TRICARE will Require Authorization to Continue ABA Services to Military Families with Autistic Children


By U.S. Government [Public domain], via Wikimedia Commons

Starting July 25th, this Thursday, the military’s healthcare insurer, TRICARE, will enact stricter qualifications to their current policy regarding the continuation of Applied Behavioral Analysis services to families with autistic children. This cold affect more than 23,000 military dependents who have a diagnosis of an autism spectrum disorder. At the same time that TRICARE will expand ABA provisions to non-active duty family members.  They will also put in place tests and progress evaluations as a basis for either continued or denied ABA intervention.

TRICARE states that all the ABA services will remain intact. The only change will be standardizing the methods used to assess the need for extended intensive treatment “Each ABA referral and prior authorization for ABA will be for one year. A new referral is needed for each period of authorized care.” Treatment needed beyond two years must be approved by the regional medical director. Any benefits needed once a child turns 17 will require a waiver. Assessments, TRICARE states, have always been conducted and progress evaluations are common in healthcare policies in order to determine whether intervention should continue. They assure beneficiaries that test results will not be the sole factor in a decision to extend ABA provisions or not.

On July 11th, Dr. Jonathan Woodson, assistant defense secretary for health affairs, held a conference call to address the controversy. He said:

“For all of the existing programs, there is no plan to implement more rigorous requirements during the next year.”

Some are relieved but not all military families are convinced. Some report that TRICARE’s new rules mean testing the child every six months. This shows a lack of knowledge about the nature of autism and its particular challenges. It also disregards the impact of hardships a child with autism experiences because of deployments, relocations, and other changes that occur in military families. The evaluation tests may not be able to accurately ascertain whether or not a child has improved because the child may be affected by recent disruptions in the home. Those on the autism spectrum generally do not respond well to change, so TRICARE’s expectations of progress may be unrealistic and shortsighted. The new policies may also hinder military readiness if families cannot depend on TRICARE’s ABA services to be there when a military spouse cannot.

Military families with autistic children are not alone in their concerns. Two senators, members of Congress and Karen Driscoll, from Autism Speaks, have also expressed concern that the TRICARE change will end up restricting ABA services, and the new periodic referral requirements will most likely cause some healthcare providers not to accept TRICARE.