(July 31 Update: Autism Speaks has received copies of letters issued by TRICARE to its regional contractors confirming in writing that there will no changes in ABA coverage under the ECHO Autism Demonstration and Basic programs. See 4th paragraph; click on links.)
WASHINGTON, DC (July 26, 2013) -- TRICARE, the healthcare program for military families, yesterday launched its pilot program to improve and expand its coverage of applied behavior analysis (ABA) for non-active personnel. Autism Speaks has analyzed the new program based on available information, and how all military personnel --active and non-active duty--may be impacted.
Here is our summary:
Last year Congress directed TRICARE to launch an ABA pilot program to improve and expand its coverage for non-active personnel. TRICARE published its ABA Pilot policy last month for non-active duty family members -- but along with it came significant and drastic changes to existing ABA coverage for all beneficiaries with autism, including active duty military families.
Last week, TRICARE stepped back, but not away, from this ill-conceived change in the policy for ABA. After a tremendous outcry from military families, service providers, and advocacy organizations, Dr. Jonathan Woodson, assistant secretary of defense for health affairs and director of the TRICARE Management Activity, assured military families that services under the TRICARE Basic program and the Enhanced Access to Autism Services Demonstration (ECHO Autism Demonstration) will not change.
As of this writing, however, the new policy itself has not been modified. Our summary here is based on Woodson’s verbal assurances and TRICARE statements that its ECHO Autism Demonstration and Basic Program will revert back to older policy versions.
We will update the summary as developments warrant – please check back.
Autism Speaks, meanwhile, remains concerned about the ABA Pilot for non-active duty family members. Specifically, these issues need to be addressed:
- by requiring specific psychometric testing, including the Autism Diagnostic Observation Schedule, 2nd Edition (ADOS-2), as a baseline measure before services can be provided, access to treatment for children may be delayed, possibly for several months
- by using the Vineland Adaptive Behavior Scales, 2nd Edition (Vineland-II), to confirm progress in treatment – a function for which the test has not been validated – needed care could be denied to children who could benefit from ABA
- arbitrary age and duration limits
- discharge criteria
- proper coverage of Assistant Behavior Analysts
TRICARE should fix these and other defects the right way – by working with families and other stakeholders as partners.