TRICARE's Autism Care Demonstration in 2026: rules and deadlines for ABA providers in Florida

The Autism Care Demonstration (ACD) is how TRICARE pays for applied behavior analysis. DHA describes ABA under the ACD as a benefit separate from the TRICARE medical benefit¹. It began on July 25, 2014 and is authorized through December 31, 2028¹², after a five-year extension published in the Federal Register in 2022³. DHA counted 17,603 participants at the end of fiscal year 2024².

Florida is in TRICARE’s East Region, whose contractor is Humana Military. TriWest is the West Region contractor⁴. Contractor bulletins differ by region, so this article uses Humana’s pages for Florida and says so whenever a rule comes from TriWest.

In July 2026 TriWest told West Region providers that a Qualified Behavior Analyst (QBA) credential alone no longer qualifies a provider as an ABA supervisor, that 97155 cannot be billed on a QBA certification only, and that a QBA counts only with an active, concurrent state license⁹. It points to the manual’s list of authorized supervisors (BCBA, BCBA-D or clinical psychologist), and DHA says that manual guides every TRICARE contractor²⁹. We found no matching Humana notice, so if you supervise under a QBA, ask Humana in writing before billing 97155. Florida’s own credential picture is in our Florida BCBA license article.

• Annual provider education. Corporate and sole providers must attend Humana Military’s training at least once a year, with one representative, and Humana reports attendance to DHA¹⁰⁸. Skipping it brings a 10% penalty on all claims billed under the provider’s Tax ID, remedied when the training is completed⁶. TriWest sets its cutoff at the last day of the calendar year⁹. Humana’s pages give no date, so plan for December 31 and confirm.
• Monthly 97155. The supervisor must render 97155 at least once a month. If not, the beneficiary’s claims face a 10% penalty or recoupment for the whole six-month authorization¹¹.
• Annual audit. All ACD providers take part. Humana reviews 35 records, and cites a manual minimum of 30⁶¹⁰. New providers are audited in their first 180 days⁶. A failed audit leads to a monitoring audit, then prepayment review if that fails¹⁰.
• Certification upkeep. Every provider must be TRICARE-certified to file claims and get paid⁵. Everyone needs an NPI and Basic Life Support or CPR certification⁸. Network providers are recredentialed every three years, and recertification applies after two years without a claim⁷⁸.
• Authorization rhythm. Authorizations last six months and referrals renew every two years¹. Requests for ongoing treatment can go in up to 60 days early, and under 30 days risks non-reimbursement¹².

Four baseline measures come before ABA starts: PDDBI, Vineland, SRS and a parent stress measure, repeated every six or 12 months depending on the measure¹. Humana’s schedule¹³:

• PDDBI: parent form at baseline, then parent and teacher forms with each authorization request. The ABA supervisor completes the teacher form.
• Vineland-3 and SRS-2: baseline, then yearly.
• PSI-4 short form or SIPA: baseline, then every six months.

Measures must reach Humana before a treatment authorization is issued, and no earlier than 90 days before they are due¹³.

Maximum allowed amounts per 15-minute unit, effective May 1, 2026¹⁴:

DHA’s table does not say which counties each locality covers. Humana’s training slides say the rates take effect each May 1 and that providers may not bill the beneficiary more than 100% of the posted rate⁸. For Medicaid readers: DHA reports that the May 2024 increase in the 97153 maximum for assistants and technicians came mainly from large rate increases in many state Medicaid programs².

In September 2025 the National Academies (NASEM) found a substantial body of evidence for ABA, recommended that DHA discontinue the ACD and cover ABA as a TRICARE Basic benefit, and asked it to halt the required outcome-measure battery¹⁵¹⁶. Its review counted 37 controlled trials of comprehensive ABA, four of them randomized¹⁵. It also said DHA’s position runs counter to the scientific and medical perspectives¹⁵. It cautions, though, that the evidence does not support high-intensity ABA for everyone and that evidence on fewer than 10 hours a week is limited¹⁷.

DHA’s April 2026 report keeps its position: ABA does not meet TRICARE’s reliable-evidence standard, and research has not advanced on dose-response, standard outcome measures or who benefits most². Its own data show average score gains of 4.7% on the PDDBI, 5.1% on the Vineland and 0.4% on the SRS, which DHA says do not show clinical or statistical significance, with no comparison group². DHA says the NASEM report offers valuable insights². On June 26, 2026, two senators wrote that nine months had passed with no action on the recommendations¹⁶.

So the sources show no decision. The ACD stays authorized through 2028¹. Nothing published says what happens to ACSP certification, rates or outcome measures if it ends or converts.

In force: the ACD through December 31, 2028¹³ and the rates effective May 1, 2026¹⁴. TriWest’s QBA and calendar-year rules are July 2026 bulletins for the West Region⁹. The TRICARE manual itself blocks automated readers, so the paragraph numbers above come from DHA and contractor pages that cite it. Confirm them in the manual. This is not legal or billing advice: confirm with Humana Military.