Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid


Pentagon Slashes Autism Healthcare Payments

By Elizabeth Snell

- Impending policy changes around TRICARE, a healthcare program for the military and their dependents, have many individuals concerned over how autism therapy coverage will be handled. The Pentagon announced planned healthcare payment adjustments for autism care in the Federal Register in June, which will include cuts to providers.

An article in The Hill reported that the September TRICARE manual said that providers’ pay will decrease from $125 per hour to between $50 and $68 an hour. Providers claim that the cuts could hinder how they are able to provide care.

“Beneficiaries currently receiving (coverage) under an existing TRICARE policy will seamlessly transition to the Autism Care Demo with no gap in coverage and no increase in cost — there will be no changes to their current plan,”  Maj. Gen. Richard W. Thomas, director of health operations for the Defense Health Agency, told the news source.

The Hill cited a survey of TRICARE providers who work with autistic children. Results showed that 95 percent of respondents plan to cut back on the services they offer, while 22 percent plan to stop working with military children altogether.

According to the Pentagon, it is trying to simplify the autism program and families will continue to have access to autism treatment under the new program.

“The overarching goal is to analyze, evaluate, and compare the quality, efficiency, convenience and cost effectiveness of those autism-related services that do not constitute the proven medical care provided under the medical benefit coverage requirements that govern the TRICARE Basic Program,” read the Federal Register announcement.

The announcement explained that there are not currently any established uniform Applied Behavior Analysis (ABA) coverage standards. Therefore, the proposal will determine the appropriate provider qualifications for the proper diagnosis of Autism Spectrum Disorder (ASD) and the provision of ABA. Additionally it will “assess the feasibility and advisability of establishing a beneficiary cost share for the treatment of ASD, and develop more efficient and appropriate means of increasing access and delivering ABA services under TRICARE while creating a viable economic model and maintaining administrative simplicity.”

However, not all providers are convinced that the change will be a positive one.

Providers will still be greatly limited in what they can do for the children who are still able to receive services, according to Megan Miller, a board certified behavior analyst with Navigation Behavioral Consulting.

A rally was even planned for October 4 at the Scott Field Air Park, near Scott Air Force Base in Illinois. Jenna Cuenca is a therapist who works with 20 families with autistic children at the base and told she thinks that Tricare is close to drastically reducing its therapy services. That would represent a huge setback for her clients because a disruption of therapeutic services could hurt her clients, Cuenca said.


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