Tricare would expand its coverage of applied behavioral therapy for children of beneficiaries with autism and other developmental disabilities under an amendment approved as part of the Senate version of the 2013 defense authorization bill.
The amendment, sponsored by Sen. Kirsten Gillibrand, D-N.Y., would extend coverage for ABA to families of military retirees, who currently are ineligible, and increase services across the board for all beneficiaries, eliminating a $36,000 annual cap on benefits.
In July, a federal judge ordered Tricare to cover the intensive therapy for affected children of service members and retirees. Following the ruling, Tricare notified beneficiaries it would pay for the treatment, offered by “masters-level board-certified behavior analysts.”
But critics say the stipulation has actually reduced access to care. They point out that masters-level trained analysts often oversee those with bachelor’s degrees or occupational therapists and speech therapists who work one-on-one with patients and don’t actually conduct the treatment themselves.
“They’ve actually twisted the judge’s ruling and are using it to cover fewer children who need it, not more,” said Dawn Berge, a plaintiff in the class-action lawsuit that prompted Judge Reggie Walton’s ruling.
A House version of the defense authorization bill also would require Tricare to pay for ABA treatment for children of Defense Department active-duty and retirees diagnosed with autism.
But the Senate’s version is broader, including the Coast Guard, National Oceanic and Atmospheric Administration and the Public Health Service, as well as children with other developmental disabilities.