Military families plan demonstration against Tricare’s autism therapy coverage

Posted at 7:19 PM, Jul 16, 2013
and last updated 2013-07-17 11:08:06-04

Virginia Beach, Va. - Military families with autistic children are gearing up for a demonstration to show their frustration with Tricare's changes to therapy for autism and the insurance group's lack of communication about the changes.

Beginning July 25, 2013, Tricare will make it a lot tougher for military families with autistic children to qualify for Applied Behavior Analysis therapy, or ABA.  Families and providers have planned a demonstration this Sunday, July 21, 2013 at 1535 Amberly Forest Road in Virginia Beach.  Click herefor more information.

Below is a statement from Tricare NewsChannel 3 has been waiting days to receive:

The Department of Defense is greatly expanding applied behavior analysis (ABA) services with introduction of the ABA Pilot for non-active duty family members starting July 25. These changes are being made to provide non active duty family members, including retirees, with access to additional areas of ABA reinforcement. There is no change in the services available to active duty family members.

Active Duty Family members Active duty family members (ADFMs) and Non Active Duty Family Members, such as retirees, continue to be eligible to receive medical and behavioral health services such  treatment by a physician, psychological services and testing; occupational and physical therapy and other medical treatments under the TRICARE basic medical program.  In addition,  Active Duty Family Members will continue to receive  ABA reinforcement under the Extended Care Health Option (ECHO) Autism Services Demonstration from supervised board certified assistant behavior analysts (BCaBA) and paraprofessional ABA tutors.  The change in what is being provided is the addition of the ABA reinforcement through a separate pilot program for those TRICARE beneficiaries who are not active duty.  Prior to this pilot, the ABA reinforcement has not been available for non-active duty family members.

The treatment plans for all beneficiaries who have been receiving treatment and support for an Autism diagnosis has always included an assessment and evaluation of progress.  The expectations for these will continue through a more standardized method.   It is typical in any type of intervention to evaluate both medical necessity and progress using an established test.  Beneficiaries who are currently receiving ABA under the TRICARE Basic Program or the Autism Demonstration may continue to receive those services until their current authorization expires. Upon expiration, reauthorization will be based on a new referral, assessment/testing, medical necessity review, and documentation requirements of the revised TRICARE Basic Program ABA coverage policy.

The development of a plan of care for an individual and the evaluation of their progress, is based on many factors.  Testing alone does not and will not be the sole basis for the  TRICARE authorization for ABA. Our goal is to support our beneficiaries.  Part of this support is assuring that the interventions they are receiving are assisting and supporting them in their individual progress.

ABA coverage is not limited to two years - Each ABA referral and prior authorization for ABA will be for one year. A new referral is needed for each period of authorized care. Additional ABA beyond two years requires approval by the regional medical director. ABA benefits are available to children age 18 months and older, and ABA coverage does NOT  stop at age 16. Upon reaching age 17, additional  authorization is accomplished through a waiver process.

NewsChannel 3 also obtained the following statements from local representatives.

Congressman Randy Forbes

'I was pleased to support this year's House-passed defense policy bill which seeks to expand coverage for treatments for families with members affected by autism. I look forwarding to continuing to work on this issue with our military families to ensure they have the support and care necessary to continue serving our nation.'

Senator Tim Kaine

Medical treatment and care for service members and their families is critically important to me. I recently met with Virginia Active Duty members and their families who participate in the Exceptional Family Member Program (EFMP) and receive services at National Children`s Hospital and other leading medical facilities across the state. As a member of the Armed Services Committee, I will continue to follow up on these issues to ensure we provide the best coverage we can for military families and their children.

Congressman Rob Wittman

'I am firmly committed to ensuring the best medical care for our military and their families. In June, I voted to continue the authorization of Applied Behavior Analysis coverage through TRICARE because I strongly believe military families should have access to this critical coverage.  I understand how important it is to our military families and am concerned about the potential impacts of the new TRICARE requirement.  Families in the First District have rightly contacted me with their concerns. The House Armed Services Committee continues to engage with the Department of Defense regarding this issue and as a member of this committee, I will follow this issue closely and will continue efforts to support the well-being of our military families.'

Senator Mark Warner

Over the past 2-3 weeks, we`ve been hearing from some Virginia military families about this. Senator Warner supported expanded autism treatment options as part of the 2013 defense bill, because we know military families face unique stresses and challenges due to frequent deployments and relocations.

We`re asking the Pentagon to explain why they now have chosen to limit these important services to military families with special needs children.

There must be a better way to deal with this instead of interrupting services for autistic kids.


New TRICARE requirements could impact coverage of critical therapy for autism

Click the links below for more information. 

Tidewater Autism Society

Tidewater Autism Society Resource Directory

Autism Speaks

What is Applied Behavior Analysis?

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