[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]


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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.

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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