Paycheck Chronicles

Autism, Tricare and Treatment


If you have any friends with children, you probably have a friend with a child who has autism or similar behavioral situations.  And if that family is military, you've probably heard about the extra challenges that come with moving that child from their doctors, schools and therapies.

A new bill could help make those challenges just a little easier.   Called the Caring for Military Children with Developmental Disabilities Act, this bill would broaden and codify Tricare’s coverage of applied behavior analysis therapy (ABA).

If passed, this bill would require Tricare to pay for doctor or psychologist prescribed ABA therapy, regardless of the child's diagnosis.  It would also specify what type of providers are authorized, expanding the current criteria to include any ABA specialist certified or licensed by their state or a national board.   In addition, it would create a specific pot of money to pay for these services.

Until 2012, Tricare covered up to $36,000 per year in  ABA for children of active-duty members through the Extended Health Care Option (ECHO) program.  In 2012, there was a court case regarding coverage for retiree's children.  As a result of this court ruling, the Department of Defense created an entirely new ABA program.

This 2013 program required that the initial therapy be conducted by a board-certified analyst with at least a master’s degree.  In this growing field, most programs are run by specially trained therapists who do not meet this stringent educational and licensing requirement.  Requiring board certification and a master's degree left many families without access to a provider.

 In addition, the new program required an autism diagnosis.  This left out many children who were receiving, and benefiting from ABA.

The proposed bill provides ABA coverage to all children whose doctor or therapist prescribed the treatment.  It would pay for treatment by any state-certified or nationally certified therapist.  It would also extend the coverage to ensure that the entire cost of treatment is paid by the program.

This is great news for families who can benefit from ABA, but it is mighty expensive for the Department of Defense.  The bill is expected to cost $20 million. It also would require the Defense Department to move $250 million to the separate account to pay for continuing treatment.

If you have an interest in this legislation, be sure to contact your representatives to express your support.

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