TRICARE and ABA

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.

 Berkeley Lovelace Jr., Jason Kane and Erin McLaughlin at NBC:

ABA helps children with autism to develop important life skills, said Alycia Halladay, chief science officer at the Autism Science Foundation, a nonprofit advocacy group.

“It’s all about breaking things down into smaller steps, and then also providing the appropriate reinforcement for things,” Halladay said.

“This is how we all learn, by the way,” she added. “We all learn to go to the potty by somebody reinforcing us by going to the bathroom on the potty. We learned to be on time by people reinforcing us and giving us positive accolades for being on time. Kids with autism, they get it more intensely and they get it more directed based on the skill they need help with.”

Most states have mandates requiring private insurers to cover ABA or other behavioral interventions for children with autism, Halladay said.

Those mandates, however, don’t apply to the federal government, including federal programs such as TRICARE, she said. (Some federal programs do cover the therapy for children, including Medicaid and the Federal Employees Health Benefit, the government’s health insurance program for federal employees, retirees and their families.)

In 2021, Kristi Cabiao started a nonprofit called Mission Alpha aimed at pressuring both TRICARE and members of Congress to restore broad coverage of ABA. She lobbied Congress for an independent study reviewing the effectiveness of the therapy, which was launched that same year and conducted by the National Academies of Sciences, Engineering, and Medicine. Last September, the group published a 336-page report affirming that ABA should be included as a basic benefit under TRICARE, without the excessive administrative barriers that have disrupted treatment for children in military families.

The report stated the evidence to support ABA therapy “is robust” and meets “the Department of Defense’s own criteria of reliable evidence.”

Report Supports Tricare Funding for ABA

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.

 Karen Jowers at Military Times:

Defense Health Agency officials should formally authorize Applied Behavior Analysis, a widely recognized intervention to help children with autism, as a basic Tricare benefit, according to a report on the findings of a congressionally mandated independent study.

The report, conducted by the National Academies of Sciences, Engineering and Medicine, debunks DHA officials’ repeated assertion that ABA services don’t meet their standards for reliable medical evidence.

The researchers lay out their analysis of why ABA meets Tricare’s own standards, defined in law.

Researchers recommend this major shift in Tricare’s policies for military family members diagnosed with autism spectrum disorder, citing problems with an 11-year-old demonstration project that in effect limits the care available for these children.

“It’s time for ABA to be a basic benefit in the Defense Health Agency,” said Dr. Eric Flake, a retired Air Force colonel who is a member of the committee that conducted the study, during a webinar Tuesday.

DOD Extends Tricare Autism Program

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.

Patricia Kime at Military.com:

The Defense Department will extend its program meant to help provide care for military dependents diagnosed with an autism spectrum disorder through 2028 to evaluate its effectiveness, the agency announced Thursday.

In a Federal Register notice, DoD officials said research at the University of Rochester, as well as a newly required review by the National Academies of Sciences, Engineering, and Medicine, need additional time, and they have decided to extend the program past its current Dec. 31, 2023, sunset date to support the studies.

The program, formally known as Tricare Comprehensive Autism Care Demonstration, was started in 2014.

...
In March 2021, the program underwent significant changes, with the DoD combining several benefits under one umbrella and broadening services beyond ABA. Under the revised program, Tricare began covering group treatment for autism, if deemed appropriate, and families were assigned a care coordinator to develop care plans and coordinate therapy and treatment.

From its inception, the demonstration project has drawn both support and criticism, with proponents pressing for broad access to early, intense intervention they say contributes significantly to improved quality of life for patients and their families, and the DoD raising concerns about the effectiveness of ABA therapy.

A 2020 DoD report to Congress noted that the current demonstration project "and the delivery of ABA services, is not working for most Tricare beneficiaries."

But a year later, the 2021 report found that 57% of participants in the program made "statistically significant improvements," while 43% showed no improvement or worsening symptoms.

Autism Families Take Offense at TRICARE

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 previous post noted that TRICARE has been touting Autism Acceptance Month.  Military families are not buying it.

Maggie BenZvi at Coffee or Die:

On April 8, the Facebook page for TRICARE, the government health care program that provides medical insurance for military service members and retirees, posted a message regarding April’s status as a month for awareness and acceptance of autistic people.

“April is #AutismAcceptanceMonth!” the post read. “We can all work to make room for more inclusivity and tolerance with just a little patience, understanding, and education.”

For Holly Duncan, the post was a stab in the heart.

“I don’t ‘tolerate’ my kids,” Duncan told Coffee or Die Magazine in the days after the post went up. “I don’t ‘tolerate’ their autism. I learned to live in their world.”

...

TRICARE is not just some corporate PR department looking for clicks. Rather, as demonstrated by the hundreds of responses to the post and according to parents who spoke to Coffee or Die, TRICARE has failed to deliver needed help to their families.

The reaction to TRICARE’s Facebook post was instant and outraged: scores of military parents who say they have spent hours or even years fighting with TRICARE to get appropriate therapy services covered for their children.

Hundreds of comments quickly piled up on the post.

“Oh, look, useless virtue signaling as they cover less for families. Thanks, TriCare,” wrote a user named Rachel Dawn.

“What a slap in the face #TRICARE with this post!” Kira Barrett-Voelker commented.

“Whoever marketed this mess is an embarrassment,” wrote Kristin Borg.

Duncan, along with Jennifer Bittner, co-chairs the Autism Family Advocacy Committee for Exceptional Families of the Military.

Both women are military spouses, both have two children on the autism spectrum, and both are dismayed by recent TRICARE changes that make receiving those therapies even more difficult.

TRICARE Angers Military Families

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.

Karen Jowers at Military Times:

A Facebook post from Tricare celebrating April as “Autism Acceptance Month” has struck a nerve, with hundreds of military families criticizing the Defense Department for its health care coverage of autism treatment for military families.

Families complained that recent DoD policy changes have resulted in cuts in coverage for autism treatment.

“What a gross post from a group that has made getting services so difficult for hundreds of people,” wrote Meigan Toland, commenting on Tricare’s simple April 8 post.

At last look on April 11, there were 690 comments to the post, which reads: “We can all work to make room for more inclusivity and tolerance with just a little patience, understanding and education. Learn more about Tricare coverage of Autism treatment: tricare.mil/autism.

The post “immediately, albeit unintentionally, highlighted the concerns and limitations with the changes in autism care that many military families encounter,” stated a press release from the organization Exceptional Families of the Military.

ABA and Military Families

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.

Dr. Kristi Cabiao, CEO and president of Mission Alpha Advocacy, at Military Times:

ABA is a primary intervention for autism spectrum disorder; it is delivered by a behavior analyst involving multiple sessions several times a week over months or years. In commercial health plans, it’s considered a mental health service and is protected through the Mental Health Parity and Addiction Equity Act, or MHPAEA, of 2008.

The 2022 Report on MHPAEA to Congress by the Departments of Labor, Health and Human Services, and of the Treasury found egregious violations of the parity law regarding ABA services for autistic individuals. This report was not a surprise to the autism community. But the often-overlooked tragedy is that this federal protection does not apply to military families receiving ABA. The ABA services provided by Tricare are exempt from the MHPAEA laws, and military families are paying the cost.

MHPAEA prohibits health policies placing high co-payments, separate deductibles, and stricter pre-authorization or medical necessity reviews compared to other medical treatments covered by the plan. The Department of Defense policies guiding Tricare oversight of ABA services have clear examples of MHPAEA violations.

Parents seeking ABA services for their children must undergo stress assessments every six months to receive authorization for ABA. This mandate for parent stress assessments does not apply to any other population within the military healthcare system. Now, imagine this exact policy applied to children receiving insulin for diabetes. Children would be denied medically necessary treatment due to the parent’s noncompliance. Mandating parent stress assessments in order to receive ABA is a violation of MHPAEA.

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.

Letting Military Families Down

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.

Rachael Riley at The Fayetteville Observer:

In March, the Defense Health Agency, which oversees TRICARE, announced that by May, advanced behavioral analysis services outside of clinical settings will no longer be covered by the military insurance.

...

Prior to the TRICARE changes, technicians could accompany children with autism to school and help facilitate the child’s learning.

According to a July news release from TRICARE, behavior technicians were reclassified as non-clinical, thus not covered by the insurance, and as a result, not accompanying children into the classroom.

The release states a TRICARE contractor may authorize board-certified behavior analysts to provide time-limited clinical advanced behavioral analysis services for a child in the school setting.

 [Fort Bragg combat veteran James] Martin compared the change to going to a doctor’s office that has no support staff, physician assistant or licensed practical nurse.

Community settings such as dental appointments or sporting events are no longer considered the space for behavior technician unless determined “clinically appropriate” based on a child’s treatment plan, the news release states.

...

 Martin said it seems as if the Defense Health Agency is limiting services, which he said is causing applied behavioral analysis companies to leave Fayetteville. 

“It feels like this new policy change was backdoored and was not in the best interest of the families concerned,” Martin said. “I know the government needs to budget, but going after services for disabled children with autism is a new low.”  

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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Juking the Stats at DOD

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.

Ellis Giacomelli at The Watertown Daily Times:

Health insurance for military members and their families falls under the DOD through TRICARE, and for autism, plans cover occupational therapy, physical therapy, physician services, psychological services, psychological testing, prescription drugs and speech therapy.

For ABA specifically, coverage is separately offered through TRICARE’s Comprehensive Autism Care Demonstration. Used by several federal departments, demonstrations are designed to gauge the effectiveness and direction of a program.

According to an analysis prepared by Dr. Ira L. Cohen and published earlier this year, DOD reports have been “substantively flawed and based on the incompetent interpretation and analysis of the collected data,” leading to results that suggest military children with autism were not making behavioral progress with ABA.

“What we’ve clearly seen since 2018, is that TRICARE, if you take these reports together, is building a case against ABA services,” NCAAS spokesperson David A. Fuscus said in a February interview, adding that the case is an apparent attempt to save the department money. “At the same time, the costs for ABA services have gone up dramatically.”

With rising health care prices across nearly all sectors, the DOD has calculated ABA program costs have increased by 65% over four years, to $370.4 million in 2019.

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Autism Services for Kids is a campaign sponsored by the National Coalition for Access to Autism Services (NCAAS) to ensure that military children with autism have access to the Applied Behavior Analysis (ABA) treatment under the Department of Defense’s (DoD) healthcare provider, TRICARE. Our campaign is designed to stop DoD from discrediting a proven and effective treatment for children with autism to save money. Military families already shoulder too many burdens – wondering if their child with autism will get the treatment they need shouldn’t be one of them.

The National Coalition for Access to Autism Services (NCAAS) is the voice of service providers and other constituents who help Americans with autism achieve their full potential. NCAAS believes Americans with autism deserve affordable coverage that ensures access to quality treatment. NCAAS members provide services to individuals across a range of private and public programs, including commercial insurance through employer-sponsored plans and the individual market, Medicaid, Medicaid managed care, and TRICARE.

Military Caregivers

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.

Britt E. Farley and colleagues have brief report at The Journal of Autism and Developmental Disorders titled "Identifying Concerns of Military Caregivers with Children Diagnosed with ASD Following a Military Directed Relocation."  The abstract:

Military families relocate three times more often than non-military families. Those whom have children diagnosed with Autism Spectrum Disorder face challenges related to inconsistencies in services, delay of services, and lack of continuity of care. The current study expands the limited research examining the experiences of military families with children with Autism by focusing on impact of relocation, specifically identifying potential causes of delays in services. An online survey of 25 military caregivers of children with autism suggests potential delays in service related to provider waitlists, obtaining new referrals, and lengthy intake processes. The impact of these inconsistencies is discussed in relation to child progress and the need for future research in this area.\

From the article:

Caregivers reported that they were able to locate ABA providers that accept TRICARE; however, they were not able to access these services promptly. Factors that infuence accessing services in a timely manner include obtaining a new referral, waitlist times, and completing the ABA intake process (i.e., new assessment and treatment plan). This delay in services is on top of the time spent moving from one location to another. The total lapse in services should be measured from the termination of one ABA provider services to the beginning of the next, based on the typical military experience. During this lapse in services the child is not only afected, but there is also no parent support or training. Additional research should focus on a comprehensive overview of experiences these individuals face during and following a PCS [permanent change of station]. Measuring time to move would include the time it takes to relocate the family from one base to another and often times can include temporary housing both at the current base and new base. When moving from one side of the United States to another, or from a domestic to an overseas base, there is a need to switch TRICARE regions or health plans. Once a family arrives at a new base a Primary Care Manager (PCM) may not immediately be available. The PCM provides the new referral, so if there is a delay seeing a PCM, then there is also a delay in obtaining a new referral. In some areas providers do not put individuals on their waitlist until they are physically in location; this could be due to the possibility of a change in orders. Additional components after being put on a waitlist would be time to be seen by a provider, time to complete new assessment, time to complete new treatment plan, time to obtain  TRICARE approval, and time to start the frst session.

Military Families Have a Hard Time Getting Support

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.

Blue Star Families reports on its 2018 survey:

The National Council on Disability has found exceptional family members (EFM) and their families also face barriers in a variety of domains including health care. In particular, obtaining and maintaining disability-related services requires relentless hard work which can be time-consuming and overwhelming.20 EFM and their families are required to enroll into the Exceptional Family Member Program (EFMP), a program meant to provide a comprehensive and coordinated approach for community support, housing, medical, educational, and personnel services to families with special needs.21 However, EFMP enrolled military family respondents with a child with special needs reported being significantly less likely than their peers to indicate Tricare provided appropriate medical support for their family. These families were also significantly less likely to be satisfied with the support their family received from the DoD/military.

TRICARE and ABA

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.

Tom Philpott at Military Update:

Though TRICARE launched this ABA program in 2014, and has seen spending rise to $261 million annually, it’s still labeled a “demonstration” because the effectiveness of applied behavioral techniques for autism remains unproven, said Navy Capt. Edward Simmer, chief clinical officer of the TRICARE Health Plan.

“As of right now,” Simmer said, “Applied Behavioral Analysis does not meet TRICARE requirements for evidence-based coverage as part of the basic benefit. It still does not meet what we call the ‘hierarchy-of-evidence’ standard.”
...
First, ABA coverage coverage will continue through 2023 under a program extension approved earlier this year. Over that span TRICARE estimates that spending on ABA will rise to $430 million, the result of both medical inflation and a steady rise in number of children enrolled in the demonstration. Simmer estimates that only about half of all military children with autism currently receive ABA therapy.

A second notable development is that, at the direction of Congress, TRICARE is funding a $7 million research study, to run the length of the five-year extension. The purpose will be to learn how many ABA sessions are most effective.
...

Finally, Simmer said, TRICARE is broadening its autism program to encompass combinations of therapies, not solely ABA. The idea is to focus on “the whole child” while at the same time ensuring adequate support of parents whose involvement is seen as perhaps the most critical factor in effective therapy.

TRICARE Coverage Issues

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.

Ariana Cernius has an article at The Journal of Legislation titled “Thou Shalt Not Ration Justice”: The Importance of Autism Insurance Reform for Military Autism Families, and the Economic
and National Security Implications of Improving Access to ABA Therapy Under TRICARE." From the abstract:

The realities of military service—extended family separation, frequent changes of duty stations, and varying access to specialized healthcare—often undermine military autism families’ ability to secure adequate individualized services. These challenges have been compounded by TRICARE’s most recent adjustments in coverage of ABA, which have run counter to trend. In late 2015, TRICARE announced a 15% slash to reimbursement rates for ABA providers, justifying this dramatic change with a statement of the need to bring TRICARE rates, which had previously been higher than Medicaid and commercial rates, in line with other commercial plans. Although the intent behind this rate reduction was to avoid government overpayment, it demonstrated a fundamental misunderstanding about the nature and treatment of autism and the functioning of the health insurance industry, and a lack of recognition of the fact that the commercial insurance, Medicaid, and TRICARE business models are not identical or based solely on revenues. First, simultaneous with its cut to provider reimbursement rates, TRICARE implemented higher credentialing standards for ABA providers, essentially demanding more skilled and educated employees for significantly lower pay. Additionally, because TRICARE does not reimburse providers for certain services that commercial insurance and Medicaid do provide reimbursement for, TRICARE’s move to slash rates was particularly harmful to ABA providers. This combination of policy changes essentially rendered children with autism from military families the least-desirable clients for ABA providers, because the lowered rates and profit margin per autistic child with TRICARE insurance are so significantly below the national average that it is unsustainable for the ABA provider business model to maintain their military autism family clients, and many providers are deterred from taking on new autism families with TRICARE insurance. It is estimated that 23,000 military dependents have a diagnosis of autism, and many stand to join them in the coming years; aside from the harm caused to the children with autism of the families that serve our nation by the increase in hardship in accessing ABA, there are negative implications for broader society as well. Studies show that lack of care and interrupted services have negative impacts to the progress of children with autism, leading to an increase in the economic burden of this population to society due to anticipated higher health costs, and the greater chance that these children with autism will be dependent on society as adults. Furthermore, inadequate or inconsistent access to ABA through TRICARE jeopardizes the health and well-being of military families, which affects national security, given the direct impact family health care plays on military readiness. This article examines the history of TRICARE’s coverage of autism treatment, analyzes the most recent policy missteps, and provides recommendations for policymakers in future efforts to care for and improve the lives of the autism population.

TRICARE is FUBAR

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

Many posts have discussed Tricare  a health care program of the Department of Defense Military Health System.  It Tricare provides civilian health benefits for military personnel, military retirees, and their dependents. Military autism families depend on it.

Dianna Cahn at Stars and Stripes:

Across the country, parents and providers say they are facing overwhelming obstacles to sustaining services under Tricare following the Jan. 1 reorganization that included merging Tricare East and Tricare South and changing out contracts for Tricare East and West.

Servicemembers and family members have reported difficulties connecting to online systems and hourslong waits to speak to customer service. Parents and providers said they learned more from each other in online forums than from attempts to reach their insurance representatives.

Meanwhile, providers say reimbursements are patchy; they are slow to be approved; many providers are being reimbursed at rates of less qualified professionals; and the management companies – Humana Military in Tricare East and HealthNet in Tricare West – are slow to correct errors or address problems.

The Defense Health Agency says it is aware of the problems, particularly in Tricare East, and it has established a joint DHA/Humana Autism Task Force to resolve issues. It also says many of the problems have been corrected or are being resolved. But providers say that while claims that do go through without error are being processed more quickly, many of the issues still persist – including frequent errors in processing, payment rates and full reimbursements.

Tillis and Gillibrand Restore TRICARE Reimbursement Rates

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 December 13 release from Senator Thom Tillis:

U.S. Senators Thom Tillis (R-NC) and Kirsten Gillibrand (D-NY), members of the Senate Armed Services Committee, announced that the Senate has passed their provision that would address issues with reimbursement rates for the TRICARE Autism Care Demonstration program. The Department of Defense is currently implementing a demonstration project that is scheduled to expire in December, 2018 that provides access to Applied Behavioral Analysis therapy to all military dependents with Autism Spectrum Disorder (ASD). Gillibrand and Tillis’s efforts would reset reimbursement rates for providers to no less than the levels that were in effect on March 31, 2016 to ensure access to care for all military dependents with ASD. The provision passed the Senate as part of the Fiscal Year 2017 National Defense Authorization Act (NDAA) and now heads to the President for his signature.

"During the past year, Senator Gillibrand and I have been working across the aisle to help restore reimbursement rates for ABA providers, and I'm pleased our provision was included in the NDAA," said Senator Tillis. "I now look forward to working with appropriators in the House and Senate to ensure that we provide for our military families.”

“I am so pleased that we were able to come together and roll back these rates to ensure that providers continue to participate in the Autism Care Demonstration program and that our military families have access to the critical services, care and support they need and deserve,” said Senator Gillibrand.

In March, Tillis and Gillibrand urged the Defense Secretary in a bipartisan letter to delay the new rates until after completion of the Demonstration program to protect ABA therapy access for over 26,000 children of military personnel and retirees. The following month, the Defense Health Agency (DHA) moved forward with adjusting TRICARE reimbursement rates for ABA therapy to beneficiaries diagnosed with ASD. Although metropolitan areas saw an increase in reimbursement rates, military bases mostly located in suburban or rural areas saw drastic cuts and substantial decreases in reimbursement rates.

The Demonstration program was designed to combine three different TRICARE programs that covered ABA services for beneficiaries into a single program with one uniform benefit. The demonstration program would also expand access to these services among the 26,000 TRICARE beneficiaries with ASD.

Reversing TRICARE Rate Cuts

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.

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]

Senators Push for TRICARE Funding

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 Thom Tillis:

Bipartisan Group Of Senators Call For Sustained Funding For Autism Therapy For Military ChildrenOct 04 2016

Senators Thom Tillis (R-NC), Kirsten Gillibrand (D-NY), Bob Casey (D-PA), Roger Wicker (R-MS), Amy Klobuchar (D-MN), and Chris Murphy (D-CT) sent a letter to the Chairmen and Ranking Members of the Senate and House Appropriations Committee urging funding to be included in the final version of the FY 2017 Department of Defense Appropriations Act to reverse cuts to reimbursement rates for Applied Behavioral Analysis (ABA) treatment for military children with Autism Spectrum Disorder (ASD) to ensure they can continue to receive care under TRICARE.

TRICARE is a managed health care program for active duty, reserve component and retired members of the uniformed services, their families, and survivors. TRICARE began a demonstration project last year to provide a single, uniform benefit to the estimated 26,000 TRICARE beneficiaries with ASD. However, in April, TRICARE adjusted the reimbursement rates to providers of ABA therapy threatening a severe reduction in access to crucial ABA services for dependents with ASD. The Senators called on the committees to ensure the final appropriations for the Department of Defense include a reversal in the TRICARE cuts to mirror this reversal in the House and Senate National Defense Authorization Act bills.

“ABA therapy is an intensive one-on-one therapy usually conducted at the home of the recipient. One of the objectives of the demonstration program was to provide a single, uniform benefit to the estimated 26,000 TRICARE beneficiaries with ASD, and approximately 40% of eligible beneficiaries receive ABA services under this program,” the Senators wrote. “We request that you include $32 million in the final appropriations bill that provides funding for the Department of Defense for FY 2017. These funds will ensure that military children with ASD in need of therapy can obtain the services they and their families deserve.”

Read the full text of the letter.

Help for Military Families

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 news release from Rep. Tom Rooney (R-FL):

The U.S. House of Representatives passed an amendment to the FY 2017 Defense Appropriations Act sponsored by Representatives Tom Rooney (FL-17), John B. Larson (CT-01) and Chris Smith (NJ-04) that will provide increased assistance to military families who have a child with Autism Spectrum Disorder (ASD).

“Having a child with Autism Spectrum Disorder (ASD) shouldn’t make it harder for you to serve in the military,” Rooney said. “This amendment is a commonsense adjustment in policy that never should have been changed in the first place. We need to ensure that our service members and veterans have the tools to raise their families and give back to them a small fraction of what they have sacrificed for this country.”

In December 2015, the Defense Health Agency (DHA) announced cuts to reimbursement rates for applied behavior analysis (ABA) services – a widely recognized treatment program for children with ASD that is already covered by a majority of private insurers in most regions of the country. Since becoming effective in April, these cuts have resulted in many areas with military facilities facing shortages of ABA therapy providers.

Further, the enactment of these cuts came in the middle of the DHA’s Comprehensive Autism Care Demonstration; a demonstration program on ABA services set to run through December 2018. Consequently, these ill-timed cuts would skew the strong analytical analysis of ABA services the Demonstration was expected to yield.

The bipartisan Rooney-Larson-Smith Amendment would restore ABA reimbursement rates, a provision already authorized by a similar amendment offered by the group to the FY 2017 NDAA (H.R. 4909), which was adopted by voice vote on the House floor. Once the cuts have been rolled back, rates will not be allowed to increase or decrease until the conclusion of the Autism Care Demonstration in 2018.

From Rep. Larson :

“With everything our servicemembers and their families give to our country, we should not hesitate to provide the care they need in return,” said Larson. “Every military family makes sacrifices, but they should never be asked to sacrifice the health and wellbeing of their children. I was extremely proud to work with Reps. Rooney and Smith on this effort. They have been great champions for our military families.”

Larson has won several bipartisan victories to make ABA a permanent benefit in TRICARE. Last month, Larson’s amendment passed as part of the National Defense Authorization Act (NDAA). Today’s victory ensures the measure is funded so military families receive the help they need.

Sanders on Autism and Disability

In The Politics of Autism, I discuss the issue's role in presidential campaigns.  As I explain in the book, Hillary Clinton has a long history with the issue, and has issued an autism policy statement for the 2016 campaign.

From the independent "Feel the Bern" site:

Has Bernie advocated for [sic] increased funding to programs meant to support people with disabilities?

Yes, multiple times. Bernie co-sponsored the Expand TRICARE Coverage of Autism amendment, which expanded the program’s coverage to include autism spectrum disorders and appropriated an additional $45 million for the insurance coverage of autism therapy. He also co-sponsored the Assistive Technology Act of 2004, supporting grants to programs intended to address assistive technology needs of individuals with disabilities.

Bernie Sanders's official page on disabilities:

“The Americans with Disabilities Act established a clear national mandate that we as a nation have a moral responsibility to ensure that all Americans have access to the programs and the support needed to contribute to society, live with dignity, and achieve a high quality of life.”
— Senator Bernie Sanders


When the Americans with Disabilities Act (ADA) was passed 25 years ago, it was hailed as the world’s first comprehensive declaration of equality for people with disabilities. Today, as a result of this landmark legislation, millions of people with disabilities are no longer denied the opportunity to get on a bus, go to a decent school, make a decent living, attend a baseball game, and live successful and productive lives. Instead of being isolated and hidden from society, kids with disabilities are now in classrooms all over America and graduating from high school and college with the respect and admiration of their classmates, teachers, and families.

This transformation in our culture and society did not happen by accident, and it did not happen overnight – it happened because a grassroots movement demanded change. Despite the progress that has been made over the past two decades, we unfortunately still live in a world where people with disabilities have fewer work opportunities and where the civil rights of people with disabilities are not always protected and respected.
Bernie has been a champion for the rights of people with disabilities and he will continue to fight to ensure that our society is one where people with disabilities can live full and productive lives.

As President, Bernie will:

PROTECT AND EXPAND THE SOCIAL SECURITY DISABILITY INSURANCE PROGRAM (SSDI)
SSDI is vitally important to more than 11 million Americans, including more than one million veterans and nearly two million children. The average disability benefit is about $1,200 a month. For many people, that is their entire income.

INCREASE EMPLOYMENT AND EDUCATIONAL OPPORTUNITIES FOR PERSONS WITH DISABILITIES.
In the year 2016, it is unacceptable that over 80 percent of adults with disabilities are unemployed. We need to fully fund the Individuals with Disabilities Education Act (IDEA) and vocational education programs. We also need to expand funding for Aging and Disability Resource Centers (ADRCs), which aim to provide “one-stop shopping” for information on long-term services and support.

FIGHT FOR THE U.S. RATIFICATION OF THE CONVENTION ON THE RIGHTS OF PERSONS WITH DISABILITIES.
Bernie will continue to fight for equal access and equal rights for people with disabilities. That’s why Bernie strongly supports the ratification of this important treaty.

Nearly one-in-five Americans have a disability. Disability may occur at any stage of life, to anyone, and how our government and elected leadership respond to the issues facing people with disabilities and their families – from housing and transportation, to autonomy, to employment and education and access to services – shapes the fabric of our society.

At a time when millions of disabled Americans are struggling to keep their heads above water economically, Bernie believes that we must expand the social safety net in this country so that every American can live in dignity.

As the lead Democrat on the Budget Committee, Bernie fought against the Republican budget that would make lives much more difficult for persons with disabilities by throwing 27 million Americans off of health insurance, cutting Medicaid by $500 billion, turning Medicare into a voucher program, and making savage cuts in education, affordable housing, vocational assistance, and nutrition programs.

Instead of slashing Medicaid, instead of privatizing Medicare, Bernie believes what the United States must do is join every other major nation on earth and recognize that health care is a right of citizenship for every American, regardless of age.

That’s why Bernie is fighting for a Medicare-for-all single-payer health care plan for every man, woman, and child in this country.

As Franklin Delano Roosevelt reminded us: “The test of our progress is not whether we add more to the abundance of those who have much, it is whether we provide enough for those who have little.” And that is a test that we as a nation must once again meet and master.