Bill Seeks to Expand Autism Coverage for Military Families

Kapacziewskis

Joe Kapacziewskis and son Cody

The Caring for Military Children with Developmental Disabilities Act is a bill that would expand coverage of applied behavior analysis therapy for children with autism and other developmental disabilities from military families. The bill, introduced by Senator Roy Blunt, R-Mo, Senator Kirsten Gillibrand, D-NY, Senator Patty Murray, D-Wash, and Senator Marco Rubio, R-FL, passed the House last month.

“No military family should have to worry that their child might not receive access to quality care, and this legislation will ensure they won’t have to,” says Rubio.

Families like the Kapacziewski’s, whose son, Cody, was diagnosed with autism at 20 months. Cody is currently receiving 12 hours of ABA therapy per week, about half of the 25 weekly hours recommended by his developmental pediatrician. That’s the maximum amount that Tricare, the military insurance provider for Cody’s family, will cover, up to $36,000 per year.

The bill has gained support from several members of Congress, from both parties, including Rep. John Larson, D-CT, and Rep. Tom Rooney, R-FL. Larson says,

“This is a rarity in Congress where you get bipartisan support and consensus. I’m optimistic about its success.”

If passed, the bill will not only expand on the number of hours covered, but will also make ABA available to any child whose doctor or therapist prescribes the treatment, including children with Down Syndrome and other developmental disabilities. The bill would also cover therapy provided by any state-certified or nationally-certified therapist. Currently, the program requires that the initial therapy be conducted by a board-certified analyst with a master’s degree or higher, severely limiting the pool of qualified professionals available to help families in need.

According to the Defense Health Agency, there are currently 3, 307 beneficiaries receiving ABA therapy through Tricare’s basic program, with 5, 131 enrolled in extended therapy under ECHO, a program offering additional hours of tutoring and therapy to children of active duty troops.

Last year, Tricare introduced a pilot program to cover the children of military retirees after consulting with Autism Speaks, the Behavior Analyst Certification Board, representatives from Exceptional Family Member Programs, and the Pentagon Office of Special Needs. The program has currently approved 124 beneficiaries to receive ABA, while another 177 are waiting for approval.

The bill is expected to cost $20 million, and would require the Defense Department to move $250 million to a separate account to pay for continuing treatment. It has been described as “one of the most generous ABA benefits available.”

Sen. Murray says,

“Every parent of a child with a disability wants to do everything they can to provide the best care, but for parents in the uniformed services dealing with overseas deployments and frequent moves from state to state, the challenge to access quality care is even greater.

“The least we can do for our service men and women is provide quality health care for their loved ones.”

For families like the Kapacziewskis, it could make all the difference in the world.