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TRICARE helps families face autism

TRICARE recently increased the annual benefit reimbursement limit for certain Extended Care Health Option (ECHO) services, including the Autism Services Demonstration, by 20 percent. (Courtesy graphic)

TRICARE recently increased the annual benefit reimbursement limit for certain Extended Care Health Option (ECHO) services, including the Autism Services Demonstration, by 20 percent. (Courtesy graphic)

VANDENBERG AIR FORCE BASE, Calif. -- Autism delays development of important life skills.

Most people may take these social and communication skills for granted, but autism-related delays and problem behaviors usually start in infancy and can last a lifetime. Life is challenging not only for the diagnosed child, but for parents and siblings, too. 

Parents should talk to their child's primary care manager if they have concerns about their child's development. Developmental delays may have a number of root causes, but treatment is most effective with early intervention.

For an autism diagnosis, Applied Behavior Analysis may help reduce problem behaviors and teach new skills, according to the National Institute of Child Health and Human Development. TRICARE's Enhanced Access to Autism Services Demonstration allows eligible active duty military families access to certain ABA services.

The demonstration benefit is growing to help families get the care they need. In the past three months, the number of Autism Services Demonstration supervisors has doubled in the TRICARE west region. TRICARE recently increased the annual benefit reimbursement limit for certain Extended Care Health Option services, including the Autism Services Demonstration, by 20 percent.

TRICARE implemented a fiscal year (Oct. 1 to Sept. 30) ECHO reimbursement limit of $36,000. Certain ECHO services remain subject to a $2,500 monthly cap and count towards the fiscal year limit, with the exception of the following services that have no monthly cap but also accrue to the fiscal year limit:

- Training

- Rehabilitation 

- Special education

- Assistive technology devices

- Institutional care 

- Certain transportation 

- Services under the Autism Services Demonstration

Children eligible for the Autism Services Demonstration must have an active duty sponsor, be living in the United States, be age 18 months or older and be enrolled in the ECHO program through their regional TRICARE contractor. A TriWest Healthcare Alliance ECHO case manager helps eligible families in TRICARE's 21-state west region to enroll into the ECHO program and the demonstration, find providers and get the required authorizations. TriWest also offers an interactive state-by-state directory of contracted EIA supervisors in the TRICARE West Region online at www.triwest.com/autism.  

Registered users can also track reimbursements throughout the year by logging on to a secure www.triwest.com account to view past and current explanations of benefits. Beneficiaries who use ECHO are also responsible for monthly cost-shares based on the sponsor's pay grade. Cost information is available at www.tricare.mil/costs.  

TriWest's ECHO case manager can help explain the program, the benefits and
the costs. A case manager directory is available online at www.triwest.com/beneficiary/echo. You may also call 1-888-TRIWEST (874-9378) for assistance.