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Delayed TRICARE Pilot Program Comes Under Senate Scrutiny

WASHINGTON, DC (April 18, 2013) -- Critical questions regarding a one-year ABA pilot program ordered by Congress but yet to be created were left unanswered by TRICARE during a hearing before the Senate Armed Services Committee.

Pressed by Sen. Kirsten Gillibrand (D-NY), who chairs the committee's personnel subcommittee, TRICARE Director Jonathon Woodson said the pilot program would cover ABA technicians, but declined to say when the program would begin, whether dollar caps would be imposed or when military families would begin receiving information. Congress directed late last year that the program be up and running by April 2, but Woodson said the Department of Defense had been unable to meet the deadline due to budget issues.

"We are moving ahead with all due haste to set up the program," Woodson told Gillibrand.

TRICARE began offering the ABA coverage as a medical benefit after a U.S. District Court judge last July ruled against the Department of Defense in a class action lawsuit brought by military families.  TRICARE implemented the ABA medical benefit last summer, but most beneficiaries could not access services because of TRICARE’s narrow definition of who can deliver care. 

Before the judge’s ruling last summer, TRICARE coverage of ABA care was limited to active-duty personnel and treatments were subject to dollar caps that did not address the level of treatment needed.  Woodson said that if left to TRICARE's discretion, ABA would be considered an educational rather than medical benefit, “but the law says we have to provide it so we will provide it.” 

Congress created the pilot program to improve TRICARE coverage for ABA as a medical benefit and expand access to a greater number of providers, but for now the details of the program are still unknown leaving families in limbo. An estimated 23,000 military families care for loved ones with autism.

"We call on TRICARE to be more transparent so that families and providers can plan accordingly," said Karen Driscoll, Autism Speaks' associate director for federal government affairs and military relations. "The pilot is essential to expand access to a greater number of ABA providers, but it is also important it address the level of care that has been medically recommended. The law is clear -- TRICARE must cover all medically necessary treatment."