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Thursday, May 27, 2021

Tricare Woes

In The Politics of Autism, I discuss the day-to-day challenges facing autistic people and their families.  As many posts have discussed, the challenges are especially great for military families.

 ,At WTVD-TV Raleigh-Durham, North Carolina, Samantha Kummerer reports:

As of May 1, Tricare added limitations and restrictions to ABA therapy, particularly in schools and community settings.

"To me, they just want people like him to go away," [autism parent Shelly] Roper said. "There's no other alternative for a family like myself and where else would we go? We can't move, we're stationed at this base."

Chase isn't the only one in Cumberland County affected by this change.

"When I heard that they were taking ABA away out of school, I literally felt sick to my stomach. It was a devastating blow because for my daughter to get the education that she deserves and that she's capable of getting it she needs her RBT [registered behavior technician]" said Katrina Powers.


Tricare's changes still allow individuals to receive ABA therapy and see RBTs but in a more limited capacity and not during the entire school day.

A spokesperson for Tricare explained the changes were made after three years of collaboration with industry stakeholders and lessons learned.

"Although this is a new requirement that went into effect May 1, 2021, it was never the intent to reimburse for non-clinical or educational services. School services, where BTs serve as school supports, shadows, or aides are beyond the scope of ABA services covered under the ACD [Autism Care Demonstration]. The ACD is authorized to reimburse for the active delivery of ABA services. Tricare authorized BTs in the school setting are not actively rendering ABA services," a spokesperson wrote in an email.

From Autism Speaks:

Autism Speaks urges the Department of Defense to reconsider recently announced changes that would make it harder for children with autism to access needed care. These changes would make applied behavior analysis (ABA), an evidence-based treatment that helps reduce challenges with social communication and repetitive behaviors, less available in school and community settings.

The changes would also impose new burdens on families and otherwise create more barriers to services. The changes are memorialized in the TRICARE Operations Manual, which sets guidelines for the healthcare program for military families.

Children with autism benefit from an array of interventions, including occupational therapy, speech therapy, physical therapy and behavioral interventions like ABA. ABA is a routinely covered benefit for the children of federal civilian employees. But for the children of military families in TRICARE, ABA is considered an “experimental treatment” available only through a demonstration program.

“TRICARE should listen to the voices of the military families affected by the Manual changes and reverse course. TRICARE is making it more difficult for these families to care for their children,” said Stuart Spielman, Esq., senior vice president for Advocacy at Autism Speaks. “The thousands of autistic children of military servicemembers who rely on TRICARE deserve to have the services they need to reach their full potential. We strongly urge TRICARE to turn its focus to how it can maximize, not restrict, the benefits it offers to its beneficiaries and follow the science when it comes to ABA.”

The Manual changes follow Department of Defense reports to Congress on the Autism Care Demonstration program that cast doubt on the effectiveness of ABA.

“More than 20 studies have established the benefits of ABA therapy,” said Thomas W. Frazier, Ph.D., chief science officer at Autism Speaks. “While we support continued high-quality studies of interventions that use blinded assessments or other objective measures, the evidence that the Department cites does not meet that standard and is not appropriate to justify the finding that ABA lacks effectiveness. TRICARE stands alone in its assessment of ABA as ‘experimental.’ The flawed methodology it has used to evaluate ABA’s effectiveness appears as if it is designed specifically to show a lack of evidence of its efficacy. We hope TRICARE will reconsider this approach, meet with experts and families, and transparently revisit their findings.” 

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