In 2016, advocates worked for 9 months to fight the reduction in Tricare’s ABA reimbursement rates (that went into effect in April 2016). Congress voted to reinstate rates to previous levels, effective 12/23/16.
The National Defense Authorization Act (NDAA) passed last year. Current rates for direct treatment, as of 1/8/17, are $125 for BCBA-level professionals, $75 for BCaBA professionals, and $50 for RBT professionals.
If you are currently providing, or plan to become a provider of, Tricare ABA therapy services, please note that there are several changes this year to how services are to be documented (reporting outcomes). You may find that information here:
In addition, in April 2017, requirements will go into effect that impact the Tricare beneficiaries (your clients). Changes include the requirement of:
· a PDDBI assessment to be conducted
· Legacy beneficiaries (those clients who have been receiving ABA therapy since October 2014) to obtain an updated diagnosis (they will need to be “re-diagnosed” by a physician) before their next reauthorization cycle
· a variety of re-assessments every two years, performed by the diagnosing physician
Please make sure to sign up for email updates directly from Tricare to stay in the loop about all of these changes- we expect more information to be disseminated on an ongoing basis as Tricare figures this all out!
Here is one place that you can go to sign up for updates: http://www.tricare.mil/About/Partners/Changes?sc_database=web