Tricare & Autism - New Access Rules and 46 percent reduction in ABA reimbursement!

Do you or your family member have Tricare for autism related services? 

Note MAJOR changes in the programs

"Those who are diagnosed with autism spectrum disorder after July 25 will receive current benefits under the Autism Care Demo by Dec. 31. Beneficiaries should contact their regional or plan contractor for information about how to get started."

Please let your legislator and the assistant sec-def named below know how important these services are. Many other insurances are playing this game. This cut is likely to affect access. - JR

TRICARE "Delays" Change in Autism Reimbursement to April

By Cheryl Pellerin
DoD News, Defense Media Activity

WASHINGTON, Oct. 10, 2014 – TRICARE has delayed until April a 46-percent reduction in the reimbursement level for some autism services while it awaits the results of an independent assessment of the prevailing rate for the services, defense officials said today.

The reduced reimbursement rate -- for one-on-one therapy with a board-certified behavior analyst for those with autism spectrum disorder -- was one of several program changes scheduled to go into effect Oct. 20 as TRICARE implements its new Comprehensive Autism Care Demonstration, or Autism Care Demo.

On Sept. 19, after the Defense Department published related changes to the TRICARE Operations Manual, providers and beneficiaries raised issues.

Rand Corp. independent analysis

On Oct. 8, Assistant Secretary of Defense for Health Affairs Dr. Jonathan Woodson directed that the rate change be postponed until April 20, 2015, while RAND Corp. completes an independent analysis of prevailing rates for the service.

TRICARE will continue to pay the previous rate of $125 an hour for one-on-one therapy with a board-certified behavior analyst rather than the new $68-per-hour rate. Defense officials say the new Autism Care Demo does not cut applied behavior analysis benefits.

The new TRICARE Autism Care Demo began July 25 and replaces current applied behavior analysis benefits with one simple program, according to the TRICARE website.

TRICARE-covered services

TRICARE covers the following services under the basic applied behavior analysis benefit, and a TRICARE-authorized board-certified behavior analyst must provide the services:

-- An initial applied behavior analysis assessment and treatment plan;

-- Direct one-on-one applied behavior analysis services;

-- Supervision of subordinate applied behavior analysis providers;

-- An updated applied behavior analysis treatment plan and updates; and

-- Training of family members or caregivers.