Sen. Kirsten Gillibrand, D-N.Y., and three other senators signed a letter to the Defense Department.

Sen. Kirsten Gillibrand, D-N.Y., and three other senators signed a letter to the Defense Department. Lauren Victoria Burke/AP

Senators Urge Pentagon to Postpone Cuts to Autism Coverage for Military Kids

Proposed reductions in reimbursement rates for a popular therapy offered under TRICARE would take effect on March 30.

A bipartisan group of senators is urging the Defense Department to postpone impending cuts to reimbursement rates for autism benefits under TRICARE.

Defense has proposed cuts of up to 15 percent for reimbursement rates for Applied Behavior Analysis, 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. The rate changes for 2016 are supposed to take effect on March 30.

The lawmakers questioned the different reimbursement rates that two studies requested by the Defense Health Agency came up with, including one from RAND Corporation that said the department’s new proposed rates were 35 percent below the national average. Because of the discrepancies, the senators have asked Defense Secretary Ash Carter to hold off on implementing the cuts until “valid” reimbursement rates for ABA providers are established.

“With the announced cuts, some ABA providers have already announced plans to leave certain service areas and we expect more providers will follow suit upon implementation of the cuts,” said the March 8 letter from Sens. Kirsten Gillibrand, D-N.Y.; Amy Klobuchar, D-Minn.; Jerry Moran, R-Kansas; and Thom Tillis, R-N.C. “Over time, given the disparity between the national average reimbursement rate and TRICARE’s proposed rates, we expect the imbalance between supply and demand to further reduce military family access to these ABA services.” 

The Pentagon did not immediately respond to a request for comment.

The proposed cuts would be in addition to a 5 percent cut in ABA reimbursement rates that hit 22 states and Washington, D.C., in 2015. In 2014, 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. 

Defense previously has postponed cuts to the TRICARE autism benefit after complaints from military families and advocates. More than 26,000 military dependents have a diagnosis on the autism spectrum.

Lawmakers also said the timing of the cuts, which come as DHA is imposing new certification requirements for ABA providers, could make things worse.

“While these certification requirements will ensure that TRICARE beneficiaries obtain ABA services from qualified technicians, they also impose additional costs on TRICARE ABA service providers,” the letter said. “Certification may extend as many as 130 additional days to the time it takes to hire, train, and credential BTs to serve TRICARE beneficiaries. When considering that BTs are typically part-time employees with high turnover rates, these certification requirements will likely exacerbate the impact of reimbursement rate reductions.” 

The Office of Personnel Management announced in February that beginning in 2017 all insurance carriers participating in the Federal Employees Health Benefits Program must cover ABA as a medical treatment for children with some form of autism. Since 2013, FEHBP insurance carriers have had the option of covering ABA, as a medical treatment (rather than an educational intervention) for enrollees’ children with disorders on the autism spectrum.