A MOAA-supported report evaluating TRICARE’s Autism Care Demonstration (ACD) recommends discontinuing the program and authorizing applied behavior analysis (ABA) as a TRICARE basic benefit, among other changes to autism care.

The National Academies of Sciences, Engineering, and Medicine (NASEM) report includes several recommendations to align coverage with evidence-based care standards and reduce barriers to access for military families. It stems from MOAA-backed language in the FY 2022 National Defense Authorization Act (NDAA) to address military family concerns about the ACD and access to ABA services. Congress directed the independent review shortly after TRICARE announced comprehensive changes to the ACD in 2021.

The report addresses numerous long-standing concerns from military families and recommends the Defense Health Agency (DHA) make the following changes in addition to authorizing ABA:

• Eliminate mandatory assessments that do not support treatment planning.
  
  
• Discontinue use of the Parenting Stress Index and Stress Index for Parents of Adolescents.
  
  
• Make Autism Services Navigators and caregiver training optional, not mandatory.
  
  
• Align TRICARE ABA coverage with clinical best practices, including allowing ABA services to address activities of daily living and enabling services in homes, schools, and communities.
  
  
• Establish an independent advisory council to guide the ABA transition and ensure high quality care and continuity for military-connected families.

[RELATED: House NDAA Includes TRICARE Reforms, Military Housing Improvements]

NASEM assembled a broad expert committee to research the report, reviewing literature and TRICARE claims data while seeking testimony from researchers, providers, families, and other stakeholders. MOAA participated in a June 2024 NASEM workshop, reminding the committee of testimony from Pentagon leadership promising world-class health care to military families and highlighting the role of military service organizations in advocating for legislation that allows TRICARE coverage policy to evolve with changes in technology, treatment protocols, and benchmarks established by high-quality commercial plans and other government payers.

Why These Changes Matter

DHA officials are reviewing the report “to determine our way forward with the Autism Care Demonstration,” the agency told Military Times.

More than 109,000 TRICARE-eligible children faced an autism diagnosis from 2018-2023, the report said. Should the report’s recommendations be implemented, these children and their families would see multiple benefits beyond ABA access, including two highlighted by Military Times:

Removal of Access Barriers. With ABA as a basic benefit, enrollment in the Exceptional Family Member Program (EFMP) and Extended Care Health Option (ECHO) would no longer be required to access autism resources. Families facing frequent moves or long waits for behavioral evaluations may have difficulty with the enrollment process, limiting their care options.

Clarity on Future Benefits. The ACD is set to end in 2028, with no clear path forward for future treatments. Transitioning ABA services to the TRICARE basic benefit would allow families to avoid potential problems with registration for another DHA demonstration or other disruptions to care that could cause setbacks.

[UPDATED MONTHLY: MOAA's TRICARE Toolkit]

MOAA is pleased the report addresses military family concerns about the ACD, and we will advocate to ensure TRICARE policy is updated to address the committee’s recommendations.