Senators Question TRICARE Policy

A release from Senator Kirsten Gillibrand (D-NY):

The recent announcement of new federal rules to the military health insurance program (TRICARE) would put thousands of military children with developmental disabilities such as autism at-risk of losing critical behavioral treatment and care. Today, Senators Kirsten Gillibrand (D-NY), a member of the Senate Armed Services Committee, and Patty Murray (D-WA), a member of the Senate Veterans’ Affairs Committee, expressed their outrage over the new policy which cuts off care for children who do not show progress over a six month period. The new policy reveals a complete lack of understanding of the needs of children with developmental disabilities. The Senators urged the head of TRICARE to explain how the restrictive rules that require standardized testing, limit the eligibility of treatment, and set an age limit on receiving the care were determined and urged the agency to consult with experts before the new rules go into effect on July 25th.
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The Senators wrote in a letter to Assistant Secretary of Defense for Health Affairs & Director of TRICARE Management Activity, Dr. Jonathan Woodson, “We are writing to express complete frustration and dismay over the recent changes to coverage of applied behavior analysis (ABA) for all TRICARE eligible beneficiaries with autism. Prior to last year, children with developmental disabilities other than autism were also receiving and making progress from ABA services. However, new policies last year resulted in these children losing access to ABA services. The policies we write about today are another step in the wrong direction... The apparent lack of understanding of the needs of children with developmental disability, including autism, when drafting the recent TRICARE policy changes is astounding. The departure from how TRICARE covers all other medical care is also very concerning. Before these new policies are in effect, we strongly urge you to consult with experts in developmental disabilities such as autism and ABA treatment practices.”

Under the new policy, key restrictions include:

• Discharge from care if military children do not demonstrate progress over a limited period of time
• Limits care to patients age 16 and under
• Limits treatment to 2 years (requests beyond 2 years must go through a waiver process)
• Requires standardized testing every 6 months to receive care
• Places significant administrative burden on the care provider which will impact the number of providers willing to accept TRICARE
• The Senators emphasized that children of military families often experience regression due to life events such as deployment, relocation, and new school environment and returning from periods of regression often take significant time and effort. The Senators also requested prompt responses to their list of questions, including on what basis these rules were determined.

Autism is the fastest growing developmental disability in the country, with over 23,000 TRICARE beneficiaries diagnosed with autism. Nationwide, this disease affects 1 in 88 children and 1 in 54 boys, according to the Centers for Disease Control.