AUGUST UPDATE: TriCare and the
Asst. Secretary of Defense for Health Care have announced that the official
changes in the TriCare and DoD manuals to the Autism Services were never
intended to apply to Active Duty Military Personnel or their Dependents.
They have asserted that no changes in how services to dependents of Active
Duty personnel will be provided or supported under TriCare. We will
continue to monitor this situation and share whatever information we obtain as
soon as possible.
JULY 2013: TriCare is changing how ABA
services are delivered under all three of their programs: Basic, ECHO, and
the Demonstration Program effective July 25, 2013. We have not
received any notice from TriCare directly as of July 12, 2013 but we try to
stay on top of these programs in order to best serve our families.
As of now this is what we know,
and it is subject to revision as we learn more or if we get any direction at
all from TriCare itself on these matters. We do not speak for TriCare in
any way, if you have ANY questions about these changes we recommend that you
contact your Case Manager at TriCare to obtain guidance.
is changing the rules for access to, and reauthorization for, ABA therapy.
Here is our summary of what we know so far, subject to revision.
TriCare has NOT sent us any of this, we have received this from other
BCBAs that we know around the US and via the internet searches we conducted.
- Each BCBA at Reinforcement
Unlimited will have to have their cases supervised by Dr. Robert
Montgomery. TriCare now
requires supervision for all BCBAs (including BCBA-Ds).
- Reinforcement Unlimited
can do this easily because we are fortunate to have one of the only
experienced BCBA-D’s in the state in private practice who is also a
licensed clinical psychologist specializing in Autism Spectrum
disorders. Families will
not have to go multiple places to get approvals, supervision, ongoing
consultation, and share records and obtain signatures – it can all
be handled in-house at Reinforcement Unlimited.
This should make it simpler to comply with the new rules and less
likely that paperwork will hold anything up in obtaining
authorizations and renewals.
- All cases now have to have a
comprehensive diagnostic evaluation, a recommendation of medical
necessity, a diagnosis on the Autism Spectrum including the ADOS2 &
Vineland II, and a specific recommendation for ABA prior to asking for
approval for a BCBA to develop a treatment plan for ABA.
- Again, Reinforcement
Unlimited can do this easily because we are fortunate to have one
of the only experienced BCBA-D’s in the state in private practice
who is also a licensed clinical psychologist specializing in Autism
- Ongoing cases will have to be
renewed every 6 months and each renewal will have to include the results
of a NEW administration of the ADOS-2 and Vineland II.
- Again, Dr. Montgomery can handle this
issue too. However, this
does mean that TriCare patients are going to have to come into the
clinic at least 4 weeks prior to that 6 month deadline in order to
seen for a 3 hour appointment so that the ADOS2 and Vineland II can be
administered and the report written prior to the deadline for
inclusion with the request for renewal to go to TriCare.
Those results will have to be included in the request for
reauthorization for services each 6 months.
None of these changes are Reinforcement Unlimited decisions but
all come from Department of Defense regulations on TriCare delivery of
services. We will have to live
with them until/if any are changed.
Dr. Montgomery is willing to do the same services for other BCBAs that need
supervision and/or testing for their ongoing ABA cases.
Please let any BCBA’s know that they can contact Reinforcement
Unlimited to discuss
If you have any questions about this please let us know.
Also, if you hear ANYTHING about this from anyone - please let us know.