WASHINGTON, DC (July 11, 2013) -- In a strongly worded letter to the Department of Defense, U.S. Senators Kirsten Gillibrand (D-NY) and Patty Murray (D-WA) demanded to know the reasoning behind new policy changes that severely restrict access to applied behavior analysis (ABA) for the nation's 23,000 military kids with autism.
"The apparent lack of understanding of the needs of children with developmental disability, including autism,...is astounding," the Senators wrote in their letter to Dr. Jonathan Woodson, director of TRICARE, the military health insurance program. Gillibrand [below] and Murray [right] expressed "complete frustration and dismay" with the policy changes which became public in late June.
Murray chairs the Senate Veterans Affairs Committee; Gillibrand chairs the Senate Armed Services' personnel subcommittee.
"Given the impact family health care plays on military readiness, it is essential military families have assurances of continued health care. Policies inconsistent with good clinical practice only serve to limit, restrict, delay, and deny care," the letter continued. "Before these new policies are in effect, we strongly urge you to consult with experts in developmental disabilities such as autism and ABA treatment practices."
The Senators were responding to policy guidance issued on June 25 by TRICARE affecting ABA coverage for all TRICARE-eligible beneficiaries. The changes are scheduled to take effect July 25.
TRICARE will now require:
- standardized testing every 6 months in order to continue receiving care
- evidence of "measurable progress" as indicated by standardized testing results to receive continued therapy
- waivers to continue care beyond two years of treatment and after age 16
- new discharge criteria for failure to make progress, sustainable gains, or a parent's inability to participate in the treatment
The new policies require the use of psychometric testing (VBS-II every 6 months; ADOS-2 annually) to show progress in order to continue receiving ABA. Gillibrand and Murray questioned whether those tests are valid or reliable for measuring progress with ABA and directed TRICARE to cite the authority they used to require them.
Imposing that condition to continue receiving care "is a significant shift in how TRICARE covers all other medical services," the Senators said. "Military children with developmental disabilities, such as autism, often experience periods of regression due to life events (such as deployment, relocation, change in school, change in medications, etc.).
"Coming back from those periods of regression often takes significant time and effort (months and sometimes years), and sometimes progress may be simply the absence of regression," they continued. "During these challenging times of need, discharging an individual from care is inappropriate and will have longlasting results on patient outcomes."
The Senators also directed TRICARE to identify any other chronic health condition that requires standardized testing to authorize care or evidence of progress in order to continue receiving coverage under its policies. TRICARE was directed to explain why it will require parents year after year to obtain new assessments reconfirming their child's existing autism diagnosis.
“Autism Speaks commends Senators Gillibrand and Murray for their commitment to the thousands of military families raising kids with autism and other developmental disabilities,” said Karen Driscoll, Autism Speaks’ associate director for federal government affairs and military relations. “Access to consistent healthcare services is essential to the physical and mental well-being of our military families. We greatly appreciate their leadership to ensure TRICARE policies provide the care our military families have earned and deserve.”