U.S. Rep. Chris Smith (R-NJ-04) announced today that he is leading a bipartisan effort to urge the Department of Defense (DOD) to halt proposed reimbursement rate reductions that could restrict the access many military dependents with autism spectrum disorder (ASD) now have to a behavioral therapy that has proven critical to a child’s long term development. Smith, co-chair of the Autism Caucus, is joined by fellow co-chair Rep. Mike Doyle (D-PA-14) and 38 bipartisan members of Congress on the letter to the Secretary of Defense.

   DOD is scheduled to implement proposed reductions in TRICARE reimbursement rates for applied behavior analysis (ABA) treatment on April 1st. ABA is an evidence based behavior intervention that is widely accepted among health care professionals as an effective treatment that improves a variety of skills by encouraging positive behaviors and discouraging negative behaviors.

    “Military life, defined by frequent changes of residence and schools, and the prolonged absences of a parent, is particularly difficult for children with autism and their families,” said Smith, the author of three laws to increase federal research efforts and assist families impacted by ASD. “ABA brings about positive behavior change that can assist military children in coping with the unique challenges of military life, while also demonstrating positive long-term results. We need to ensure that these families do not lose access to critical services.”

   The current autism coverage under the TRICARE program began as a demonstration program on July 25, 2014 and is scheduled to end on December 31, 2018. The demonstration was designed to combine three different TRICARE programs that covered ABA services for beneficiaries into a single program with one uniform benefit. Among the objectives of the demonstration is to expand access to these services among TRICARE beneficiaries, especially active duty dependents. With the most recent proposed changes, however, some ABA providers have already announced plans to leave certain service areas and there is concern more providers will follow upon implementation of the new rates.

   “My colleagues and I are concerned that the new rates could result in a substantive reduction in access to crucial ABA services for the more than 26,000 military children with ASD,” Smith said. “We are particularly concerned about the effect the proposed reductions of as much as 15 percent annually in reimbursement rates for ABA services will have on communities where access is already limited. DOD’s own study to justify these proposed reimbursement reductions notes that there are locations near large, important military bases throughout the U.S. where there is no access to ABA services at all.”

   Prevalence rates of ASD have been increasing at an alarming rate and nationally, 1 in 68 children has ASD according to the Centers for Disease Control (CDC). In New Jersey, that number is 1 in 45. In response to this, there are recent across-the-board efforts to increase access to ABA treatment. There are now 43 states that have mandated autism coverage. Only last month an important milestone occurred when the Office of Personnel Management (OPM), which manages the Federal Employees Health Benefits Program (FEHBP), sent a letter directing insurance companies in every state to cover ABA starting in 2017. However, while access grows outside of the military community, TRICARE’s reduced reimbursement rates for ABA coverage compounded with overall increase in demand will further draw resources away from military families, instead of expanding access.

   In addition to Congressional concern, this proposal has drawn the attention of Autism and Military advocates.

   Leading advocacy group Autism Speaks released a statement on February 19 expressing its concerns that “Shortages of Board Certified Behavioral Analysts (BCBAs) already exist near Fort Campbell, Fort Sill, Wright-Patterson Air Force Base and other locations around the country. The DoD’s own studies indicate that TRICARE’s proposed rates for technicians are significantly below the national average. If adopted, the rate cuts might lead providers to leave TRICARE’s networks or give priority to children with other types of health insurance.”

   The National Military Family Association (NMFA) has also expressed concern regarding this proposal. On February 22, NMFA wrote a letter to the Defense Health Agency (DHA) stating that “NMFA urges the proposed ABA reimbursement rate reductions be postponed pending the completion of the ongoing Comprehensive Autism Care Demonstration in 2018. We also recommend TRICARE undertakes a comprehensive analysis of ABA services, including commercial insurance reimbursement rates, to assure adequate autism insurance coverage for TRICARE beneficiaries.”

     Smith’s most recent autism law, the 2014 Autism CARES Act (PL 113-157), tasks federal agencies with undertaking a comprehensive review of current federal policies and programs impacting individuals with disabilities who transition from a school based support system to adulthood and make recommendations to improve outcomes. His first autism law, the Autism Statistics, Surveillance, Research and Epidemiology Act (Title I of the Children’s Health Act, PL 106-310)—the first major federal response to autism—passed in 2000. Smith has also authored the 2011 Combating Autism Reauthorization Act, (Public Law 112-32), which is built on by the Autism CARES Act (PL 113-157). 

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