[Federal Register Volume 78, Number 248 (Thursday, December 26, 2013)]
[Notices]
[Pages 78342-78343]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-30670]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF DEFENSE
Office of the Secretary
Extension of Autism Services Demonstration Project for TRICARE
Beneficiaries Under the Extended Care Health Option
AGENCY: Department of Defense.
ACTION: Notice of demonstration.
-----------------------------------------------------------------------
SUMMARY: This notice provides a 1-year extension of the Department of
Defense (the Department) Enhanced Access to Autism Services
Demonstration Project (Autism Demonstration) under the Extended Care
Health Option (ECHO) for beneficiaries diagnosed with an Autism
Spectrum Disorder (ASD). Under the demonstration, the Department
implemented a provider model that allows reimbursement for Applied
Behavior Analysis rendered by providers who are not otherwise eligible
for reimbursement.
DATES: The demonstration will continue through March 14, 2015.
ADDRESSES: Defense Health Agency, Health Plan Operations, 7700
Arlington Boulevard, Suite 5101, Falls Church, Virginia 22042.
FOR FURTHER INFORMATION CONTACT: For questions pertaining to this
demonstration project, please contact Mr. Richard Hart at (703) 681-
0047.
SUPPLEMENTARY INFORMATION:
On December 4, 2007, the Department of Defense published a notice
in the Federal Register (FR) (72 FR 68130-68132) of a TRICARE
demonstration to increase access to ABA services. The purpose of the
demonstration is to allow the Department to determine whether such a
provider model increases access to services, the services are reaching
those most likely to benefit from them, the quality of the services
rendered meets the standard of care currently accepted by the community
of providers, and whether State requirements for licensure or
certification of providers of ABA services, where such exists, are
being met. The effective date was 60 days following publication of the
notice, and the demonstration was implemented on March 15, 2008, for a
period of 2 years.
Recognizing that the subject of ASDs is complex, in particular,
with respect to the number of individuals diagnosed with ASD, the
treatment of ASD that generally includes several years of behavior
modification through educational services, and the ability of the
provider community to increase the number of qualified providers, the
Department published a notice in the FR (75 FR 8927-8928) on February
26, 2010, that extended the Demonstration through March 14, 2012, and
again on December 27, 2011 (76 FR 80903) through March 14, 2014.
Based on the favorable subjective response from parents of TRICARE
beneficiaries who participated in the ABA tiered delivery model under
the ECHO Autism Demonstration and responded to TRICARE Management
Activity satisfaction surveys, the Department published a Proposed Rule
on December 29, 2011 (76 FR 81897-81899) that would add coverage of the
ABA tiered delivery model under ECHO for ASD as a non-medical ``Other
service,'' as that term is used in Title 10, U.S.C., Section 1079(e).
However, the publication of a final rule and transition of the Autism
Demonstration to a permanent benefit under ECHO was placed on-hold due
to pending resolution of the ongoing litigation and separate
legislative efforts addressing coverage of autism-related services
under TRICARE, and the interim
[[Page 78343]]
coverage of ABA as a TRICARE Basic Program benefit.
Under the added authority of the 1-year ABA Pilot Program
established by section 705 of NDAA for Fiscal Year 2013 (the ``ABA
Pilot''), a new interim TRICARE ABA reinforcement benefit for Non-
Active Duty Family Members (NADFMs) was implemented on July 25, 2013,
as a separate interim benefit from the coverage of medical benefits
currently provided under the TRICARE Basic Program to both ADFMs and
NADFMs with ASD, and separate from the Autism Demonstration services
available by law only to ADFMs enrolled in their Service's Exceptional
Family Member program and otherwise eligible for ECHO.
In accordance with Congressional direction concerning the purposes
of the ABA Pilot, TRICARE will include an assessment of the feasibility
and advisability of establishing a beneficiary cost share for the
treatment of ASD. TRICARE will submit an interim Report to Congress
(RTC) in December 2013 and a final RTC after the July 2014 ABA Pilot
completion date, to include: an evaluation of the beneficiary cost
shares; a comparison of providing various ABA services under the
TRICARE Basic Program, ECHO (including the Autism Demonstration for
ADFMs) and the separate ABA Pilot (for NADFMs); recommended changes in
legislation; and additional information as appropriate. The Department
has determined that continuation of the demonstration for an additional
1 year is both in the best interest of TRICARE beneficiaries diagnosed
with an ASD, and necessary to fully evaluate the effectiveness of the
delivery model employed by the demonstration. Continuation of the
Autism Demonstration will also provide additional information needed to
make a formal decision regarding the use of that delivery model in the
long-term. The demonstration continues to be authorized by Title 10,
United States Code, Section 1092.
Dated: December 19, 2013.
Aaron Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2013-30670 Filed 12-24-13; 8:45 am]
BILLING CODE 5001-06-P