TRICARE Policy Manual, Chapter 11, Addendum D
Autism Care Demonstration-Corporate Services Providers (ACSPs)
8.3.1 Submit evidence to the contractor that professional liability insurance in the amounts of one million dollars per claim and three million dollars in aggregate, is maintained in the ACSP’s/Sole Provider’s name,
unless state requirements specify greater amounts;
8.3.2 Submit to the contractor all documents necessary to support an application for designation as a TRICARE ACSP/Sole Provider;
8.3.3 Enter into a Participation Agreement, Addendum A, approved by the Director, DHA or designee (i.e., the contractor).
8.3.4 Employ directly or contract with qualified authorized ABA supervisors, assistant behavior analysts, and/or BTs, if applicable;
8.3.5 Certify that all authorized ABA supervisors, assistant behavior analysts, and BTs employed by or contracted with the ACSP meet the education, training, experience, competency, supervision, and ACD requirements specified in the
TRICARE Operations Manual Chapter 18, Section 4.;
8.3.6 Comply with all applicable organizational and individual licensing or certification requirements that are extant in the State, county, municipality, or other political jurisdiction in which ABA services are provided under the ACD;
8.3.7 Maintain all applicable business licenses and employment or contractual documentation in accordance with Federal, State, and local requirements and the authorized ABA supervisor’s business policies regarding assistant behavior analysts and BTs.
8.3.8 Report to the contractor within 30 calendar days of notification of a state sanction or BACB sanction issued to the BCBA or BCBA-Doctoral level (BCBA-D) for violation of BACB Professional and Ethical Compliance Code for
Behavior Analysts (http://www.bacb.com/ethics-code) or notification of loss of BACB certification. Loss of state licensure or certification, or loss of BACB certification shall result in termination of the Participation Agreement with the
authorized ABA supervisor with an effective date of such notification. Termination of the Participation Agreement by the contractor may be appealed to DHA in accordance with the requirements of Chapter 12. While the Participation Agreement is with
the ACSP/Sole provider, failure to remove the sanctioned provider will result in the termination of the entire ACSP or Sole provider group from the ACD.
8.3.9 Familiarize themselves with, and comply with program requirements as stated in 32 CFR 199.6 and 32 CFR 199.9. This information is available online and is accessible to the public. TRICARE Manuals and CFRs can be found online at https://manuals.health.mil/.
8.3.10 Attend a contractor-hosted “provider education” training, no less than annually, beginning no later than October 1, 2021.
8.3.11 Comply with all applicable requirements of the Government designated utilization and clinical quality management organization.
Article 1: Recitals
Article 2: References
Article 3: Reimbursement
By reference, the requirements set forth in the TRICARE Operations Manual (TOM), Chapter 18, Section 4, are incorporated into this
participation agreement and shall have the same force and effect as if fully set out herein.
2.2 General agreement
The undersigned ACSP agrees to render appropriate ABA services to eligible beneficiaries as specified in the TOM, Chapter 18, Section 4.
3.1 Claims for demonstration services will be submitted on a Centers for Medicare and Medicaid Services (CMS) 1500 claim form by the
ACSP in accordance with TOM, Chapter 18, Section 4, paragraph 11.0.
3.2 The ACSP shall:
Article 4: Term, termination and amendment
a. Submit claims to the appropriate TRICARE regional contractor in accordance with the TOM, Chapter 18, Section 4, paragraph 11.0.
b. Collect the monthly sponsor cost-share in accordance with TOM, Chapter 18, Section 4, paragraph 14.0
c. Not bill the sponsor/beneficiary for:
1. Services for which the provider is entitled to TRICARE reimbursement.
2. Services that are denied due to provider non-compliance with all applicable requirements in the TOM, Chapter 18, Section 4.
The term of this participation agreement shall begin on the date this participation agreement is signed and shall continue in effect
until terminated or superseded as specified herein.
4.2 Termination of agreement by DHA
a. The director, DHA, or designee, may terminate this participation agreement upon written notice, for cause, if the ACSP is found not
to be in compliance with the provisions set forth in 32 CFR 199.6, or is determined to be subject to the administrative remedies
involving fraud, abuse or conflict of interest as set forth in 32 CFR 199.9. Such written notice of termination shall be an initial
determination for purposes of the appeal procedures set forth in 32 CFR 199.10.
b. In addition, the director, DHA or designee may terminate this agreement without cause by giving the ACSP written notice not less than
45 days prior to the effective date of such termination.
4.3 Termination of agreement by the ACSP
The ACSP may terminate this agreement by giving the director, DHA or designee written notice not less than 45 days prior to the
effective date of such termination. Effective the date of termination, the ACSP will cease being a TRICARE-authorized provider
of demonstration services. Subsequent to termination, an ACSP may be reinstated as a TRICARE-authorized provider of demonstration
services only by entering into a new participation agreement.
4.4 Amendment by DHA
Article 5: Effective date
a. The director, DHA or designee may amend the terms of this participation agreement by giving 120 days notice in writing of the
proposed amendment(s) except when necessary to amend this agreement from time to time to incorporate changes to the 32 CFR 199.
When changes or modifications to this agreement result from changes to the 32 CFR 199 through rulemaking procedures, the director, DHA
or designee, is not required to give 120 days written notice. Any such changes to 32 CFR 199 shall automatically be incorporated herein
on the date the regulation amendment is effective.
b. An ACSP who does not accept the proposed amendment(s), including any amendment resulting from changes
to 32 CFR 199 accomplished through rulemaking procedures, may terminate its participation as provided for in this article. However, if the
ACSP notice of intent to terminate its participation is not given at least 30 days prior to the effective date of the proposed amendment(s),
the proposed amendment(s) shall be incorporated into this agreement for services furnished by the ACSP between the effective date of the
amendment(s) and the effective date of termination of this agreement.