[Note: Shared for #AutisticHistory archive purposes. This is NOT An Autistic Ally.]
New TRICARE Policy Shortchanges Military Families
August 28, 2012
WASHINGTON, DC (August 28, 2012) — An interim TRICARE policy change affecting ABA benefits for military families fails to provide the level of coverage that was ordered by a federal judge in a class action lawsuit in July.
The Department of Defense (DoD) developed the interim policy change in response to a July 26 ruling by U.S. District Court Judge Reggie B. Walton that struck down the limited ABA benefits provided by TRICARE as “arbitrary and capricious.” Walton ordered the DoD, which manages the TRICARE program, to begin offering coverage to military retirees, as well as active duty personnel. An estimated 23,000 military dependents are affected by autism.
An analysis by Autism Speaks of the DoD policy change found that its list of authorized ABA providers is severely restricted. “Very few dependents will actually receive any level of care, let alone the intensive level of services many require,” the Autism Speaks analysis concludes.
For FAQs developed by Autism Speaks on the policy change and further background, go here.
For FAQs developed by TRICARE, go here.
Military Families & Autism
August 28, 2012
On July 26, 2012, the U.S. District Court for the District of Columbia struck down the Department of Defense’s denial of ABA therapy coverage under the TRICARE Basic Program as “arbitrary and capricious.” The court remanded the case back to the DoD with instructions that ABA therapy coverage be provided to TRICARE Basic Program beneficiaries “who otherwise qualify for reimbursement and such reimbursement be provided in compliance with the applicable TRICARE guidelines for the expenses incurred by qualified beneficiaries to acquire ABA therapy for their children.”
In response to the court’s ruling, TRICARE on August 10 issued interim guidance that will remain in effect until the litigation is completed. The interim policy provides for coverage of ABA therapy when delivered by a TRICARE authorized provider.
In pertinent part, authorized providers are defined as a:
- Physician board-certified or board-eligible in behavioral developmental pediatrics, neurodevelopmental pediatrics, pediatric neurology or child psychiatry;
- Ph.D. clinical psychologist working primarily with children; or
- Board Certified Behavior Analysts (BCBA) or state-certified/licensed ABA providers working under the supervision of the above specialists
Services delivered by non-authorized providers are specifically excluded under the interim policy.
Full text of TRICARE’s ABA policy can be accessed here.
ABA therapy is typically delivered under a tiered service model, with intensive one- to-one treatment provided by highly trained yet non-certified professionals supervised by a BCBA. This delivery model compares to the “modified corporate services provider” model that serves active duty service members in the Department of Defense’s Enhanced Access to Autism Services Demonstration under the TRICARE Extended Care Health Option program.
By restrictively defining authorized providers, TRICARE’s interim policy severely impedes access to services. Very few dependents will actually receive any level of care, let alone the intensive level of services many require.
The Department of Defense has to this point not provided the quality of care that the court ordered and many military dependents need. Autism Speaks continues to work with Congress and military family advocates to ensure appropriate resolution to these policy deficits. Military families that have served this country with honor and integrity deserve access the benefits they have earned.
Frequently Asked Questions
I am a retiree and have a child with autism. Can I obtain coverage of ABA under the TRICARE basic program?
The judge’s order applies to all TRICARE eligible beneficiaries with autism. That being said, it is important to note that to obtain coverage of ABA under the TRICARE program, all hands-on services must be delivered by a TRICARE authorized provider (listed above).
Authorized provider is defined as: Physician board-certified or board-eligible in behavioral developmental pediatrics, neurodevelopmental pediatrics, pediatric neurology or child psychiatry; or Ph.D. clinical psychologist working primarily with children; or Board Certified Behavior Analyst (BCBA) referred by AND working under the supervision of any of the providers listed above.
How will the judge’s order impact families receiving services under the ECHO program?
TRICARE beneficiaries with an autism diagnosis receiving ABA services under the ECHO Autism Services Demo program will not experience any service changes. All services received under the ECHO program are still subject to the annual $36,000 financial cap; provider standards outlined under the ECHO program and the Autism Services Demonstration remain the same.
The TRICARE policy under the Basic Program extends retroactively to March 2010. Can I submit claims for out-of-pocket expenses?
Yes, but we expect the same providers standards mentioned above will apply for retroactive reimbursement claims. If you did not receive ABA services directly from an authorized provider listed above, your reimbursement claim may be denied. If you are able to get reimbursed successfully, please contact us and share your story.
Please note that this is a developing situation. As updates are received, we will continue to notify the community. Please check back often.
Frequently Asked Questions TRICARE
- I understand I can receive reimbursement for out-of-pocket costs for Applied Behavior Analysis (ABA) therapy services my child received before ABA therapy coverage as a medical benefit was announced. What do I need to do to be paid for these past services?
Once policy guidance is implemented, you will need to file claims for reimbursement for past applied behavioral analysis services. Please note that for reimbursement your child must meet eligibility criteria and have received services from TRICARE-authorized providers who meet established criteria. You will be able to file claims for applied behavioral analysis therapy services received on or after February 16, 2010 in the United States and February 16, 2008 overseas. Visit http://www.tricare.mil/abatherapy/ for more information and to sign up for e-mail updates.
- If there is a U.S. District Court order requiring TRICARE to offer applied behavioral analysis
(ABA) therapy, why is it taking so long for TRICARE to cover ABA therapy for all beneficiaries?
Although interim policy is in place, covering applied behavior analysis therapy under the TRICARE medical benefit is extremely complex and implementation guidance is still in development. (09/06/2012)
- I just retired. While on active duty, my child received Applied Behavior Analysis (ABA) therapy services under the Extended Care Health Option (ECHO) Enhanced Access to Autism Services Demonstration. My child received services from a board-certified behavior analyst (BCBA) and a board certified assistant behavior analyst (BCaBA). Why can’t my child get services from these same providers under the TRICARE medical benefit?
The Enhanced Access to Autism Services Demonstration is only available to active duty family members registered in the Extended Care Health Option program. The demonstration allows qualified family members to receive applied behavioral analysis services as educational interventions for autism spectrum disorders. The U.S. District court order requires TRICARE to provide applied behavior analysis (ABA) therapy under the medical benefit. Educational services are not offered under the medical benefit.
- Can my child receive Applied Behavior Analysis (ABA) therapy from any ABA provider?
No…not just any applied behavioral analysis provider. First, to receive benefits your child must be TRICARE-eligible. Your child must be diagnosed with an autism spectrum disorder by a TRICARE- authorized primary care provider or a specialized autism spectrum disorder provider, defined as:
Physician board-certified or board-eligible in behavioral developmental pediatrics, neurodevelopmental pediatrics, pediatric neurology or child psychiatry; or
Ph.D. clinical psychologist working primarily with children.
Second, your child must have a treatment plan and prior-authorization to receive services. Lastly, ABA
therapy services must be provided by an authorized primary care provider (PCP), autism spectrum
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disorder (ASD) specialist, or a TRICARE-authorized provider (supervised by a PCP or ASD provider) who meets the following requirements:
Has a current state license to provide applied behavioral analysis services; or
Is currently state-certified as an applied behavioral analyst; or, where state license or certification
is not available,
Must be certified by the Behavioral Analyst Certification Board (BACB) as a Board Certified
Behavior Analyst (BCBA); and
Otherwise, meet all applicable requirements of TRICARE-authorized providers.
Note: Individuals certified by the BACB as a Board Certified Assistant Behavior Analyst (BCaBA) are not TRICARE-authorized ABA providers under the TRICARE medical benefit.
- Now that Applied Behavior Analysis (ABA) Therapy is provided as an interim medical benefit under TRICARE, what services are available?
Eligible beneficiaries with a covered autism spectrum disorder** diagnosis may receive the following services:
An initial beneficiary assessment;
Development of a treatment plan;
One-on-one applied behavioral analysis interventions with the eligible beneficiary, as well as
training of immediate family members to provide services according to the established treatment
Monitoring of the beneficiary’s progress toward treatment goals.
** Autism spectrum disorder diagnoses include Pervasive Developmental Disorders (PDD), to include the associated diagnoses of Autistic Disorder, Rhett’s Disorder, Childhood Disintegrative Disorder (CDD), Asperger’s Disorder, and Pervasive Development Disorder Not Otherwise Specified (PDDNOS) (including Atypical Autism).
- Why is TRICARE only offering applied behavior analysis (ABA) therapy services under the medical benefit on an interim basis?
TRICARE is only offering applied behavior analysis therapy coverage on an interim basis due to ongoing litigation. Regrettably, the Department of Defense and TRICARE Management Activity cannot discuss issues related to ongoing litigation against the Department.
- I understand that because of a U.S. District Court order, any TRICARE-eligible beneficiary can now get Applied Behavior Analysis (ABA) Therapy under TRICARE. Is this true?
Yes. Based on a U.S. District Court order, TRICARE is covering applied behavior analysis therapy to eligible beneficiaries with an Autism Spectrum Disorder (ASD) diagnosis as a medical benefit on an interim basis.
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The Autism Community Is Not The Autistic Community
More With Autism Votes
Autistic people have fought the inclusion of ABA in therapy for us since before Autism Speaks, and other non-Autistic-led autism organizations, started lobbying legislation to get it covered by insurances and Medicaid.
ABA is a myth originally sold to parents that it would keep their Autistic child out of an institution. Today, parents are told that with early intervention therapy their child will either be less Autistic or no longer Autistic by elementary school, and can be mainstreamed in typical education classes. ABA is very expensive to pay out of pocket. Essentially, Autism Speaks has justified the big price tag up front will offset the overall burden on resources for an Autistic’s lifetime. The recommendation for this therapy is 40 hours a week for children and toddlers.
The original study that showed the success rate of ABA to be at 50% has never been replicated. In fact, the study of ABA by United States Department of Defense was denounced as a failure. Not just once, but multiple times. Simply stated: ABA doesn’t work. In study after repeated study: ABA (conversion therapy) doesn’t work.
What more recent studies do show: Autistics who experienced ABA therapy are at high risk to develop PTSD and other lifelong trauma-related conditions. Historically, the autism organizations promoting ABA as a cure or solution have silenced Autistic advocates’ opposition. ABA is also known as gay conversion therapy.
The ‘cure’ for Autistics not born yet is the prevention of birth.
The ‘cure’ is a choice to terminate a pregnancy based on ‘autism risk.’ The cure is abortion. This is the same ‘cure’ society has for Down Syndrome.
This is eugenics 2021. Instead of killing Autistics and disabled children in gas chambers or ‘mercy killings’ like in Aktion T4, it’ll happen at the doctor’s office, quietly, one Autistic baby at a time. Different approaches yes, but still eugenics and the extinction of an entire minority group of people.
Fact: You can’t cure Autistics from being Autistic.
Fact: You can’t recover an Autistic from being Autistic.
Fact: You can groom an Autistic to mask and hide their traits. Somewhat. … however, this comes at the expense of the Autistic child, promotes Autistic Burnout (this should not be confused with typical burnout, Autistic Burnout can kill Autistics), and places the Autistic child at high risk for PTSD and other lifelong trauma-related conditions.
[Note: Autism is NOT a disease, but a neurodevelopmental difference and disability.]
Fact: Vaccines Do Not Cause Autism.