[Note: Shared for #AutisticHistory archive purposes. This is NOT An Autistic Ally.]
Autism Speaks Reports On Efforts To Improve New TRICARE Plan
October 24, 2014
WASHINGTON, DC (October 24, 2014) — Autism Speaks, military families and other service and advocacy organizations met last week with TRICARE and Department of Defense (DoD) representatives to address questions and concerns regarding coverage of Applied Behavior Analysis (ABA) under TRICARE’s new Autism Care Demonstration (ACD). A copy of TRICARE meeting handouts is included below.
The following summary of the TRICARE meeting is to help inform the community of issues discussed. Confirmation with your regional contractor is strongly recommended before making any decisions affecting your operations or a beneficiary’s treatment plan. If you are not receiving a timely or complete response to your policy questions from the regional contractor, please email us at Militaryfamilies@autismspeaks.org.
- Reimbursement rate cuts to services delivered by a Board Certified Behavior Analyst (BCBA) and Board Certified Assistant Behavior Analysts (BCaBA) have been put on hold for 180 days. The DoD has contracted with the RAND Corporation to conduct an independent study to assess ABA reimbursement rates. The Contractor shall continue to process claims at the prior reimbursement rates of $125 for services delivered by a BCBA and $75 for one-on-one ABA delivered by a BCaBA. A copy of TRICARE’s letter to the regional contractors can be found HERE
- TRICARE confirmed that BCBA delivered services can be combined with the tiered service delivery model provided one BCBA is designated for treatment plan oversight. We requested this be clarified in policy to ensure consistent implementation across the three regions.
- The issue of one BCBA per case was raised, and TRICARE representatives confirmed that this meant that one BCBA must be responsible for care coordination and oversight of the patient’s treatment plan. TRICARE further explained that this was “a billing issue” and “the ACD does not limit a team approach to ABA or preclude consultation with or assistance by other BCBAs.” We requested this be clarified in policy to ensure consistent implementation across the three regions.
- BCaBAs may perform supervision duties, but must also work under the supervision of a BCBA. When asked how BCaBA supervision services were to be billed, TRICARE explained that the BCaBA supervision must be billed by the BCBA. We requested this be clarified in policy to ensure consistent implementation across the three regions.
- Concern was raised that the new Registered Behavior Technician (RBT) certification requirement may result in treatment delays. A one-year delay of this requirement was proposed by attendees. TRICARE agreed to re-examine its RBT timeline and the additional requirements it places on technicians over and above the RBT requirements.
- There was discussion regarding the discharge criteria and the two-year clinical review included in the ACD policies; concerns were raised that other outpatient services do not have discharge criteria mandated in policy. The disparity between TRICARE’s discharge criteria and the BACB guidelines was also discussed. TRICARE assured attendees that this language was not intended to discharge patients from care and that such decisions should be made at the clinician level with patients and parents. TRICARE agreed to reconsider the discharge language and the necessity of a two-year clinical review.
- Concerns about the minimum age eligibility of 18 months were raised. TRICARE agreed to re-examine this requirement.
- TRICARE confirmed that the monthly five percent supervision rule applied to time the behavior technician spends with each ABA recipient.
- There was discussion emphasizing the importance of ensuring referring physicians receive a copy of the ABA treatment plan and progress report each six months.
- There was discussion about expanding the pool of ABA providers to include licensed clinical psychologists as long as ABA was in the scope of their practice. TRICARE agreed to reconsider including licensed clinical psychologists as authorized ABA providers.
- Concerns were raised that not all cost shares under the ACD accrue to the family catastrophic cap, resulting in significant out-of-pocket costs for non-active duty family members and effectively barring access to recommended treatment services. TRICARE and DoD personnel agreed to re-examine the ACD cost shares and catastrophic cap concerns, but it was unclear what the timetable for that would be.
- Because of time, the group was not able to discuss concerns regarding limitations on treatment domains, but the handouts TRICARE provided for the meeting include assurances that, “The ACD interprets the medically identified ASD treatment domains as behavior, communication, and social skills broadly to include the array of targets identified by the BCBA during the development of the ABA treatment plan. The ACD does not limit ABA treatment plan targets developed by the BCBA but rather leaves treatment plan targets to the professional judgment of the BCBAThe change in terminology is intended to map care and treatment to medically defined requirements – not to limit the scope of care that can be provided.”
Autism Speaks will continue to work for positive policy improvements to ensure all beneficiaries with autism have access to affordable and timely services in a manner consistent with best practices. As policy develops, we will work to keep the community informed.
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.