Salute to Spouses Blog

We're excited to be blogging about the latest topics in military life. We want to keep you informed on topics such as current events, education, career advice, etc. Feel free to post comments or questions to any of our entries.
Changes to Tricare Autism Services May Hurt Military Families

By Tiffany Shedd

I have been writing a fair bit about health care and health care reform lately on this blog.  It’s important that we know what’s going on with our benefits and how those changes will affect the care out loved ones receive.

As of April 1, Tricare is implementing new reimbursement rates for applied behavioral analysis services (ABA). These changes will affect more than 10,500 families, and 16,000 additional families who are eligible to receive these services. According to Tricare, the ABA coverage and benefits are not changing, but the rates that providers receive are being adjusted and will be evaluated and adjusted on a yearly basis.

This rate cut is up to 15 percent of reimbursement to your providers.

For those of us unfamiliar with ABA services and those providing this service, here’s a very brief overview of what it involves and what is involved in being qualified to render these services.

Currently there are no "official" standards for certifying or licensing applied behavior analysts nationwide. Some states, however, have certification or registration procedures for behavior analysts (e.g., Florida, California), and the field has identified the following formal training and competencies required of professionals in behavior analysis.

It is by and large an unregulated profession. That being said, there are providers who do amazing work with patients and have brought about a lot of progress that is invaluable to them and their families. Some of these providers have helped vastly change the lives of those who use this therapy, whether it’s helping a non-verbal dependent better express their needs and wants to their caregivers or help with behavioral and sensory issues, like being able to get a haircut without having a total meltdown.

While these milestones may sound like small things, they are big steps forward for families with autism. So, it is essential to give families access to quality providers.

What does a 15 percent rate cut look like to providers? Before April 1, providers were being reimbursed on a sliding scale based on their level of education and degrees. A provider with a PhD or master’s degree was being reimbursed at a rate of $125, while those with bachelor’s degrees or technicians with a high school diploma were being reimbursed $75 and $50 respectively.

A 15 percent rate decrease would mean PhDs earn $114, holders of master’s degrees $107, $67 for a bachelor’s degree provider, and only $40 for a technician with a high school diploma.

What does this mean for you if you use these services? You could see a decrease in providers willing to accept Tricare as a method of payment. You could also see more out of pocket spending in order to stay with providers you already see. If you already have trouble finding quality providers in your area, this is not going to help you. The quality of available providers may drop as well.

As I said before, this new rate decrease is going into effect. We can’t do anything about it right now. It will be re-evaluated over the next year, so that means your experiences under this new system will be very valuable in demonstrating how this decrease hurts or helps Tricare patients.

Keep records and notes about how this rate change affects you and your family. Write to your representatives. Congress was actually opposed to this particular change, so your representatives need to know and be reminded that you are out there and being affected by this.

Don’t just complain about it on Facebook to your friends or spouse group. Go to Tricare’s Facebook page and let them know what you think. Be specific. Tell them if your child is no longer making the improvements they made with a previous provider who no longer accepts Tricare.

Let them know if the only providers in your area aren’t as qualified as you would like. And as always, stay up to date on any changes that Tricare is making to programs and benefits. For those of us in the EFMP program, small changes can mean big changes in our lives.

$6,000 SCHOLARSHIP
For Military Spouses
Apply for the Salute to Spouses scholarship today and begin your education! You’ll be on the way to your dream career.
BLOG CATEGORIES
MONTHLY ARCHIVES

Salute to Spouses Scholarship Recipients

© 2013 SALUTE TO SPOUSES ALL RIGHTS RESERVED