The Pentagon is postponing a plan to cut reimbursements for autism therapy provided under the Tricare health program.
Responding to complaints from military families and congressional inquiries on the proposed reductions, which were scheduled to go into effect Oct. 20, a Defense Department official said Thursday that Tricare has put off the change until April 20.
The cuts were among the changes planned under a revision of the Tricare Applied Behavioral Analysis, or ABA, therapy programs for autistic children.
Tricare announced in July that it planned to consolidate its various ABA programs into a single Autism Care Demonstration Project designed to solve problems related to continuity of care, eligibility and cost-shares.
But many military families found the proposed program confusing and also learned — mainly from their childrens’ therapists — that the reimbursement rate changes in the new program might leave their children without access to treatment, since some providers planned to drop Tricare as a result.
Nearly 8,000 active-duty dependents and 653 children of retirees receive ABA therapy under Tricare.
Jennifer Ackerman’s 3-year-old son Michael was diagnosed with an autism spectrum disorder earlier this year and has been going to ABA therapy for 10 hours a week.
She was told in September by Michael’s therapist that the therapist would stop accepting Tricare as a result of the pending cuts.
Ackerman said Thursday that the change would deprive Michael of any treatment because the Ackermans live in an area where the only provider qualified to provide services under Tricare is her son’s current therapist.
The delay in reimbursement cuts is a welcome “stay of execution,” Ackerman said.
“I am hopeful this means Tricare is at least willing to talk about the changes and get feedback from the families and autism advocacy groups,” Ackerman said. “But at the same time, there is so much confusion about the new program, it would be very helpful if we could get answers.”
Megan Miller, a managing supervisor with Navigation Behavioral Consulting, has pressed for modifications to the new program to ensure that therapists can continue seeing their patients.
According to a survey conducted by Navigation Behavioral Consulting, of 100 ABA business owners, 81 percent said they would drop Tricare as a result of the rate cuts.
“We are very excited that they have decided to delay the rate cuts but we still have concerns about the other changes they have proposed in the demonstration project. We wish they had consulted with some providers who actually work with the kids,” Miller said.
According to Miller, some of the new regulations regarding which providers can oversee certain types of therapy are so restrictive that they’ll leave some beneficiaries scrambling to find new providers.
“We’d like for them to communicate more clearly with us and the regional Tricare contractors so there is a seamless transition to the new program,” Miller said.
The Defense Department maintains that the new program will not increase costs for ABA to military families. A DoD spokesman said on Oct. 10 that active duty family members will continue to pay the same monthly enrollment fee they paid under the previous program and retiree families will pay the same cost-shares or co-payments.
But Ackerman, whose son faced being dropped from his certified therapist — the only board-certified behavior analyst in their area — said if her son was forced to receive his therapy from a tutor or behavior technician as a result, the therapy would no longer qualify for a $12 copayment and instead, the Ackermans would pay a 10 percent cost-share that would not be applied to the family’s $3000 annual catastrophic cap.
“Michael goes every day for two hours. It would be very expensive for us to keep him in therapy,” Ackerman said.
Defense officials plan to meet with representatives of military and veterans advocacy groups as well as autism advocates Wednesday to discuss the new demonstration project.
A DoD spokesman, Army Maj. James Brindle, said the department “understands the concerns caused by the rate change” and has commissioned an independent review of the program.
More than 17,618 active-duty dependents and 9,427 children of retirees have an autism spectrum disorder diagnosis.
News of the decision to postpone the reimbursement reduction first was reported Wednesday in The Hill newspaper.
