New TRICARE Comprehensive Autism Care Demonstration (ACD) Requirements

US Family Health Plan (USFHP)

October 01, 2021  

Under the TRICARE Comprehensive ACD, all providers of applied behavior analysis (ABA) services to USFHP members must meet the educational/credentialing requirements* set forth under the TRICARE guidelines outlined below. Note: Payment of claims cannot be completed unless these standards are met.

The following additional verifications that ABA providers meet the standards as TRICARE-certified providers for supervisors, assistants and technicians is now required:

ABA Supervisors (BCBA, BCBA-D or Clinical Psychologist)

  • CPR/BLS training documentation
  • Criminal History Review (CHR) documentation

ABA Assistant Behavior Analysts

  • Current license/certification by approved certifying body: certification from the BACB or the Qualified Applied Behavior Analysis (QABA) certification board
  • Criminal History Background Check (CHBC) if treating USFHP members for the first time
  • BLS or CPR training documentation

ABA Technicians

  • Current certification: Must be Registered Behavior Technician (RBT), ABA Technician (ABAT), or Board-Certified Autism Technician (BCAT) certification, or state certification
  • CHBC if treating USFHP members for the first time
  • BLS or CPR training documentation

The Department of Defense requires the submission of these documents to USFHP in order to certify provider staff as TRICARE providers. The required certifying documentation should be faxed directly to USFHP at 855.270.5469.

Outcome measurement tools are now required to be submitted on an ongoing basis and must accompany the ABA authorization requests processed by Tufts Health Plan. Providers can access the Autism Spectrum Disorder Services Prior Authorization Form in the Resource Center on the public Provider website and fax the completed form along with outcome requests to 617.673.0314.

For more detailed information about these requirements, refer to the USFHP website. Complete information on these comprehensive changes can be found here.

For questions, contact Stephanie Milligan, Manager of Care Coordination, USFHP, at 617.562.5522. *Note: These changes apply to ABA providers treating USFHP members only.