APBA Update: Addressing Concerns About TRICARE Coverage of ABA Services

August 29, 2012

From Gina Green, PhD, BCBA-D, APBA Executive Director:

The Association of Professional Behavior Analysts (apbahome.net) is aware that some confusion has followed in the wake of the recent federal court decision requiring TRICARE insurance to cover ABA treatment for autism spectrum disorders (ASD) as a medical benefit under its basic health insurance program, and the interim policy that TRICARE issued after the decision was handed down. It is likely to be some time before the full implications of the court's decision are known, as further legal proceedings are underway and others may ensue. For the present, however, we offer the following information and suggestions:

• ABA services for dependents of active military with ASD under the *ECHO program* should not change or be interrupted due to the recent court decision and policy, which pertain only to the TRICARE *basic* program. Military families who encounter problems with ECHO coverage should document the problems and contact Karen Driscoll, Associate Director, Federal Government Affairs & Military Relations, Autism Speaks at [email protected].
  
  
• ABA providers who are credentialed in the ECHO ASD program and have difficulty getting authorizations, getting tutors approved, or who have claims rejected should document those problems (get a written reason for every "no") and contact the person in their TRICARE Regional Office (TRO) who oversees ECHO services for help in resolving the problems.
  
  TRICARE Regional Office North:
  tricare.mil/tronorth/regional-resources.cfm
  Phone: 703-588-1850
  Email: [email protected]
  
  TRICARE Regional Office South:
  tricare.mil/trosouth
  Phone: 1-800-554-2397
  
  TRICARE Regional Office West:
  tricare.mil/trowest
  Phone: 1-800-558-1746
  
  
• The situation for ECHO beneficiaries with diagnoses other than ASD is unclear at this time. Although they have been eligible for ABA services since 2001, it appears that some TRICARE contractors are now acting as if the ECHO ABA benefit applies only to people with ASD and not to other active military dependents with special needs, though TRICARE has not announced such a change in policy. Autism Speaks is seeking clarification from TRICARE. Meanwhile, families and providers who encounter problems might ask the person in their TRO who handles ECHO services for help.
  
  
• At this point TRICARE's policy regarding ABA services for ASD under its *basic program* is that all such services must be provided by BCBAs who are supervised by physicians or licensed psychologists. The attorneys who brought the federal court case against TRICARE on behalf of military families will be challenging that policy in court, and asking the judge to clarify his order regarding coverage of ABA as a medical benefit under the TRICARE basic program. It is difficult to predict how those proceedings will play out. ABA providers and TRICARE basic program beneficiaries are advised to document all problems they encounter in seeking coverage.