By: Beth Vaughan (with the help of Missy Rolison)

Paul Napier (Founder and Executive Director) and Melissa Rolison (Billing Manager) of Reaching Milestones came back from DC with good news after they attended the ACD Roundtable Meeting (Autism Care Demonstration Project under the TRICARE Health Benefit) at the Pentagon on May 5, 2015. Paul was one of only three ABA providers to attend the meeting in person. He was able to ask a question in reference to supervision, which sparked more discussions amongst the other providers. Paul advocated strongly for improvement in the behavior supervision policies and they have agreed to review this and should have a response sometime in July.

In addition to Paul and the ABA providers, other notable attendees included: 2-Star General, Deputy Undersecretary of Defense (this is the first time ever that the Department of Defense has intervened in a Tricare issue), The American Academy of Pediatrics, APBA, BACB, and Karen Driscoll (Associate Director, Federal Government Affairs & Military Relations – Autism Speaks). The overall consensus was that the Generals and every person in attendance seemed authentic and genuine in their efforts towards improvement.

Below are the notes that summarize the key points from the Roundtable Meeting. The notes were taken by Megan Miller, BCBA and do not represent the Military Health System. The biggest win/takeaway was the cost shares for retiree (or non-active duty) families that will apply to their catastrophic cap. Huge for retiree families!

Reimbursement Rates

Reimbursement rates were discussed and the status regarding the rate change was provided. It was indicated that RAND was hired to help determine market rate for reimbursements. RAND is still working on this determination by looking at going rate for Medicaid and private insurance for every state. It was indicated that they will choose the reimbursement rate by finding the going rate in every state and that will set reimbursement rate. Reasons identified for doing it in this way were that it is: cost effective, ensure don’t adversely impact market place. Because this work has not been finished, rates will stay as is $125/hr BCBAs, $75/BCaBA until next fiscal year. Lastly, it was indicated that this has been well communicated and ample warning will be provided when it is time to implement state by state reimbursement rates.

Cost Shares

The issue of cost shares was also discussed. For non-active duty family members, the cost were not applying to the cap but it is a long process to change the requirements. It was indicated that they are allowing DHA to pursue the option of having these costs apply to cap. Cannot officially announce as policy yet. The policy change will first need to be announced in Federal Register. Once permission is given to make the change, the goal is to have it go into effect 60 days from that point.

Waitlists

The issue of long waitlist was discussed. There seems to be a disconnect between the information that Tricare has about waitlists and the actual waiting time that parents are experiencing to get access to services. The plan right now is to have all providers encourage people on their waitlist to contact their regional contractor to let them know they are on a waitlist. A more formal process for identifying families on waitlists is also being developed and will be communicated.

Behavior Techs and Supervision

An overview was given regarding the current requirements for technicians and supervision. This topic produced a lot of discussion and concerns were voiced over the wait time in credentialing technicians and the supervision requirements of per beneficiary and 2 contacts per month. It was indicated that the “monthly” requirements refers to a 30 day period not the calendar. It was indicated that work will be done to determine the best solution for supervision requirements that balance quality of care with not being overly burdensome and logisitically impossible for providers. The BACB indicated that their requirement is 2 contacts per month not per client and that it is logistically difficult to expect a tech who sees 3 or 4 clients to then have 6 to 8 contacts per month.

Communications

It was indicated that there is a flow chart being developed to give beneficiaries and providers contact information for each different person they would need to contact within Tricare. This should help people have an avenue for resolving issues because it will be more clear who to contact.

A new brochure about ABA coverage was also passed out and will be disseminated for families. There will also be communication efforts on the Tricare.mil website and social media to keep people updated of changes.

Do-Outs

The following activities were listed as things that will be done based on the meeting today:

• Need points of contacts
• Need to work with Tricare providers to get good reimbursement
• Beta test for autism code under ICD 10 to make sure there aren’t issues. Get input from providers
• Waitlists at MTFs need to get this information. Working on a process to know the population that is out there
• Education and Training process how to manage the waitlist
• Supervisory requirements: balance between patient safety and not too onerous for ability to serve

Please go to www.tricare.mil for up to date information from Tricare.