Specialized Training of Military Parents -- STOMP Project--: ABA Updates Begin to Take Effect July 25, 2014

ABA updates released in the Federal Register

The June 16, 2014 Federal Register contains important information regarding changes coming to Tricare’s three ABA programs (Tricare Basic interim, Autism Demonstration under ECHO, and the Autism Pilot for Non-Active Duty). The action read “notice of comprehensive demonstration project for all Applied Behavior Analysis (ABA), including the tiered model of ABA, for all Tricare beneficiaries with Autism Spectrum Disorder (ASD).”

Essentially, beginning July 25, 2014, one day after the end of the current pilot, Tricare will begin to provide ABA services under one united program called the Autism Care Demonstration. Qualifying beneficiaries with autism will now be able to have the same access to care, regardless of the Tricare plan or status (Active Duty, Reserve, Retired, etc). Little is still known how this will begin being implemented other than it will occur in a phased approach from July 25, 2014 until its completely turned over by December 31, 2014. The Autism Care Demonstration is set to run until 2018 at the current time.

Below described our breakdown of the new Autism Care Demonstration. If you would like a condensed version, scroll to the end to view our Quick Facts.

Autism Care Demonstration (Information as of June 16, 2014)
When:	To begin transitioning July 25-Dec 31, 2014 and continue through Dec 31, 2018
Who:	For all beneficiaries who meet criteria/program requirements, regardless of Tricare plan and to include both activity duty and non-active duty sponsors
What is included:	· Initial ABA Assessment · Functional Behavioral Assessment and Analysis · Development of an ABA Treatment Plan (TP) to include goals and objectives and specific evidence based interventions · One-on-one ABA interventions · Assessments in accordance with Treatment Plan · Periodic ABA TP updates that reflect re-assessment of progress
How much will it cost:	· No annual cap · Active Duty will pay the monthly ECHO cost share based on pay grade to satisfy Autism Care Demonstration for ABA provided by BCaBA and/or Technicians · Non-Activity duty cost share at 10% for BCaBA and/or Technicians · One on one ABA by BCBA/BCBA-D will be equal to regular cost sharing under basic program (based on Prime, Standard, Extra, etc) · Cost share is outside Tricare basic catastrophic cap ·
Purpose:	Said provide the opportunity to analyze and evaluate the following: · Appropriateness of ABA tiered delivery model · Appropriate provider qualifications within framework of Board of Certified Behavior Analyst current guidelines · Determine the appropriate provider qualifications for proper diagnosis of ASD and need/referral for ABA · The value of tutors, or Behavior Technicians in addition to ABA provided by BCBCAs · Assess the need and feasibility of a beneficiary cost share for treatment of ASD · Develop more efficient means if access and delivery of ABA services · Assessment whether ABA should be considered an educational service or medical · Under what parameters should it be provided (age, length of treatment, etc) · Assessing the charactericts of beneficiaries who do and do not utilize the BCBCA only benefits · Determination of specific factors which contribute to non-utilization of only BCBA delivery · Which beneficiary age groups benefit most · Relationship between utilization of medical services (such as OT, PT, Speech, etc) and ABA
Requirements for beneficiary:	· Beneficiary must have a diagnosis of ASD by a provider who is capable · Even though it will officially begin on July 25, 2014, it will be implemented in a phased approach with a target date for all beneficiaries to be transitions by December 31, 2014 · Active Duty will still be required to register for ECHO (Extended Care Health Option) · ABA will be considered an ECHO registered service necessary to qualify for respite
Referrals/Authorizations:	· Beneficiary must have a diagnosis of ASD by a provider who is capable then the diagnosing provider will submit a referral to the Tricare regional contractor o PCMs (such as nurse practitioners and physician assistants, etc) who do not have specific ASD qualifications may not refer · Tricare regional contractor will issue a one year authorization from a Tricare authorized BCBA or BCBA_D · Prior to authorization expiration, BCBA or BCBA-D will request re-authorization based on documented reasoning for continued ABA included an updated treatment plan ·
ABA authorized providers:	· A BCBA or BCBA-D must serve as an “ABA Supervisor” who will create and modify behavior plans, deliver and/or supervise ABA programs o Minimum of a Masters Degree · Tutors or Behavioral Technicians may support ABA supervisors by working under then and providing one-on-one with the beneficiary with ASD
Tests/Assessments:	· For patients who have an ASD diagnosis not met by authorized specialty ASD provider, an ADOS-2 is required within first year of ABA, to confirm diagnosis · Progress to be presented by BCBA/BCBA-D every 6 months o Must be in graphic form, and/or standardized assessment measures (ie ABLLS-R), or the Verbal Behavioral Milestones Assessment and Placement Program (VB-MAPP) · Annual Vinneland-II testing is covered but is not a requirement Must submit documentation of clinical progress annually to referring provider and regional
Discharge Criteria:	Considered by regional contractor when ABA is no longer considered appropriate · No measurable progress made toward meeting goals in ABA treatment plan after a number of review periods and repeated modifications to TP · ABA TP gains are not generalizable or durable over time and do not transfer to larger community (to include school) after repeated modifications and progress reviews · Patient can no longer participate in ABA (due to medical factors, family problems or other factors that prohibit participation) · Patient has met ABA TP goals and is no longer in need of ABBA · Loss of eligibility for Tricare benefits
Program evaluation:	Program will be evaluated by parental surveys in 2016 and 2018 · Questions will be targeted on the following topics: o Reasons why parents use ABA benefit o ABA by BCBA/BCBA-D only vs no ABA o Parent’s perceived impairments of child with ASD o Difficulty in accessing/obtaining ABA and other clinical services o Overall satisfaction with the benefit
Overseas- Tricare Overseas Program (TOP)	· Must be provided directly by a BCBA or BCBA-D in countries where they have certifications by the Behavioral Analyst Certification Board (BACB) · ABA by tutors or technicians is not authorized

For a quick overview here is a condensed breakdown of information:

QUICK FACTS SUMMARY

• Active Duty must be registered in ECHO

• Must have ASD diagnosis by Tricare authorized PCM or Autism specialist who will submit the referral

(If do not have a diagnosis from a qualified ASD provider, must conduct an ADOS-2 to diagnosis within first year)

• ABA services under Basic, Demo and Pilot will be transferring to Autism Care Demonstration between July 25 and Dec. 31, 2014, and will be in effect through 2018.

• Two delivery models: direct service by BCBA/BCBA-D and direct service by a BCaBA/tutor

• Costs shares: Non activity duty 10%, Activity Duty will pay monthly ECHO fee for services provided by BCaBA and/or Technicians/tutors

• No annual Cap

• Discharge criteria: no measurable progress, no generalization or no durability of gains, no generalization of goals to other settings, no participation of patient (due to medical problems, family problems or other)

• Progress to be measured weekly in graphic and or/standardized measures and submitted annually to referring provider as well as Tricare regional contractor

• Tricare Overseas Program(TOP)- only authorized for services under BCBA/BCBA-D

• All ASD patients will have the same access to care, regardless of sponsor status or plan.