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Pentagon Delays Until April Changes to Autism Coverage for Military Kids

Department is holding off on cutting reimbursement rates for one-on-one therapy after families complained.

The Defense Department has delayed until April cuts to the reimbursement rates for autism benefits under TRICARE because of complaints from many military families.

The department planned as of Oct. 20 to decrease by 46 percent reimbursement rates for applied behavior analysts who provide one-on-one therapy for children with some form of autism, as part of several changes to TRICARE’s autism coverage. But Defense changed course after several military families and advocates said the lower rates would leave autistic children without an important benefit. TRICARE will continue until April 20, 2015, to pay the current reimbursement rate of $125 an hour for one-on-one therapy with a board-certified behavior analyst, rather than the new $68-per-hour rate.

“The good news is that TRICARE listened to vocal complaints from our association, military families, and providers operating under the ACD [Autism Care Demo] and hired RAND to conduct an independent audit of the prevailing rates for services,” said the National Military Family Association in a statement.

RAND Corp., a nonprofit research firm, will study how changes to reimbursement rates could affect coverage before the new rates take effect.

“We are encouraged to see the DoD respond to the concerns of families and providers and look forward to working with the department to ensure the final policies meet the needs of families, align with best practices, and provide for timely and affordable services,” said Karen Driscoll, Autism Speaks' associate director for federal government affairs and military relations. The group is an autism science and advocacy organization founded by the grandparents of an autistic child.

Applied Behavior Analysis, or ABA, is a popular therapy for children with disorders on the autism spectrum. ABA can help increase an autistic child’s I.Q., language abilities and coping skills.

In July, TRICARE launched the Comprehensive Autism Care Demonstration, which runs through 2018, to consolidate the three previous ABA programs into one comprehensive benefits package for all TRICARE beneficiaries. Under the new Autism Care Demo, beneficiary costs for applied behavior analysis did not increase, but military families worried that the reduced reimbursement rates for one-on-one therapy with ABA providers would result in a loss of that benefit.

More than 23,000 military dependents have a diagnosis on the autism spectrum, according to Autism Speaks.