In Conflict with Parents of Autistic Children, Defense Department Blinks

Posted by Jason Van Steenwyk

militaryauthority.com military families autistic childrenThe Department of Defense has canceled a controversial plan to restrict access to applied behavior analysis approaches to treatment for military children with autism.

The DoD planned to begin requiring parents of autistic children to have them tested every six months in order to continue receiving treatments under TRICARE, and show military doctors that they were demonstrating “measurable progress” under the therapy. After two years of therapy, after age 16, the Department of Defense proposed granting access to therapy only after the child had been granted a waiver.

The DoD actually planned on requiring two separate assessments – the Vineland and ADOS-2. Meanwhile, military families had been encountering long waiting lists just to get an assessment. In some cases, waits were as long as six months. In the meantime, access to health care services for autism spectrum disorder could have been cut off.

The decision sparked a firestorm of protest among autism activists and military families alike, and attracted Congressional attention from Senators Kirsten Gillebrand (D – New York), Patty Murray (D – Washington) and Mark Warner (D – Virginia), who put pressure on the Administration to roll back the contemplated changes.

“Your new policy also requires a patient show progress to receive continued care. This is a significant shift in how TRICARE covers all other medical service,” wrote Senators Murray and Gillebrand in a joint letter to Secretary of Defense Chuck Hagel. “Military children with developmental disabilities such as autism often experience periods of regression due to life events (such as deployment, relocation, change in school, change in medications, etc.). Coming back from those periods of regression often takes significant time and effort (months and sometimes years), and sometimes progress may simply be the absence of regression. During these challenging times of need, discharging an individual from care is inappropriate and will have long lasting results on patient outcomes.” 

And just to drive the military bonkers, the Senators signed their letter in blue ink. 

It is unclear how many children the measure would directly affect: The Department of Defense estimates that there are approximately 8,500 children of active duty servicemembers with a form of autism; Autism Speaks, Inc., a prominent support group, says that there are 23,000 military children with autism.

On July 19th, the Defense Department blinked, however, and announced that there would be no changes to current access to care for active duty military members under either TRICARE Basic or the Extended Health Care Option (ECHO) program.

ECHO is a program under TRICARE that extends access to additional benefits for certain beneficiaries who are enrolled in the DoD’s Exceptional Family Member Program. Beneficiaries must be enrolled in DEERS to qualify.

In addition, the Department of Defense has announced a congressionally mandated 1-year pilot program to extend services to the children of retirees and survivors of deceased servicemembers. The pilot program begins July 25th, 2013, and is called the Enhanced Access to Autism Services Demonstration.

 

Current eligibility

The platform that the DoD and TRICARE have established to provide services to children with autism-spectrum disorders is called the Enhanced Access to Autism Services Autism Services Demonstration. It covers any beneficiary registered under ECHO and who have been diagnosed with an autism spectrum disorder. Services include access to an expanded network of Board Certified Assistant Behavior Analysts and non-certified tutors. The demonstration is not available outside the United States.

To enroll, you must submit your child’s Individualized Family Service Plan (IFSP) or Individualized Education Program (IEP) to your TRICARE regional contractor.

Children who are being homeschooled where the state does not require an IFSP or IEP should provide a letter from your child’s primary care doctor or a specialized professional in the field of autisms spectrum disorder. The letter should verify that the child’s autism-related disability results in impairment severe enough that it requires special education and other support services.

The services aren’t completely free of charge: Servicemembers must pay a portion of the monthly expenses, called a “cost share.” However, services provided for autism spectrum disorder count towards the annual coverage limits under ECHO.

 

Monthly Cost Share

If you use ECHO benefits during any calendar month, you must pick up a portion of the cost. The amount you must pay depends on the TRICARE sponsor’s rank. The higher the rank, the more you must pay. The breakdown is as follows:

 

Sponsor Pay Grade

Monthly Cost Share

E-1 to E-5

$25

E-6

$30

E-7, O-1

$35

E-8, O-2

$40

E-9, W-1, W-2, O-3

$45

W-3, W-4, O-4

$50

W-5, O-5

$65

O-6

$75

O-7

$100

O-8

$150

O-9

$200

O-10

$250

Source: TRICARE

 

Costs are not shared between family members.

The total cost share for all ECHO benefits combined (not including ECHO Home Care) is $36,000 per year. As you can see, it is pretty rare for a family to reach the full cap!

 

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