Defense Department Keeping Its Autism Care Program Through 2028

The Defense Department will extend its program meant to help provide care for military dependents diagnosed with an autism spectrum disorder through 2028 to evaluate its effectiveness, the agency announced Thursday.

In a Federal Register notice, DoD officials said research at the University of Rochester, as well as a newly required review by the National Academies of Sciences, Engineering, and Medicine, need additional time, and they have decided to extend the program past its current Dec. 31, 2023, sunset date to support the studies. 

The program, formally known as Tricare Comprehensive Autism Care Demonstration, was started in 2014.

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"While much information has been learned about [applied behavior analysis therapy, or ABA] while administering services under the demonstration … the department needs time to further evaluate the goals of the demonstration," officials wrote in the notice.

"In addition, by extending the Demonstration, the Department will not only be able to fully implement the program improvements, but also will continue to gain greater insight and understanding of the effectiveness of ABA services being delivered to Tricare beneficiaries based on outcome data," they added.

The program provides ABA services to Tricare-eligible beneficiaries diagnosed with an autism spectrum disorder. ABA therapy consists of intense, one-on-one instruction to autism patients that focuses on promoting appropriate behavior, social skills, communication and emotional expression.

The demonstration project also covers telehealth services to provide support and training for parents, introduced at the beginning of the COVID-19 pandemic.

In March 2021, the program underwent significant changes, with the DoD combining several benefits under one umbrella and broadening services beyond ABA. Under the revised program, Tricare began covering group treatment for autism, if deemed appropriate, and families were assigned a care coordinator to develop care plans and coordinate therapy and treatment.

From its inception, the demonstration project has drawn both support and criticism, with proponents pressing for broad access to early, intense intervention they say contributes significantly to improved quality of life for patients and their families, and the DoD raising concerns about the effectiveness of ABA therapy.

A 2020 DoD report to Congress noted that the current demonstration project "and the delivery of ABA services, is not working for most Tricare beneficiaries."

But a year later, the 2021 report found that 57% of participants in the program made "statistically significant improvements," while 43% showed no improvement or worsening symptoms.

Given the total cost of the program -- $385.6 million in fiscal 2020, more than double the cost in 2015 -- the DoD believes it is prudent to study the therapies and treatment and keep close watch on the program's providers.

The University of Rochester was awarded a contract in 2018 to evaluate traditional intensive ABA compared with modified ABA services to see whether less intensive, time-limited ABA is as effective as the more extensive traditional therapy.

The National Academies is studying the effectiveness of the DoD's Autism Care Demonstration and will make recommendations to the DoD based on its analysis.

"The findings may offer more clinical program choices to families, potentially identifying variables beneficial to clinical success. Findings may also lead to lowering costs to families and payers while also increasing access to effective and targeted ABA services," DoD officials wrote in the Federal Register notice.

According to the report, the average age of children enrolled in the program was 8 in 2020 and the average cost per participant is $24,569. Of the 16,610 enrolled, more than 3,700 children exceeded the annual $36,000 threshold for expenditures, while services for 325 patients exceeded $100,000 each per year.

-- Patricia Kime can be reached at Patricia.Kime@Military.com. Follow her on Twitter @patriciakime.

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