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Sunday, November 23, 2014

TRICARE Autism Care Demonstration

At The Star-Tribune in Tacoma, Tom Philpott reports on TRICARE:
[A] Comprehensive Autism Care Demonstration that began a slow rollout in late October will still leave retirees and reserve component families facing heavy out-of-pocket costs to provide children with intensive ABA therapy that has become a standard of care, say advocates for families.

Defense Health Agency officials say the demonstration, which is to run through December 2018 and open to any military family’s child diagnosed with autism, will be a platform for evaluating ABA therapy, a series of behavior interventions, to learn which ones benefit autism patients the most.
Army Maj. Gen. Richard W. Thomas, chief medical officer and director of health care operations for DHA, calls ABA therapy is an “emerging science.” Just as military has done for trauma care and other facets of health care delivery, Thomas sees the autism demonstration resulting in “new, innovative solutions to these patients” and discovery of best practices that are safe and effective.

When DHA released more details on the autism care demonstration in September, it sparked outrage among parents for another reason: a proposed cut in payment rate for board-certified behavior analysts performing one-on-one ABA therapy. DHA wanted to cut the rate from $125 an hour to $68 for providing day-to-day therapy. The higher rate would only be paid when assessing a patient’s need or drawing up a treatment plan. Otherwise rates would fall 46 percent.
The proposed rate change appears to have been based in part on a recent survey of Medicaid rates for ABA therapy in 14 states, which found board-certified behavior analysts receiving payments that ranged from $35 up to $125 a hour.
But DHA didn’t anticipate the reaction from families. Many said they feared board certified behavior analysts would drop Tricare patients and scuttle their child’s therapy. [Autism Speaks director of military relations Karen] Driscoll predicted it indeed would affect“thousands of kids.”
DHA has shelved the rate change until next April, giving it time to consider a more thorough review of ABA therapy payment rates being conducted by the think tank RAND.