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Tricare expands autism therapy for families

Nov. 28, 2012 - 01:42PM   |   Last Updated: Nov. 28, 2012 - 01:42PM  |  
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The Pentagon has taken steps to cover intensive autism therapy for affected children of service members and retirees but is still fighting a judge's order that it pay for the treatment, known as applied behavior analysis.

The Justice Department has appealed a July 26 ruling by Judge Reggie Walton of the U.S. District Court in Washington, D.C., that Tricare cover ABA as a medical benefit for beneficiaries. Tricare maintains that ABA is an educational intervention, and as such should not be a covered service.

Dr. Jack Smith, DoD's director of clinical program policy and integration, told the Defense Health Board Tuesday that the Tricare manual is being revised to comply with Walton's decision, but he added that DoD has asked the judge to reconsider.

DoD also is conducting a "thorough literature review" to determine whether evidence supports ABA as a medical treatment, Smith said.

Walton's ruling, which stemmed from a class-action lawsuit, cleared the way for the children of military retirees to receive ABA under Tricare and also expanded ABA coverage for active-duty dependents as part of Tricare's basic program.

Previously, Tricare paid for ABA therapy only as part of its Extended Health Care Option program, available only to active-duty personnel. The benefit was capped at $36,000 annually.

From 2005 to 2008, Tricare registered 9,300 beneficiaries with autism under age 21 with autism: 6,025 active-duty dependents and 3,271 family members of active-duty and reserve component retirees, and survivors.

Another 10,000 family members had a related disorder, such as Asperger's syndrome or pervasive development disorder.

Smith told the Defense Health Board that the Pentagon is offering ABA through a group of approved "masters-level board certified behavior analysts."

But the advocacy group Autism Speaks has called DoD's efforts to comply with Walton's ruling insufficient and said its list of authorized providers is "too restrictive."

"Very few dependents will actually receive any level of care, let alone the intensive level of services many require," an Autism Speaks press release stated.

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