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March 30, 2021 at 11:28 PM
by Compass Behavioral & Developmental Consultants LLC

Specialists providing autism care to military families will face a pay cut in the spring, Tricare officials announced Tuesday, as reimbursement rates are reduced by as much as 35 percent for providers in certain locations.

Providers of applied behavior analysis therapy are currently reimbursed at a fixed rate based on education and certification level, regardless of location. Providers with a doctorate or master’s degree are paid an hourly rate of $125, those with a bachelor’s degree, $75; and technicians, $50.

Under the new plan, the national hourly rate will be set at $114.23 for doctors, $107.14 for those with a master’s, $67.39 for those with a bachelor’s and $40.12 for technicians. The rates will then be adjusted based on a geographic rate calculation used by Medicare.

In very low cost of living areas, that change could further reduce rates as much as 15 percent per year until they settle at the new level for that region, Tricare officials said. Locations with a higher cost of living could instead see rates above the national plan, they said. Specific regions that could see a swing in rates weren’t identified.

“We really have worked hard to ensure the ongoing communication with the professional groups and advocacy groups and families to engage with us throughout this process,” Tricare Health Plan Director Mary Kaye Justis said.

The new rate plan is the latest in a series of changes to Tricare’s controversial autism coverage. In 2014, officials announced plans to slash reimbursement rates for day-to-day therapy by 46 percent, a move that outraged military families who were concerned that such a cut would result in a provider shortage. Rather than push that change forward, Tricare hired the RAND Corp. to conduct a study on the current reimbursement rates from private insurers so they could better gauge where Tricare’s rates should be.

That study, Justis said, found that Tricare was paying well above the rates offered by private insurers and that the newly proposed cuts would bring the figures more in line. She said Tricare plans to work closely with autism therapy providers, community and advocacy group members to communicate the changes and listen to concerns.

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