Diagnosis

Start With a Formal Autism Spectrum Disorder Diagnosis

To enroll in the TRICARE Autism Care Demonstration (ACD), your child must have a definitive autism spectrum disorder (ASD) diagnosis from a TRICARE-authorized diagnosing provider. A provisional diagnosis does not meet TRICARE’s requirements.

Your child’s documentation must include:

• A definitive ASD diagnosis
• The date of the initial diagnosis
• The severity level of the diagnosis
• A completed DHA-approved DSM-5 Diagnostic Checklist
• Results from an approved validated assessment tool

Approved assessment tools include:

• Screening Tool for Autism in Toddlers and Young Children (STAT™)
• Autism Diagnostic Observation Schedule, Second Edition (ADOS™-2)
• Autism Diagnostic Interview-Revised (ADI™-R)
• Childhood Autism Rating Scale, Second Edition (CARS™-2)
• Gilliam Autism Rating Scale, Third Edition (GARS-3), along with a complete diagnostic evaluation

The diagnosing or referring provider completes the DSM-5 Diagnostic Checklist. This does not need to be the same provider who completed the original diagnosis.

If your child is older than 8, the referral must be submitted by a specialized ASD-diagnosing provider.

Find a TRICARE-authorized provider

Referral

Ask Your Provider to Submit a Referral for ABA Services

Your child’s primary care manager or diagnosing provider must submit the ABA referral and required diagnostic documents to TRICARE. The referral must include your child’s diagnosis date and ASD severity level.

If your provider needs help submitting the referral, contact your regional TRICARE contractor:

• West Region: TriWest Healthcare Alliance — 888-TRIWEST (888-874-9378)
• East Region: Humana Military — 800-444-5445

Not sure which region you are in? Use TRICARE’s region tool to confirm your regional contractor based on your ZIP code.

Find Your TRICARE Region

The referral is required to enroll your child in the Autism Care Demonstration and begin the authorization process for ABA services. TRICARE also requires families to accept Autism Services Navigator services.

If the active authorization or provider placement lists another ABA provider, contact ACES before requesting a change. Our team can confirm whether ACES is accepting new clients in your area and explain the next steps.

Call ACES at (855) 223-7123 or complete our Start Here form.

What to Expect From ACES

The ACES Onboarding Process

After you submit the Start Here form, the ACES Client Access team will review your information and contact you about service availability in your area.

If TRICARE has authorized ACES to complete an initial ABA assessment, our team will create your child’s profile and work with you to schedule the assessment.

If ACES is not listed on the authorization, our Client Access team can explain how to contact TRICARE about changing the authorized provider. TRICARE makes the final authorization and provider-placement decisions.

After the initial assessment, an ACES Treatment Manager will develop an individualized treatment plan with your family. ABA services may begin after TRICARE approves the treatment authorization and ACES identifies an available, appropriately credentialed therapist.

TRICARE Outcome Measures

What Are Outcome Measures?

TRICARE requires outcome measures before ABA services begin and at specific intervals during treatment. ABA providers use these measures to inform treatment plans and track changes over time.

Your child’s required measures may include:

• Pervasive Developmental Disorder Behavior Inventory (PDDBI): Completed before ABA services and every six months
• Vineland Adaptive Behavior Scales, Third Edition (Vineland-3): Completed before ABA services and annually
• Social Responsiveness Scale, Second Edition (SRS-2): Completed before ABA services and annually
• Parenting Stress Index, Fourth Edition Short Form (PSI-4-SF): For children ages 0–12; completed before ABA services and every six months
• Stress Index for Parents of Adolescents (SIPA): For children and adolescents ages 11–19; completed before ABA services and every six months

Your ABA provider submits the required outcome measures with the treatment plan. If your ABA provider cannot complete a required measure, your Autism Services Navigator can assist.

Completing Outcome Measure With ACES

If TRICARE authorizes ACES to provide both ABA services and the required outcome measures, our team will coordinate their completion with your family and treatment team.

‍