Posted on: 7:19 pm, July 16, 2013, by Jessica Larche, updated on: 09:40pm, July 16, 2013
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 here for 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
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Military families plan demonstration against Tricare’s autism therapy coverage