1. 1 DoD ENHANCING ACCESS TO AUTISM SERVICES DEMONSTRATION March 21, 2008 An Overview of Main Provisions

2. 2 DoD Autism Demonstration Highlights More educational intervention providers –Expanded definition of supervisors should quickly increase # available –Newly defined provider class (Tutors) will make thousands of new providers available to implement services such as ABA to military families –Incentives for supervisors to bring on and train tutors Expanded services –Functional definition of covered services should permit families to have access to a greater range of existing evidence-based services

3. 3 DoD Autism Demonstration Highlights Quality provisions –Education, training, experience and competency standards set for Tutors –Required supervision of Tutors (intensity of supervision is tied to level of experience) –Required supervision of certain supervisors –Diagnostic and functional assessment of child encouraged or required depending on clinical needs Widening availability of providers thru technology –Web-based instruction of approved curricula permitted for Tutors –Video, web-based direct supervision of Tutors permitted allowing reach into remote and less well-served areas

4. 4 ECHO* vs. DEMO COVERED SERVICES Special education services defined as ABA Educational interventions for ASD (EIA) services are: Defined by characteristics of evidence- based interventions; and Based on interventions rooted in applied behavior analysis. If an intervention meets those characteristics, it can be covered by TRICARE. *Extended Care Health Option currently covers applied behavior analysis services for eligible beneficiaries (for more info go to http://tricare.mil/mybenefit/home/overview/SpecialPrograms/ECHO

5. 5 ECHO vs. DEMO PROVIDERS OF SERVICES Board Certified Behavior Analyst (BCBA) Board Certified Associate Behavior Analyst (BCABA) No requirement for professional liability insurance No requirement for criminal background review EIA Supervisors are: BCBA BCABA (w/supv) Eligible to sit for BCBA exam (w/supv or joint supv) 75% coursework and experience of BCBA (w/supv) Experienced professional with BCBAs recommendations (w/supv or waiver of supv) Professional liability insurance required Criminal background review required

6. 6 ECHO vs. DEMO PROVIDERS OF SERVICES No tutor level provider may be reimbursed for services provided EIA Tutors are: Tutors enrolled in (6 mn completed) or completed 2 yrs of college 40 hours classroom training Indirectly and directly supervised fieldwork required Competency certified by EIA Supervisor Intensity of on-going supervision linked to degree of practical experience Services of Tutor reimbursed through EIA Supervisor or clinic/center Criminal background check required

7. 7 ECHO vs. DEMO ELIGIBILITY FOR SERVICES ADFM EFMP enrolled ECHO Registered Qualifying condition (for ASD most often moderate/severe dysfunction in at least one major life activity e.g. cognition, age appropriate ability essential to bathing, dressing, eating, grooming, speaking, etc.) Public facility use certification required ADFM EFMP Enrolled ECHO Registered a)Qualifying diagnosis (AD, PDDNOS, AS, CDD) b)IEP/IFSP with special ed services (special provisions for homeschooled) (a) + (b) is equivalent to the ECHO qualifying condition Age 18 months or older to begin services Previously documented diagnoses are OK for qualifying diagnosis Public facility use certification required

8. 8 ECHO vs. DEMO PROVISIONAL ELIGIBILITY 90 day provisional eligibility Provides for administrative delays in enrolling in ECHO 120 day provisional eligibility Permits the child with ASD to begin receiving services while –securing enrollment in EFMP –securing registration in ECHO –Completing clinical review of the diagnosis, if required –Completing IFSP/IEP (two additional 120 day provisional periods permitted)

9. 9 ECHO vs. DEMO DIAGNOSING/REFERRING PROVIDERS Any TRICARE authorized provider within the scope of their professional license SPECIALIZED ASD PROVIDER - A TRICARE authorized provider who is: MD board-certified/board-eligible in behavioral developmental pediatrics, neurodevelopmental pediatrics, pediatric neurology or child psychiatry; A physician or PhD educated psychologist working primarily with children with specialized fellowship or on-the-job training OTHER PROVIDERS TRICARE authorized provider within the scope of their professional license Primary Care Manager under the TRICARE Prime or TRICARE Prime Remote for Active Duty Family Member programs Primary Care Provider under the TRICARE Standard program

10. 10 ECHO vs. DEMO PARENT/CAREGIVER TRAINING TRICARE covers, but training is not required TRICARE covers, IS required Classroom + practical training required of one parent/caregiver 12-18 hours/yr total depending on age of child and number of years receiving services Multiple venues for classroom training with approved curriculum Practical training required from EIA Supervisor Waiver for both classroom and practical training permitted under certain conditions

11. 11 ECHO vs. DEMO QUALITY PROVISIONS Maintain records that substantiate the rationale for each course of treatment, the methods, modalities or means of treatment, periodic evaluation of the efficacy of treatment, and the outcome at completion or discontinuation of treatment as described separately in this agreement. General language as in ECHO; and Behavior Plan (BP) w/long and intermediate term habilitative goals and short term behavioral objectives EIA progress reports on goals and objectives based on quantified behavioral data BP/progress reports every 6 months reqd for authorization of services Family treatment progress meetings required every 3 months

12. 12 ECHO vs. DEMO STANDARDIZED TESTING None required Testing, if done, paid under Basic plan or ECHO depending on the nature and purpose of the tests Diagnostic – for establishing an ASD diagnosis of AD or PDDNOS – reqd when PCM/PCP makes ASD diagnosis Cognitive, Language and adaptive behavior testing required in first 12 months Previously performed tests generally meet the requirement Temporary waiver for cognitive testing possible if indicated

13. 13 ECHO vs. DEMO WIDENING AVAILABILITY OF PROVIDERS Not applicableWeb-based instruction approved for EIA Tutor training and parent/caregiver training Video, web-based direct supervision of Tutors permits EIA supervisors to direct and oversee services in remote and less well-served areas.