The TRICARE Health Plan announced new reimbursement rates effective April 1, 2016 for applied behavior analysis (ABA) services, which are provided under the Autism Care Demonstration (ACD). TRICARE's ABA coverage and benefits are not changing. The new provider rates align ABA with all other TRICARE rates, ensuring the rates are reviewed and appropriately adjusted each year.
"We do not expect these changes to have a negative impact on our beneficiaries' continued access to ABA services," said Doug McBroom with the TRICARE Policy & Benefits Office. McBroom said he anticipates TRICARE will continue to have a large national network and in those areas without a network provider available, the regional contractors will arrange for care with non-network providers.
Rates were determined using two studies and included input from providers and advocates in the autism community. McBroom explained the rates are based on extensive research and evaluation, and will be annually reviewed, using three factors: The national Medicaid reimbursement rates; The Medicare locality factors that account for the cost of living in 89 current and 14 newly designated geographic areas; And, the calculated National Rate. Approximately 23,500 approved providers are available nationwide for TRICARE's approximately 10,500 beneficiaries currently receiving ABA services under the ACD The new calculation process ensures the rates are reviewed each year and not frozen for another seven years.
TRICARE officials recognize that unrelated to payment rates, a handful of geographic locations have fewer providers than desired and this presents a challenge. The ABA provider network is closely monitored and more than 700 new providers were recruited into the ACD in recent months.
"We are moving forward and will make sure all beneficiaries receiving ABA services continue having access to high quality ABA services," said McBroom.
For more information on TRICARE's ACD benefit and ABA coverage, visit www.tricare.mil/acd, or view a TRICARE TV video explaining the benefit. The new rates have been published and can be viewed at www.health.mil/autism.