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Bill would increase access to autism, other therapy

May. 14, 2014 - 10:42AM   |  
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A bipartisan foursome of senators will introduce legislation today that would increase access to specialized therapy for military children with autism and other developmental disorders.

The bill, called the Caring for Military Children with Developmental Disabilities Act, would broaden Tricare’s coverage of applied behavior analysis therapy, or ABA.

Under the proposal, Tricare would be required to pay for the therapy as prescribed by a doctor or psychologist with an ABA specialist certified or licensed by their state or a national board.

The bill also would establish an account in the Defense Department budget, but outside the defense health budget, specifically for the treatment.

The four — Sens. Roy Blunt, R-Mo.; Kirsten Gillibrand, D-N.Y.; Patty Murray, D-Wash.; and Marco Rubio, R-Fla. — said the legislation is needed because Tricare does not cover ABA for all those who need it, and when it is covered, pays for only about half the needed treatment time.

“No military family should have to worry that their child might not receive access to quality care, and this legislation will ensure they won’t have to,” Rubio said.

Until 2012, Tricare covered ABA for children of active-duty members through the Extended Health Care Option program, up to an annual cap of $36,000.

But that year, a federal judge in Washington, D.C., ruled that Tricare must cover autism therapy for children of military retirees as well, and Tricare developed a pilot program to address the discrepancy.

In 2013, the Defense Department rolled out the new initiative, which includes diagnosis, testing and therapy by a board-certified behavior analyst up to 20 hours a week.

An additional 20 hours a week of tutoring or therapy by licensed or certified providers was made available through the ECHO program for active-duty troops and via a pilot program for retirees’ families.

But the provision in the programs that the initial therapy be conducted by a board-certified analyst with at least a master’s degree did not sit well with parents of affected children.

And a requirement that the child must have an autism diagnosis left children with other developmental disorders, such as Down syndrome, without coverage.

ABA often is conducted by trained counselors and therapists who work under a board-certified analyst — not the certified instructors themselves — and these analysts are scarce in an emerging field.

The bill would extend ABA coverage to all children whose doctor or therapist prescribed the treatment and would cover treatment by any state-certified or nationally certified therapist.

When Tricare introduced the pilot program last year, officials said they consulted with the activist group Autism Speaks, the Behavior Analyst Certification Board and representatives from Exceptional Family Member Programs and the Pentagon Office of Special Needs to develop the final policy.

They described it as “one of the most generous ABA benefits” available.

Thirty-four states and the District of Columbia have laws requiring companies to cover ABA.

According to the Defense Health Agency, 3,307 Tricare beneficiaries receive ABA therapy under the basic program while 5,131 are enrolled in the extended therapy under ECHO.

Under the pilot program that covers the children of retirees, 124 beneficiaries are approved to receive ABA and another 177 await approval.

The bill is expected to cost $20 million. It also would require the Defense Department to move $250 million to the separate account to pay for continuing treatment.

“Every parent of a child with a disability wants to do everything they can to provide the best care, but for parents in the uniformed services dealing with overseas deployments and frequent moves from state to state, the challenge to access quality care is even greater,” Murray said. “The least we can do for our service men and women is provide quality health care for their loved ones.”

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