Autism Demonstration Project

What is the TRICARE Autism Demonstration Project?

The TRICARE Autism Demonstration Project (hereafter referred to as “the project”) helps provide Educational Interventions for Autism Spectrum Disorders (EIA) for children diagnosed with ASD. This project covers services above what is already covered by TRICARE. Eligibility for the TRICARE Autism Demonstration Project requires enrollment in EFMP. You can read about the TRICARE Autism Demonstration Project through the TRICARE website and through Military OneSource (previously MilitaryHOMEFRONT).

What are the advantages to the TRICARE Autism Demonstration Project?

By expanding the definition of supervisors and adding a provider class of “tutors”, the project has increased the number of providers available to families. The project also actively works on ways to recruit more providers. The project has also changed the definition of services to “existing evidence-based services,” providing families with a greater range of services available to them.

What are Educational Interventions for ASD (EIA)?

EIA are defined as those intervention services that are:

  • Evidence based
  • Based on interventions rooted in applied behavior analysis
  • Upon meeting the former, can be covered by TRICARE

Who can serve as an EIA supervisor?

The project has expanded on the supervisor criteria set by ECHO (which stipulates that a supervisor must be a Board Certified Behavior Analyst [BCBA] or a Board Certified Associate Behavior Analyst [BCABA] while requiring no professional liability insurance or criminal background review). The project sets forth the following criteria for an EIA supervisor:

  • BCBA or BCABA (w/supervision)
  • Eligible to sit for BCBA exam (w/supervision)
  • 75% of coursework and experience for BCBA (w/supervision)
  • Experienced professional w/BCBA’s recommendations (w/ supervision or waiver of supervision)
  • Requirements for both liability insurance and criminal background review

Who can serve as an EIA tutor?

Again the project has expanded from ECHO, which does not allow for any “tutor” level service provider reimbursement. EIA tutors must be either enrolled in college (for at least 6 months) or have completed 2 years of college. In either case, the EIA tutor must have:

  • 40 hours classroom training
  • Meet fieldwork requirements
  • Competency certified by EIA supervisor
  • Intensity of on-going supervision correlates with practical experience
  • Reimbursement of tutor services comes through the EIA Supervisor or clinic/center
  • Criminal background check required

How do I enroll my family member in the TRICARE Autism Demonstration Project?

In order to enroll your family member in the project, you must:

  • Enroll your child in the Exceptional Family Member Program (EFMP).
  • Register your child in the Extended Care Health Option (ECHO) with the ECHO case manager of your regional contractor. Services may begin during the ECHO registration process. Your child must be 18 months or older.
  • Submit your child’s IEP or IFSP documentation to the Managed Care Support Contractor (MCSC). NOTE: If your child is home-schooled and your state does not require an IFSP or IEP, you must provide a letter from your child’s PCP or Specialized ASD provider verifying that the child’s disability related to Autism results in dysfunction severe enough to require special education and other support services.
  • Ensure your child’s behavioral plan, developed by the Educational Interventions for Autism Spectrum Disorders (EIA) Supervisor, has been sent to the medical provider who will oversee your child’s autism care.
  • As with ECHO, you may need to provide public facility use certification to reflect that the services you seek are not provided through other programs in your local community.

For TRICARE Autism Demonstration Project eligibility your PCP should:

  • Submit verification and date of a diagnosis of Autism or ASD to the MCSC.
  • NOTE: If the diagnosis was made by a provider other than a Specialized ASD Provider and officially recorded in the medical record on or after March 15, 2008, your medical provider must submit results of diagnostic testing and additional clinical information to the MCSC for review.
  • NOTE: If the diagnosis of autism or ASD was made before March 15, 2008, your child does not need to be re-diagnosed with ASD or to complete diagnostic testing, but you are still required to meet all other applicable requirements of the project.

For your child to continue to receive services under the TRICARE Autism Demonstration Project:

  • Ensure that standardized testing of your child’s language skills and adaptive behavior is completed in the first 12 months of receiving services. Language skills and adaptive behavior testing completed within the 24 months prior to initiation of EIA services under the TRICARE Autism Demonstration Project meets this requirement.
  • Ensure your child’s behavioral plan and EIA Progress Report, developed by the EIA Supervisor, have been sent to the medical provider who is overseeing your child’s autism care for review and approval every 6 months.
  • Submit documentation to the MCSC every six months verifying yearly completion of classroom and practical training by at least one identified parent/caregiver (your ECHO case manager can provide more information on how to fulfill this requirement).

A quick checklist about the TRICARE Autism Demonstration Project is available here.

This is such an involved process. Is there any way that I can get services started more quickly?

The project offers 120-day provisional eligibility that allows the child with ASD to begin receiving services while:

  • Securing enrollment in EFMP
  • Securing registration in ECHO
  • Completing clinical review of the diagnosis, if required
  • Completed IFSP/IEP (two additional 120-day provisional periods permitted)

What are the requirements of the caregiver in order to participate in the TRICARE autism demonstration project?

Unlike ECHO, the parent/caregiver must meet some requirements regarding training. At least one parent/caregiver must complete:

  • Classroom + practical training (12-18 hours/yr total depending on age of child and number of years receiving services)
  • Multiple venues for classroom training with approved curriculum
  • Practical training required from EIA Supervisor
  • Waiver for both classroom and practical training permitted under certain conditions