Does TRICARE Cover ABA Therapy in Maryland?

Understanding ABA Therapy Coverage with TRICARE

Applied Behavior Analysis (ABA) therapy is a vital treatment for children with Autism Spectrum Disorder (ASD). For military families in Maryland, confirming if your TRICARE plan covers ABA therapy is essential for accessing these critical services. Here is an overview of what TRICARE offers regarding ABA therapy and how to navigate their coverage.

Key Points to Consider:

• TRICARE Comprehensive Autism Care Demonstration (ACD): TRICARE covers ABA therapy for all beneficiaries diagnosed with ASD through the TRICARE Comprehensive Autism Care Demonstration (ACD). This program is designed to provide the best possible care by covering clinically necessary and appropriate ABA services.
• Eligibility and Enrollment: To qualify for the ACD, your child must be enrolled in a TRICARE health plan and diagnosed with ASD by an approved provider. Active duty service members must enroll their child in the Exceptional Family Member Program (EFMP) and the Extended Care Health Option (ECHO).
• Authorization Requirements: All TRICARE plans require a referral and pre-authorization for ABA services. The diagnosing provider will submit a referral to the regional contractor or the US Family Health Plan (USFHP) provider for authorization. An authorization letter will be issued for six months of ABA services, and reauthorization is needed every six months.
• Outcome Measures: To monitor progress, baseline outcome measures must be completed before receiving ABA services and periodically thereafter. These include assessments like the Vineland Adaptive Behavior Scales and the Social Responsiveness Scale.

Steps to Verify Coverage:

• Contact TRICARE: Reach out to TRICARE’s customer service or visit their website to review specific coverage details for ABA therapy.
• Consult Your ABA Provider: Your ABA therapy provider can assist in verifying benefits and obtaining necessary authorizations.
• Document Communication: Keep detailed records of all communications with TRICARE, including phone calls, emails, and any paperwork submitted or received. This documentation will be helpful in case of any disputes or clarifications needed later.

How Move Up ABA Can Help

At Move Up ABA, we understand navigating insurance coverage can be challenging. We are committed to assisting you through this process to ensure your child receives the necessary ABA therapy. Our team will help you verify your benefits, obtain pre-authorization, and address any questions or concerns you may have about your TRICARE coverage.

Conclusion

Understanding your TRICARE coverage for ABA therapy is crucial to ensure your child receives the necessary support. By following these steps and utilizing available resources, you can navigate the insurance process more effectively and access valuable ABA therapy services in Maryland.

For more detailed information, you can visit the TRICARE website and access specific plan documents or contact their customer service for personalized assistance.

If you have any more questions or need further assistance, feel free to reach out to us at Move Up ABA. We are here to help you every step of the way.