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TriCare Changes - July 2013
August Update

AUGUST UPDATE: TriCare and the Asst. Secretary of Defense for Health Care have announced that the official changes in the TriCare and DoD manuals to the Autism Services were never intended to apply to Active Duty Military Personnel or their Dependents.  They have asserted that no changes in how services to dependents of Active Duty personnel will be provided or supported under TriCare.  We will continue to monitor this situation and share whatever information we obtain as soon as possible.

JULY 2013: TriCare is changing how ABA services are delivered under all three of their programs: Basic, ECHO, and the  Demonstration Program effective July 25, 2013.  We have not received any notice from TriCare directly as of July 12, 2013 but we try to stay on top of these programs in order to best serve our families.

As of now this is what we know, and it is subject to revision as we learn more or if we get any direction at all from TriCare itself on these matters.  We do not speak for TriCare in any way, if you have ANY questions about these changes we recommend that you contact your Case Manager at TriCare to obtain guidance.

TriCare is changing the rules for access to, and reauthorization for, ABA therapy.  Here is our summary of what we know so far, subject to revision.  TriCare has NOT sent us any of this, we have received this from other BCBAs that we know around the US and via the internet searches we conducted.

  • Each BCBA at Reinforcement Unlimited will have to have their cases supervised by Dr. Robert Montgomery.  TriCare now requires supervision for all BCBAs (including BCBA-Ds).  
    • Reinforcement Unlimited can do this easily because we are fortunate to have one of the only experienced BCBA-Ds in the state in private practice who is also a licensed clinical psychologist specializing in Autism Spectrum disorders.  Families will not have to go multiple places to get approvals, supervision, ongoing consultation, and share records and obtain signatures it can all be handled in-house at Reinforcement Unlimited.  This should make it simpler to comply with the new rules and less likely that paperwork will hold anything up in obtaining authorizations and renewals.
  • All cases now have to have a comprehensive diagnostic evaluation, a recommendation of medical necessity, a diagnosis on the Autism Spectrum including the ADOS2 & Vineland II, and a specific recommendation for ABA prior to asking for approval for a BCBA to develop a treatment plan for ABA.
    • Again,  Reinforcement Unlimited can do this easily because we are fortunate to have one of the only experienced BCBA-Ds in the state in private practice who is also a licensed clinical psychologist specializing in Autism Spectrum disorders. 
  • Ongoing cases will have to be renewed every 6 months and each renewal will have to include the results of a NEW administration of the ADOS-2 and Vineland II.  
    • Again, Dr. Montgomery can handle this issue too.  However, this does mean that TriCare patients are going to have to come into the clinic at least 4 weeks prior to that 6 month deadline in order to seen for a 3 hour appointment so that the ADOS2 and Vineland II can be administered and the report written prior to the deadline for inclusion with the request for renewal to go to TriCare.  Those results will have to be included in the request for reauthorization for services each 6 months.

None of these changes are Reinforcement Unlimited decisions but all come from Department of Defense regulations on TriCare delivery of services.  We will have to live with them until/if any are changed.

Dr. Montgomery is willing to do the same services for other BCBAs that need supervision and/or testing for their ongoing ABA cases.  Please let any BCBAs know that they can contact Reinforcement Unlimited  to discuss arrangements.

If you have any questions about this please let us know.  Also, if you hear ANYTHING about this from anyone - please let us know. 


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