To avoid delaying receipt of services under this Demonstration while completing the Demonstration eligibility process, in particular obtaining a completed Education Plan or Individual Family Service Plan, clinical review of a beneficiary’s diagnosis, and registration in the ECHO, Humana Military Healthcare Service (HMHS) case manager may grant otherwise eligible-apparent beneficiaries a provisional eligibility status for a period of not more than 120 days during which ECHO and Demonstration benefits will be authorized and payable. Provisional eligibility may be extended for an additional two (2) 120 day periods and after that with the consent of the Director of TMA or designee, with a letter from the principal of the school legally responsible for the development of the beneficiaries IEP/IFSP stating that the IEP or IFSP has not been completed as defined under applicable local, state, and federal policy.
The provisional status will terminate upon completion of the eligibility process or at the end of the 120 days periods, whichever occurs first. The Government liability for Demonstration benefits will terminate at the end of the 120 day period.
Selection of Autism Spectrum Disorder Specialist
An ASD specialist must validate the beneficiary’s diagnosis. A TRICARE authorized ASD specialist provider is:
A physician board-certified or board-eligible in behavioral developmental pediatrics, neurodevelopmental pediatrics, pediatric neurology or child psychiatry;
A physician or PhD educated psychologist working primarily with children with
One or more years of supervised fellowship training that included 40 or more hours of clinical experience in comprehensive evaluations for ASD; or
One or more years of supervised on-the-job training that included the performance of autism diagnostic evaluations an average of twice each month.
Contact a demonstration case manager for assistance locating an ASD specialist near you.
Benefit Limitations
The maximum cumulative Government cost share of the total cost of providing benefits through both the Demonstration and the ECHO program shall not exceed $2,500 per ECHO-registered beneficiary in any single month.
The total amount of the Government cost share paid for training required under the Demonstration can not exceed $1500 per individual and $4,500 per family during each year in which EIA services are received by the beneficiary.
