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1 1 (March 14, 2023)

handle is hein.crs/govekwt0001 and id is 1 raw text is: Congressional Research Service Informing the legislitive debate since 1914 March 14, 2023 Defense Health Primer: TRICARE Comprehensive Autism Care Demonstration Since the 1950s, Congress has enacted numerous Department of Defense (DOD) health entitlements and benefits under the TRICARE program to support servicemembers, military retirees, and their dependent family members. The Defense Health Agency (DHA) administers the TRICARE program, which offers or pays for a range of services for military families who have special needs, including those diagnosed with autism spectrum disorder (ASD). In Fiscal Year (FY) 2020, DOD estimated that a total of 35,473 dependent family members have an ASD diagnosis. TRICARE policies authorize coverage of certain health care and support services to mitigate the effects of ASD; however, not all available therapies have been covered under the basic TRICARE benefit. Over the past two decades, Congress has directed permanent or temporary TRICARE coverage policy modifications to include additional autism care services for military families. DOD administers part of these services under the Comprehensive Autism Care Demonstration (ACD). This In Focus describes the evolution of DOD's coverage of autism care services, the ACD, and certain ACD challenges for potential congressional consideration. Background According to the U.S. Centers for Disease Control and Prevention (CDC), an estimated 1 in 44 children in the United States lives with ASD. The National Institute of Mental Health defines ASD as a neurological and developmental disorder that affects how people interact with others, communicate, learn, and behave. Individuals with ASD may present with a range of signs and symptoms, including challenges with social communication, interaction skills, restrictive or repetitive behaviors, and other characteristics. Generally, there is no known cure for ASD. CDC identifies a number of treatment types (e.g., behavioral, educational, pharmacological, psychological) that can be tailored by health care providers to help reduce symptoms that interfere with daily functioning and quality of life. These interventions often involve an interdisciplinary team of medical providers, allied health professionals, and behavioral health therapists. Parents and families of children with ASD also play a role in these interventions. Treatment and therapy can take place in a variety of settings (e.g., a health care facility, school, playground, or at home). Since 2001, DOD has offered certain autism care services, including a behavior modification and learning therapy known as Applied Behavior Analysis (ABA). These services have been incorporated as part of permanent or temporary TRICARE coverage expansions, some of which have been facilitated or directed by Congress. These expansions include: * ABA services through the TRICARE Extended Care Health Option (ECHO). In 2001, DOD added ABA services as part of the supplemental services offered through TRICARE ECHO (previously known as the Program for Persons with Disabilities) to military families with special needs. * Enhanced Access to Autism Services Demonstration (i.e., ECHO Autism Demo). DOD established the ECHO Autism Demonstration in 2008 in response to Section 717 of the FY2007 National Defense Authorization Act (NDAA; P.L. 109-364). The ECHO Autism Demo expanded coverage of intensive behavioral intervention and ABA services for military families with ASD using a tiered delivery and reimbursement model. * ABA Pilot. DOD established a one-year ABA pilot as required by Section 705 of the FY2013 NDAA (P.L. 112-239). The pilot extended coverage of ABA services to eligible dependent family members of military retirees. Comprehensive Autism Care Demon stration In 2014, DHA recognized that ABA services were offered under a patchwork of TRICARE coverage and announced the consolidation of these expanded services under the ACD. The ACD began on July 25, 2014, and is scheduled to conclude on December 31, 2023. DHA's goals for the ACD are to: * evaluate the appropriateness of the ACD; * determine the appropriate provider qualifications for diagnosing and delivering ABA services; * assess the effects of using different ABA delivery models; * understand which beneficiaries utilize ABA services and its effect on those with ASD; * assess the relationship between ABA services and other interventions to treat ASD; and, * assess the feasibility and advisability of establishing a beneficiary cost share for ABA services. The ACD features an ABA services navigator which is designed to help coordinate medical and non-medical care, a comprehensive care plan, and parent and family support resources. ACD Eligibility and Particpation To be eligible for the ACD, DHA requires a dependent child to be (1) enrolled in a TRICARE health plan; (2) diagnosed with ASD by a qualified health care provider (e.g., primary care provider, clinical psychologist, developmental-behavioral pediatrician); and (3) referred to S

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