Days 111-107

A brewing war has taken time away from my blogging.  As mentioned in my last posting, Tricare has decided that changing ABA therapy is the way to go.  With no word stating otherwise, the changes will be in effect in another 16 days.  I have been in the thick of the fight, writing congressmen, writing the President, writing my husband’s chain of command, and sadly even informing my son’s primary doctor of this new change.

The impacts of this new policy are broad and I don’t even think that most in Tricare have the full scope of what they have decided to do.  There are four parts of this policy that are concerning: First, Tricare has placed an arbitrary age limit on services.  Though, this does not affect as of yet, as my son is only 9, it will affect us eventually.  The second is there is a two year limit on services.  We will need a exception to policy for the waiver, and there is no word on who approves this exception to policy.  The third is the psychometric testing.  There needs to be psychometric testing (ADOS-2 and Vineland) done when a child is initially diagnosed, then the tests need to be completed every 6 months there after to show measurable improvement.  Ironically, the ADOS-2 is NOT even a psychometric test and has no quantitative value, and it’s invalid after the first two tests, because the test can be taught and learned.

When all is said and done, my son may qualify for services, and will probably be approved for the waiver.  There are three things that concern me deeply about this on a personal level.  First,  even though my son may qualify, 80-90% of the kids receiving therapy at the clinic are Tricare kids, so if 50% of those children are no longer qualified, or can no longer pay for therapy, the clinic doors may close.  There are only three clinics in the area that service children with autism, and all three of those clinics are in the same boat as my son’s clinic.  Even if he qualifies there will be no one to provide the services he needs.  This brings us to hypothetical problem number two.  If there are no ABA therapists in the area, we will have to move again.  Which means we could end up on another year or two waiting list to get the psychometric testing done to get into an ABA clinic.  My son regresses quite severely with moves, and this would mean that he would not have sufficient progress to stay within the ABA therapy program according to Tricare, because there are no allowances for military moves, frequent TDYs or deployments (at least no under written within the policy).  The third problem I have with this whole policy shift is the precedent it sets.  This policy was released June 25th.  It was not released to the parents, in fact, the parents still haven’t received any notifications, neither have the attending physicians, or the therapists.  It was posted on a website, and with no fanfare, no announcement, no nothing.  A few adept parents read the policy, and this is how a small battle is becoming a huge war.  Americans should be concerned, very, very concerned.  Right now, it’s military children with autism, who could be next?  Cancer patients, expectant mothers, diabetics, or people with depression.  Where does it end?

8 thoughts on “Days 111-107

  1. Katharina

    Well, said. We are in the same boat as your son & family. I am at a complete loss & cannot comprehend how Tricare can do this to our children.

    1. jojo613

      I’m beginning to believe that it’s some kind of conspiracy theory. That this is the DoD’s way of getting rid of troops that cost too much. Cut services and it will make it cheaper in the end.

  2. I have so many concerns with this new policy as well and I seriously hope they back track and re-visit many of these policies. Some of the concerns for me are the 2 year limits, the requirement to show progress on those specific assessments every 6 months to a year (what if the child shows clear progress in their treatment data, but it doesn’t reflect on the testing?), the fact that some of the higher functioning kids I work with the ADOS may not be appropriate for, and the requirement for parents to be able to do the ABA- what will happen to children of single parents who then deploy? Will they be denies services for their child due to their deployment,and thus “inability to participate”? There is also the issue of the referring doctor having to do all this additional work in order to provide exorbidant numbers of referrals. Many of these doctors it takes time to get in to see in the first place, requiring additional appointments and reports will bog them down even further, leading to significant delays in recieving services and lapses in treatment. This is unacceptable.
    As both a behavior analyst and a military spouse I am bothered by this policy on so many levels. I also think you have a good point, if they are messing with the autism treatment coverage to try and pinch pennies, what other conditions will get the axe next?

    1. jojo613

      It’s unreal. I did a bastardized form of ABA therapy when my son was first diagnosed, and I did some things wrong. Granted it probably still helped him, but there is no way they should put that much of the burden on the families. Especially, when they don’t put that much accountability on people who have other medications that are self-managed– diabetes, asthma, etc… I know that if they did this to diabetics, do you know how many people would cry foul!?

  3. Karen D.

    Because of the unique way military families serve, we need assurances of consistent healthcare services. Family care is essential to the ability of the warfighter to remain mission ready. When we hear wait lists because of unnecessary testing, discharge criteria, limitations, and waivers (which are not cliearly defined)….families don’t have that assurance of care. Thank you for your awesome blog.

    1. jojo613

      I’m really new at this whole blogging comments thing… So sorry it took so long to approve these.

      I agree, I’m really beginning to wonder if this is not a DoD approved way to get rid of troops that cost too much. It sounds rather conspiracy theorist, but it really is looking that way.

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