OARacle Newsletter

A congressionally mandated study by the National Academy of Sciences recommended that the Defense Health Agency (DHA) cover applied behavior analysis (ABA) for military families as a basic benefit through their TRICARE coverage. As reported by Behavioral Health Business, ABA has been a covered benefit through a demonstration program that began in 2014. But the National Academy report, released in September, suggested ending the demonstration project in favor of covering ABA as a basic benefit.

The study authors refuted the Department of Defense’s (DOD) finding that ABA doesn’t work and did not meet TRICARE’s standard for proven medical care, published in a 2019 annual report, with evidence of ABA’s effectiveness and adherence to medical standards. In addition, the researchers noted that the DHA should end the demonstration program, citing policies that differ from clinical best practices and impose excessive administrative burdens on military families and ABA providers, according to an article on the Military Times website.

In addition, the Academy researchers found that: 

• The demonstration project imposes an excessive burden on military families, due to administrative barriers such as a multi-step enrollment process, restricted service settings, and required assignment to navigators.  
• ABA providers face challenges in providing care to clients covered under the demonstration project, due to rigid documentation requirements and assessment mandates and inconsistent communication with program administrators.  
• The assessment tools required by the demonstration project are misaligned with clinical and evaluation goals. The report said that the tools lack a coherent evaluation framework and impose unnecessary burden on families and providers.  
• Demonstration project policies limit treatment goals and settings where ABA can take place, such as constraints on targeting certain skills essential to health and well-being and restricting delivery of ABA in schools and community settings.

The report is a “resounding” first step for advocacy and next steps, noted Mariel Fernandez, vice president of government affairs at the Council of Autism Service Providers, in the Behavioral Health Business article. She also cautioned that the change will not happen immediately but highlighted that the steps include advocacy with Congress to follow the recommendations outlined in the report. In the same article, Julie Kornack, a board member for the nonprofit advocacy group National Coalition for Access to Autism Services, sounded a note of caution since it is not yet clear how the report findings would weigh against the DOD’s assertion that ABA does not work.

Sherri Alms is the freelance editor of The OARacle, a role she took on in 2007. She has been a freelance writer and editor for more than 20 years.