Tricare changes could limit treatment for 23000 military children with ...

Military families deserve better.

Lawmakers and advocacy groups are calling on military insurance provider Tricare to change new restrictions they say limits services and treatment for children with autism.

Starting July 25, Tricare is requiring children with autism to undergo standardized testing every six months and show "measurable progress" in order to receive applied behavior analysis therapy, or ABA. Patients will also have to apply for Tricare waivers if treatment stretches beyond two years and for children older than age 16.

Patients that fail to make progress or show sustainable gains could be discharged from the intensive treatment.

The change has drawn the ire of Sen. Kirsten Gillibrand, D-NY, a member of the Senate Armed Services Committee, and Patty Murray, D-Wa., a member of the Senate Veterans' Affairs Committee. The two questioned the provision that cuts off care for children who do not show progress during a six month period.

"The apparent lack of understanding of the needs of children with developmental disability, including autism, when drafting the recent Tricare policy changes is astounding. The departure from how Tricare covers all other medical care is also very concerning," the Senators wrote in a letter to Tricare director Dr. Jonathan Woodson.

"Given the impact family health care plays on military readiness, it is essential military families have assurances of continued health care. Policies inconsistent with good clinical practice only serve to limit, restrict, delay, and deny care," they wrote.

The Tricare change will impact more than 23,000 military children, many of whom face unique challenges due to relocation and dealing with deployments, the Senators said.

"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." the Senators wrote. "Coming back from those periods of regression often takes significant time and effort ... and sometimes progress may be simply 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."

The Senators ask that Tricare officials consult with experts in development disabilities before instituting the changes. They also direct Tricare to identify any other chronic health conditions that require standardized testing or evidence of progress to receive care.

Advocacy group questions change

The Tricare change has drawn the attention of Autism Speaks, an autism advocacy and research group. The new requirements will limit access to ABA therapy for children, Autism Speaks officials said, adding administrative changes could also reduce the number of healthcare providers accepting Tricare.

"These policies drastically change how ABA is covered under Tricare and will impact all beneficiaries and service providers," said Karen Driscoll, Autism Speaks' associate director for federal government affairs and military relations. "Autism Speaks is very concerned about the imposition of age and duration limits, threatened cutoffs for treatment, and the administrative hurdles to access care.

"Military families deserve better," she said.

Source: http://blog.al.com/breaking/2013/07/tricare_changes_could_limit_tr.html

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