[HEALTH.MIL] TRICARE Appeals Take a Year & Autism Care Demonstration Simplifies TRICARE ABA Benefits

  • From: HEALTH.MIL@xxxxxxxxxxxxx
  • To: <HEALTH.MIL@xxxxxxxxxxxxx>
  • Date: Mon, 16 Jun 2014 19:40:21 -0500

TRICARE Appeals Take a Year

Week of June 16, 2014

A report says that appealing a
TRICARE decision can take as long as year. The report, which was sent to
lawmakers on June 4 showed it takes an average of almost a year for TRICARE
users who go through the entire appeals process to get a final ruling on whether
the agency will pay for a non-emergency procedure or treatment which are ruled
not medically necessary or against policy. According to the report, the 124
TRICARE users who appealed a coverage decision all the way to the final step --
a hearing -- between 2009 and 2013 received answers an average of about 346 days
after their initial appeals. 

ear.html> Read the full article on Military.com at

SOURCE:  Military.Com Article at .


Autism Care Demonstration Simplifies TRICARE ABA Benefits 


Starting this summer, a new Applied Behavior Analysis (ABA) policy will cover
all TRICARE beneficiaries with autism spectrum disorder (ASD) under a single
benefit. The Autism Care Demonstration (ACD) will start July 25, 2014 and will
run until Dec. 31, 2018. All beneficiaries currently receiving ABA under TRICARE
will transition seamlessly to the new benefit with no gap in coverage by Dec.
31, 2014.

Currently, TRICARE beneficiaries with ASD get ABA covered by one of three
programs, depending on their sponsor's duty status. The ACD combines these
programs into a single benefit that will stay with beneficiaries if they move
from active duty, retire or switch TRICARE plans. All ASD patients will have the
same access to care, regardless of sponsor status or plan.

TRICARE worked with military families, autism experts and advocacy groups to
develop this policy and address concerns with previous TRICARE ABA policies. The
ACD complies with the most recent Behavior Analyst Certification Board
guidelines for ABA coverage.

The ACD offers several enhancements to previous ABA TRICARE programs. There are
no annual or lifetime caps on the amount of ABA TRICARE will cover, simpler
guidelines for starting coverage once a child has an ASD diagnosis and
consistent rules for what type of Board Certified Behavior Analysts (BCAB) can
perform covered ABA. Further, the ACD's testing, authorization and review
policies are simpler and offer parents and providers greater flexibility.

The notice of the ACD was published in the Federal Register on June 16, 2014.
TRICARE is still developing policy language to implement this program. For more
information, and to subscribe to email updates on the ACD, visit
<http://www.tricare.mil/aba> www.tricare.mil/aba.

Last Updated 6/16/2014 

SOURCE:  TRICARE News Release, 16 June 2014,



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