Tricare Going AWOL on Military Autism Families?
By Sarah Stockwell
Military families with a child with autism are used to fighting. The servicemembers fight on the battlefield when deployed and the spouses, with constant military moves in and out of states and school districts fight for their childrens’ right to an appropriate education as well as the daily battle to raise a child in a world they are ill-equipped for and vice versa. One fight that military families with children with autism should not have to face however is the battle to ensure their children receive appropriate medical care. There are estimated to be over 20,000 military children with autism.
One such fight is gearing up in the military community right now. Tricare, the military healthcare provider has made drastic changes to the way it provides ABA therapy for military dependents with autism spectrum disorders and these changes are due to take effect on the 25th of July.
Military families have been campaigning for years to improve access to autism therapies for their children and until now, have been making progress. There was a semi-victory in this respect for coverage for retiree families and wounded warriors, when a ‘pilot program’ was included in the recent NDAA. Shortly after Tricare announced (later than was originally required) the details of this pilot program in June, advocates in the community noticed that Tricare had made unannounced, extensive changes to the eligibility criteria and method of access for ABA under Tricare, which would apply to the children of both active duty troops, retirees and wounded warriors.
A small smattering of the changes –
• Children will need to receive ADOS-2 and Vineland-II to ‘confirm’ their diagnosis of autism (after obtaining a DSM-IV diagnosis) for eligibility of ABA therapy and Vineland will need to be repeated every 180 days, ADOS-2 each year.
• Children older than 16 require a ‘waiver’ to be granted ABA services, effectively imposing an age limit on the provision.
• ABA will only be authorized for 2 years, one year at a time. Once the 2 years are complete, a waiver is required to continue treatment.
• Vineland and ADOS are required to show ‘progress’ and the absence of progress, as measured by these tests, is a criteria for discharge from therapy.
• BCBAs and BCBA-Ds are required to supervise the program. BCaBAs are now demoted to technician level therapists and cannot supervise programs.
Some might argue that ‘at least the military get something’ in terms of insurance and yes, that is true. Or at least it was. Because of these changes, many children may be denied services for a multitude of reasons, some of which are outlined.
- High-functioning children will be at risk, because their Vineland and ADOS scores might not be significantly impaired enough. This also includes children like my own son, who has progressed from moderate/severe autism to a high functioning child, BECAUSE of the intervention he’s received. He has progressed enormously, but he still has autism. He still has challenges that need intervention.
- Children over the age of 16 will lose coverage without a waiver. There is no data that supports the lack of efficacy of ABA in children over 16.
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