This post summarizes publicly reported findings from the National Academies. No new rules have been announced by TRICARE at this time.
Introduction
The National Academies just released their review of TRICARE’s Comprehensive Autism Care Demonstration (ACD) . This was TRICARE’s test program for covering ABA therapy, and now the recommendation is clear: ABA meets the evidence standards and should be part of the TRICARE Basic benefit .
That sounds like a win, but the report also highlights how messy the demonstration has been for families and providers. Too many hoops to jump through, too many assessments that didn’t help with...
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If you run an ABA business, this is worth paying attention to. TRICARE is just another funder — but the way they set things up here shows what can happen when payers build policies that don’t line up with how ABA actually works.
What the Report Found
- ABA works. The evidence shows ABA improves outcomes. The Academies said ABA meets the Department of Defense’s standard for reliable medical evidence.
- Families were buried in paperwork. Enrollment had too many steps. Parents had to go through stress tests, use service navigators, and deal with restrictions on where services could happen.
- Providers were frustrated. The rules didn’t leave room for individualized care. Too many documentation requirements and required assessments that didn’t match treatment goals.
- Assessments didn’t make sense. Families were forced to complete tools like the Vineland-3 or parental stress scales that didn’t add anything useful to treatment planning.
- Limits on goals and settings. ABA wasn’t allowed to target daily living skills in some cases and couldn’t always be provided in schools or community settings.
The Recommendations
- End the demonstration and move ABA into the TRICARE Basic benefit.
- Drop the unnecessary assessments.
- Cut the red tape so families can get services without jumping through pointless hoops.
- Let ABA target real-life skills and be delivered in homes, schools, and communities.
- Set up an advisory council with families, providers, and experts to oversee the transition.
Why This Matters for ABA Practice Owners
This is TRICARE today, but it could be any funder tomorrow. Here are the takeaways:
- Evidence isn’t the problem anymore. Payers may still say they’re “not sure” about ABA, but the evidence is there. That excuse doesn’t hold up.
- Paperwork kills access. Families walk away when it’s too complicated. If your billing or intake process makes things harder, you risk losing them too.
- Metrics have to match treatment. If a payer forces you to use tools that don’t inform care, that’s wasted time. Providers need to push back and explain what actually drives treatment planning.
- Coverage rules matter. If a payer limits settings or goals, families don’t get what they need. That’s not just a TRICARE problem — you’ve probably seen commercial or Medicaid plans try similar things.
One Concern to Watch
Here’s my worry: if TRICARE does make ABA a Basic benefit, they could decide that only accredited providers qualify. I don’t know that they’ll do this, but it wouldn’t surprise me at all. We’ve already seen some payers and states move in that direction.
Accreditation can sound like “quality assurance,” but for many practices it just means higher costs and more administrative work. For smaller providers, it can be a serious barrier. It’s something to keep an eye on as TRICARE moves forward.
Final Thoughts
The Academies’ report basically says what most of us already know: ABA works, but payers can make access harder than it needs to be.
For ABA Practice Owners , the lesson here is simple. Treat TRICARE like any other funder: understand their rules, track how they shift, and be ready to adjust. At the same time, keep your systems clean — billing, documentation, and communication with families — so you’re not adding to the chaos.
The military context is unique, but the business issues are the same ones every ABA provider faces: payers set the rules, and we have to decide how to adapt without losing sight of what families really need.
