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Friday, July 26, 2013

Autism Speaks TRICARE Analysis

Autism Speaks reports on a purported TRICARE policy change:
Last year Congress directed TRICARE to launch an ABA pilot program to improve and expand its coverage for non-active personnel. TRICARE published its ABA Pilot policy last month for non-active duty family members -- but along with it camesignificant and drastic changes to existing ABA coverage for all beneficiaries with autism, including active duty military families.
Last week, TRICARE stepped back, but not away, from this ill-conceived change in the policy for ABA. After a tremendous outcry from military families, service providers, and advocacy organizations, Dr. Jonathan Woodson, assistant secretary of defense for health affairs and director of the TRICARE Management Activity, assured military families that services under the TRICARE Basic program and the Enhanced Access to Autism Services Demonstration (ECHO Autism Demonstration) will not change.
As of this writing, however, the new policy itself has not been modified.Our summary here is based on Woodson’s verbal assurances that the ECHO Autism Demonstration and the TRICARE Basic Program will not change. We will update the summary as developments warrant – please check back.
Autism Speaks, meanwhile, remains concerned about the ABA Pilot for non-active duty family members. Specifically, these issues need to be addressed:
  • by requiring specific psychometric testing, including the Autism Diagnostic Observation Schedule, 2nd Edition (ADOS-2), as a baseline measure before services can be provided, access to treatment for children may be delayed, possibly for several months
  • by using the Vineland Adaptive Behavior Scales, 2nd Edition (Vineland-II), to confirm progress in treatment – a function for which the test has not been validated – needed care could be denied to children who could benefit from ABA
  • arbitrary age and duration limits
  • discharge criteria
  • proper coverage of Assistant Behavior Analysts