Getting a TRICARE ABA Referral in Florida: Humana Military Step by Step

This is the hands-on checklist for getting ABA started through TRICARE East in Florida, where Humana Military runs referrals and authorizations. It follows the order the TRICARE Operations Manual and Humana Military's Autism Care Demonstration (ACD) welcome guide use, adds the deadlines that trip families up and ends with what Hope Center does at each step. For the big-picture explanation of the program, read our TRICARE Autism Care Demonstration guide first.

Before you start: which TRICARE plan and region are you in?

• Florida is in the TRICARE East Region. The contractor is Humana Military. Customer service is 800-444-5445. Humana Military's ACD team also has an ABA phone line, 866-323-7155, and takes secure messages through the beneficiary self-service account.
• Tampa-area families: check for the Prime Demo. In the Tampa and Atlanta areas, TRICARE offers the TRICARE Prime Demo through CareSource Military & Veterans. Tricare.mil says people who "get services through the Extended Care Health Option, the Autism Care Demonstration, or the Wounded Warrior Program" are not eligible for it. If your family is enrolled in the Prime Demo and your child needs ABA, call CareSource (833-230-2080) and Humana Military before anything else to ask how to move into a plan that allows the ACD.
• Every TRICARE plan needs a referral and pre-authorization for ABA. That includes TRICARE Select and TRICARE Reserve Select, where most other care needs no referral.

Step-by-step: from diagnosis to the first ABA session

1. Get a qualifying autism diagnosis. It must come from a TRICARE-approved diagnosing provider: a primary care provider (family physician, pediatrician, or pediatric or family nurse practitioner) or a specialist such as a developmental-behavioral or neurodevelopmental pediatrician, pediatric neurologist, psychiatrist, licensed doctoral clinical psychologist or a qualifying Doctor of Nursing Practice. The referral packet must include:
   • the DSM-5 criteria on a DHA-approved checklist, with the level of support;
   • a validated assessment tool with scores, such as the STAT, ADOS-2, ADI-R, CARS2 or GARS-3 (the GARS alone is not enough without a diagnostic evaluation).
   A diagnosis based on a clinical interview alone is not sufficient. If your child was first diagnosed at age 8 or older, a specialist evaluation (not a primary care manager) is required. If the diagnosis is more than two years old, an updated evaluation is needed.
2. Active duty? Start EFMP and ECHO now. Active duty families must enroll in their service's Exceptional Family Member Program and register in the Extended Care Health Option. Humana Military allows a 90-day provisional period and says no extensions are allowed. See EFMP in Florida and TRICARE ECHO.
3. The diagnosing provider sends the ABA referral to Humana Military. The referral must say ABA services are requested. TRICARE does not accept retroactive referrals, so ABA cannot be back-dated to before the referral.
4. Choose an ABA provider. Humana Military's guide says you pick your ABA supervisor once your child is eligible and can change later through your navigator. Ask the provider whether they are TRICARE-authorized and can start soon.
5. Humana Military issues an assessment authorization. For a first request, the letter covers the ABA assessment and lists the provider's contact information. You can check status in the East Region beneficiary self-service portal.
6. Your Autism Services Navigator contacts you. TRICARE assigns a navigator, who must reach out before ABA treatment is authorized and complete a comprehensive care plan with you within 90 days. See your Autism Services Navigator.
7. Complete the four baseline outcome measures. The PDD Behavior Inventory, Vineland-3, Social Responsiveness Scale and Parenting Stress Index (or the version for parents of adolescents) must be done before treatment is authorized. See TRICARE's required outcome measures.
8. The BCBA completes the assessment and treatment plan and submits it with requested hours and settings. The manual tells the contractor to finish its clinical necessity review of a complete, compliant plan within five business days.
9. Treatment is authorized for six months. Services start. The first parent training session must happen within 30 calendar days of the treatment authorization.

What timelines should you expect?

TRICARE sets several clocks. They are standards for the contractor and provider, not promises about your child's start date.

If you are not offered an appointment within TRICARE's 28-day specialty care access standard, tricare.mil says to contact your regional contractor, which in Florida is Humana Military.

Which documents should you gather?

• Sponsor's DoD ID number and your child's TRICARE plan and enrollment information
• The diagnostic report, DSM-5 checklist with level of support and validated assessment scores
• The referral and any Humana Military authorization letters
• EFMP enrollment confirmation and ECHO registration notice (active duty)
• Your navigator's name and contact information
• Copies of completed outcome measures, with the respondent's name and relationship to your child
• The current IEP or IFSP, if any, plus speech, OT or other therapy reports
• Information on any other health insurance, since TRICARE pays after most other plans

What do you say when you call?

To your child's doctor: "My child was diagnosed with autism and we want ABA through TRICARE's Autism Care Demonstration. Can you send Humana Military an ACD referral that requests ABA and includes the DHA DSM-5 checklist with level of support and the validated assessment scores?"

To Humana Military (866-323-7155): "I am calling about an ACD referral for my child. Can you confirm you received it, tell me whether anything is missing, and tell me who our Autism Services Navigator is? We would like Hope Center for Behavior Change as our ABA provider."

To the ABA provider: "We are TRICARE East. Do you have a BCBA who can do the assessment within TRICARE's 28-day standard? Can you help schedule the baseline outcome measures?"

What keeps ABA going after month six?

• Reauthorization every six months. The BCBA submits an updated assessment and plan, and outcome measures due that period must be in before the next authorization is issued. The contractor cannot back-date late requests.
• Parent participation. TRICARE requires at least six parent or caregiver sessions every six months. Missing this two authorization periods in a row can lead to denial of the next authorization. If a parent is deployed or cannot take part, the plan must document why.
• A new referral every two years. It is a review of progress and level of support, not a new full evaluation. See renewing the TRICARE ABA referral.

How Hope Center helps at each step

Hope Center for Behavior Change accepts TRICARE East (Humana Military) and has no waitlist. Our intake follows the same path: you return initial documents and complete intake, we verify benefits, once Humana Military approves the assessment request, a BCBA does the initial assessment at our center or your home (2 to 4 hours, in one or two sessions), and the plan is written within about two weeks, signed by you and reviewed by our clinical director before it goes to Humana Military. Once TRICARE approves it, services usually begin within 3 to 5 business days. From first call to first session can be as little as three weeks; slow paperwork can stretch it to months. See the Hope Center intake timeline.

We offer parent training every week (TRICARE's minimum is six sessions every six months), and our staff can join IEP meetings and doctor visits where allowed. Visit our TRICARE ABA page or military families page, then request a free consultation and benefits check or call 561-337-8865.