Tricare covers medical and behavior modification services for beneficiaries diagnosed with autism spectrum disorder (ASD). ASD affects essential human behaviors such as social interaction, the ability to communicate ideas and feelings, imagination, and the establishment of relationships with others.
Services covered under your Tricare benefit include
- occupational therapy,
- physical therapy,
- physician services,
- psychological services,
- psychological testing,
- prescription drugs,
- speech therapy.
Tricare Comprehensive Autism Care Demonstration
In addition to these covered services, Tricare covers applied behavior analysis for all beneficiaries through the Tricare Comprehensive Autism Care Demonstration. Applied behavior analysis uses behavior modification principles, such as positive reinforcement, to increase or decrease targeted behaviors. ABA can help develop skills, such as speech, self-help, and play. It can also help to decrease certain behaviors, such as aggression or self-injury.
Applied behavior analysis services are covered for all qualifying dependents of active duty service members, retirees, and certain National Guard and Reserve members. This includes beneficiaries of the following programs:
- Tricare Prime options
- Tricare Select
- Tricare Reserve Select (member-and-family coverage)
- Tricare Retired Reserve (member-and-family coverage)
- Tricare For Life
- Tricare Young Adult
- Transitional Assistance Management Program
- Continued Health Care Benefit Program (for beneficiaries no longer eligible for Tricare)
To qualify for covered applied behavior analysis services under the Autism Care Demonstration, your dependent, or child, must also:
- Have been diagnosed with ASD by a Tricare authorized approved ASD-diagnosing provider.
- If the sponsor is on active duty, the child with ASD must be enrolled in the Exceptional Family Member Program and must normally register in the Extended Care Health Option.
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