Search This Blog

Wednesday, December 22, 2021

TRICARE Coverage Changes

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.

A release from Senator Jeanne Shaheen:

U.S. Senators Jeanne Shaheen (D-NH) and Kirsten Gillibrand (D-NY) wrote a letter to Secretary of Defense for Personnel and Readiness Gilbert Cisneros, to inquire about changes made to TRICARE coverage that limit treatment options for individuals with autism. Specifically, the letter asks the Pentagon to investigate how these changes restrict access to proven services like Applied Behavior Analysis (ABA) and add burdens to care for autistic dependents, like children, and members of the military.

“We write with concern regarding the Defense Health Agency’s (DHA) May 1, 2021, policy changes pertaining to services for TRICARE beneficiaries through the Autism Care Demonstration (ACD). We are concerned that those changes have created burdens for military families and may be detrimental to the best course of treatment for some beneficiaries diagnosed with Autism Spectrum Disorder (ASD),” the Senators wrote. “Therefore, we are seeking additional information regarding these changes, the steps being taken to support military families with beneficiaries diagnosed with ASD and the intentions of the Department of Defense with respect to the overall ACD.”

“Changes to TRICARE coverage of the ACD should be based on independent assessments of efficacy that prioritize the welfare of military families and dependents with autism. It is imperative that military families have consistent access to the highest standards of care,” the Senators concluded.

“We are deeply troubled by the barriers to care that TRICARE has erected for many military families with autistic children through the policy changes described by Senators Shaheen and Gillibrand in this letter,” said Dr. Andy Shih, Interim Chief Science Officer for Autism Speaks. “Military families who rely on TRICARE deserve to have access to the services they need. We are grateful to Senators Shaheen and Gillibrand for listening to the voices of these families and for raising this important and pressing issue with Undersecretary Cisneros.”

“EFM supports the independent review in the NDAA of the Autism Care Demonstration,” said Holly Duncan, Co-Director of the Autism Family Advocacy Committee of Exceptional Families of the Military (EFM). “However, it provides no immediate help for military families. The changes should be halted and services in the community and school settings should be resumed pending the outcome of the review. We support the request for a briefing and are grateful for Senator Shaheen and Senator Gillibrand for representing military families impacted by these changes.”

"The recent DHA policy to remove Behavior Technicians from the school and community setting is not consistent with generally accepted standards of care for Applied Behavioral Analysis (ABA). The unjustified changes to this medically-necessary service impacts military families’ mental health and readiness as uniformed members must decide between seeking costly secondary insurance, foregoing ABA therapy in these settings, or leaving the armed forces. We are grateful to Congressional leaders for advocating to ensure military children diagnosed with autism receive quality ABA services,” said Dr. Kristi Cabiao, President and CEO of Mission Alpha Advocacy.

Full text of the letter is available here.