible for the autism services demonstration must have a diagnosis falling along the autism spectrum. In addition, they must have an active duty sponsor, be living in the United States, be 18 months or older and be enrolled in the ECHO program through their Tricare regional contractor.

The Tricare autism services demonstration covers ABA treatment and other types of therapies falling under the umbrella of educational interventions for autism spectrum disorders. The providers who implement these therapies must be Tricare-authorized in order for the treatments to be covered. TriWest makes sure to take care of these providers, so they can take care of their patients.

Each month, families pay a cost share for services they receive under ECHO. This monthly cost share depends on the sponsor's pay grade. For more information on the autism services demonstration, including specifics on cost shares, visit www.triwest.com/autism.