Applied Behavior Analysis (ABA) Therapy Under ECHO
•Applied Behavior Analysis (ABA) therapy is a structured one-on-one program to identify and address problem areas unique to each individual child.•ABA falls under Section 9.1 of Chapter 9 for “special education.”
•Currently authorized 15 hours per week during the school year and 30 hours a week during the summer months, along with a two-hour evaluation once a month.
•Request stated: “Applied Behavior Analysis (ABA) Therapy through the ECHO Program for 15 hours/ week x 12 months and 2 hours/ month for evaluations, training, or team meetings by … from … through …”
•Eligibility criteria listed in Sections 2.2 through 2.4 of Chapter 9 of the TRICARE Policy Manual 6010.54-M, dated 1 August 2002 at http://manuals.tricare.osd.mil/. •Most autistic children qualify for services under the "Significant Physical Disabilities" at Section 2.3 by having problems with “unaided performance of at least one of the following major life activities is an ECHO qualifying condition: breathing, cognition, hearing, seeing, and age appropriate ability essential to bathing, dressing, eating, grooming, speaking, stair use, toilet use, transferring, and walking.”
•Some TRICARE personnel may insist that the child must also have a mental retardation (MR) diagnosis too, but that is ABSOLUTELY NOT correct.
•TRICARE will NOT approve ABA therapy for what is viewed as only educational issues, but only for behavioral or medical problems.
•Once approved, you will be assigned an ECHO case manager who will help you complete the rest of the paperwork.–Public Use Certification Form (Section 5.1 of Chapter 9) signed by your school system special education director or a county health agency official.
–Have to provide a copy of current Individualized Education Program.
–Other documentation from provider, including treatment plan.
•Current Procedural Terminology (CPT) code to be used is 99199 for ABA.
•Current problems with finding TRICARE-approved ABA providers (Section 17.1 of Chapter 9):
–“Where such State license or certification is not available, are certified by the Behavioral Analyst Certification Board (BACB) as either a Board Certified Behavior Analyst or a Board Certified Associate Behavior Analyst”.
–BCBAs and BCABA’s develop ABA programs, but do normally not deliver hands-on ABA therapy.
Rivendale is a Tricare approved
Provider!
Extended Health Care Option Program
•MUST be enrolled in Exceptional Family Member Program (EFMP) first!
•From Section 1.1 of Chapter 9, “Extended Health Care Option (ECHO) is a supplemental program to the TRICARE Basic Program and provides eligible active duty family members with an additional financial resource for an integrated set of services and supplies designed to assist in the reduction of the disabling effects of the beneficiary’s qualifying condition.”
•Congress created the ECHO program to make services accessible to
active duty service members in one state that are not accessible in
another state because they are required to move frequently and are
normally not in one area long enough to wait to become eligible for
services through Medicaid waivers in most states.
•Program provides up to $2500 of services per month for each
family member enrolled in ECHO, but with monthly co-pay
depending on sponser’s rank.