Tom Philpott reports at The Military Advantage Blog:
Language in both the House and Senate versions of the defense bill orders the Department of Defense to restore TRICARE reimbursement rates for applied behavior analysis (ABA) therapy for children with autism spectrum disorder to the higher levels paid until last April.
The rate cuts were significant enough that some groups of ABA providers stopped caring for military children, telling affected families they can’t properly pay staff or sustain their businesses with such low fees.
With the new rates TRICARE reimbursements fell sharply, but TRICARE capped the cut to no more than 15 percent the first year. Complaints from families and providers spurred the armed services committees to insert rollback language to their defense bills but then delayed final passage.
Despite the complaints, [Navy Capt. Edward Simmer, deputy director of the TRICARE Health Plan] said TRICARE has more than 28,000 ABA providers in its networks, more than two for every one of 13,000 military children receiving or seeking autism therapy.
“We’ve actually added providers under the new rates,” he said. “And everywhere we did have a provider drop because of the rates, we were able to place those patients with other very well qualified providers…So by and large we don’t believe the rates have had any significant impact on access.”
[Military autism advocate Karen] Driscoll said she the provider lists TRICARE touts are unreliable. She said she queried two clients, both of them large, multi-state ABA providers, to compare employee lists to what TRICARE posted. The results showed only 17 percent of providers listed for one company and 28 percent for the other were serving TRICARE beneficiaries. [emphasis added]