[HEALTH.MIL] TRICARE Delays Change in Autism Reimbursement to April

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To: <HEALTH.MIL@xxxxxxxxxxxxx>
Date: Fri, 10 Oct 2014 18:57:52 -0500
TRICARE Delays Change in Autism Reimbursement to April
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10/10/2014 03:31 PM CDT



TRICARE Delays Change in Autism Reimbursement to April


By Cheryl Pellerin
DoD News, Defense Media Activity

WASHINGTON, Oct. 10, 2014 - TRICARE has delayed until April a 46-percent
reduction in the reimbursement level for some autism services while it awaits
the results of an independent assessment of the prevailing rate for the
services, defense officials said today.

The reduced reimbursement rate -- for one-on-one therapy with a board-certified
behavior analyst for those with autism spectrum disorder -- was one of several
program changes scheduled to go into effect Oct. 20 as TRICARE implements its
new Comprehensive Autism Care Demonstration, or Autism Care Demo.

On Sept. 19, after the Defense Department published related changes to the
TRICARE Operations Manual, providers and beneficiaries raised issues.

Rand Corp. independent analysis

On Oct. 8, Assistant Secretary of Defense for Health Affairs Dr. Jonathan
Woodson directed that the rate change be postponed until April 20, 2015, while
RAND Corp. completes an independent analysis of prevailing rates for the
service.

TRICARE will continue to pay the previous rate of $125 an hour for one-on-one
therapy with a board-certified behavior analyst rather than the new $68-per-hour
rate. Defense officials say the new Autism Care Demo does not cut applied
behavior analysis benefits.

The new TRICARE Autism Care Demo began July 25 and replaces current applied
behavior analysis benefits with one simple program, according to the TRICARE
website.

TRICARE-covered services

TRICARE covers the following services under the basic applied behavior analysis
benefit, and a TRICARE-authorized board-certified behavior analyst must provide
the services:

-- An initial applied behavior analysis assessment and treatment plan;

-- Direct one-on-one applied behavior analysis services;

-- Supervision of subordinate applied behavior analysis providers;

-- An updated applied behavior analysis treatment plan and updates; and

-- Training of family members or caregivers.

According to TRICARE, those who already have been diagnosed with autism spectrum
disorder and now receive applied behavior analysis will not lose coverage and
will automatically move to the new program by Dec. 31.

Those who are diagnosed with autism spectrum disorder after July 25 will receive
current benefits under the Autism Care Demo by Dec. 31. Beneficiaries should
contact their regional or plan contractor for information about how to get
started.

What's new?

What's new about the Autism Care Demo is that there is one benefit -- everyone
gets the same applied behavior analysis benefits. The demo also expands the time
period allowed for testing. Beneficiaries have a year to get the Autism
Diagnostic Observation Schedule-2 assessment, if it is needed.

The new demo has no maximums, also called caps. There is no $36,000 annual cap,
no lifetime cap and no maximum age for benefits.

The demo also has simplified diagnostic criteria. For example, specialized
autism spectrum disorder diagnosing providers can waive the Autism Diagnostic
Observation Schedule-2 requirement.

These specialized providers are board-certified or board-eligible in behavioral
developmental pediatrics, neurodevelopmental pediatrics, pediatric neurology,
adult or child psychiatry, or licensed clinical psychology at the doctoral
level.

Expanded assessment options

The new demo also offers expanded progress assessment options. Board-certified
behavior analysts can choose the assessment tool or other metric to measure
progress.

Under the new Autism Care Demo, beneficiary costs for applied behavior analysis
will not increase, the TRICARE website says. A beneficiary's plan and type of
provider used determine how much such services cost.

To see a board-certified behavior analyst who has a master's degree or higher,
active-duty family members with TRICARE Prime would pay nothing. Active-duty
family members with TRICARE Standard or Extra and TRICARE Reserve Select would
pay 15 percent of the cost for an in-network provider and 20 percent for an
out-of-network provider.

To see a board-certified behavior analyst who has a master's degree or higher,
retired family members with TRICARE Prime would pay a $12 copay. Retired family
members with TRICARE Standard or Extra and TRICARE Retired Reserve would pay 20
percent for an in-network provider and 25 percent for an out-of-network
provider.

Non-active-duty family members who see a board-certified assistant behavior
analyst or a behavior technician will continue to pay a 10-percent cost share
for supervised applied behavior analysis. Active-duty family members will
continue to pay their extended health care option enrollment fee for the same
services.

(Follow Cheryl Pellerin on Twitter: @PellerinDoDNews
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Related Sites:
Tricare Comprehensive Autism Care Demonstration website
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Military Health System
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SOURCE:  DoD News, Defense Media Press Release at
http://www.defense.gov/news/newsarticle.aspx?id=123387
<http://www.defense.gov/news/newsarticle.aspx?id=123387&source=GovDelivery>
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[HEALTH.MIL] TRICARE Delays Change in Autism Reimbursement to April

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