Service Members Considering Early Separation to Ensure Appropriate ASD Treatment
Applied Behavior Analysis (ABA) is a primary intervention for autism. A large body of research exists which supports the program’s efficacy. In commercial or civilian health plans, ABA is considered a mental health service and protected by the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008. However, this federal protection does not apply to military families receiving ABA. Tricare is the military’s health care program for active duty service members, reservists, retirees and their family members. Unfortunately, ABA services provided by Tricare are exempt from the MHPAEA laws. Specifically, MHPAEA prohibits policies placing high co-payments, separate deductibles, and stricter pre-authorization or medical necessity reviews compared to other medical treatments covered by health plans. Since Tricare is not subject to MHPAEA, service members must work their way through a bureaucratic maze in order for their children to receive ABA treatment. For instance, Tricare requires parents seeking ABA services to undergo stress assessments every six months to receive authorization for the program. Tricare also mandates physicians to complete specialized forms declaring that the child’s diagnosis of autism is accurate. Additionally, children are subjected to new evaluations to reconfirm their autism diagnosis every two years. These extra steps are direct MHPAEA violations. Recently, reports of developmental pediatricians hiring extra staff to handle the influx of required Tricare paperwork for military dependents have surfaced. These federal violations coupled with severely restrictive policies on the delivery of ABA services have caused many ABA providers to stop providing care to military families. Due to these circumstances, some service members seeking ABA treatment for their children are starting to request compassionate reassignment or early separation from the military. A commentary in The Military Times reported on this dire situation and is calling on Congress to mandate that Tricare follow MHPAEA policies. The opinion piece properly points out that service members should never have to choose between their military career and access to appropriate medical treatment for their children.
