Tricare ordered to cover ABA therapy for military families

Tricare has been ordered by a federal judge to cover autism therapy for children of military families.  Unfortunately the reimbursement for applied behavior analysis (ABA) treatment could take years as the issue is still tied up in court.

Judge Reggie Walton, of U.S. District Court for the District of Columbia who made the ruling, could also extend ABA coverage for active-duty dependents, considering it a medical treatment that would fall under Tricare’s basic program.

Walton sent the class-action suit back to Tricare “with instructions that ABA therapy coverage be provided to Tricare beneficiaries who otherwise qualify for reimbursement.”

ABA therapy is paid for under the Extended Health Care Option program, which is available only to active-duty personnel under Tricare.  Reimbursement for the intensive therapy, which teaches and reinforces behavior skills, stops when the active-duty Tricare sponsor retires.

“The government has finally taken a step toward providing all men and women who have served our country with the health care Americans expect them to have,” said Karen Driscoll, associate director of government affairs.

Kenneth Berge v. the U.S., the class-action suit, was filed initially by Air Force retiree and his wife, Dawn Berge, on behalf of their son, whose treatment cost over $50,000.

Families of active-duty troops are only covered for up to $36,000 annually for ABA treatment.

Tricare registered 9,300 beneficiaries between 2005 to 2008, under age 21 with autism: 6,025 active-duty dependents and 3,271 family members of active-duty and reserve component retirees, and survivors.

Another 10,000 family members had a related disorder, such as Asperger’s syndrome or pervasive development disorder.

The new House bill would include a provision that would remove the cap of $36,000 annually and cover ABA therapy for children of military retirees.

The version of the Senate defense bill does not include similar language, making this one of many issues that will have to be resolved later this year in a final compromise version of the defense legislation.