TRICARE to temporarily cover telehealth support for special needs children amid coronavirus pandemic

JACKSONVILLE, Fla. — March 31 UPDATE: TRICARE announced Monday it will temporarily cover telehealth support for Applied Behavior Analysis Services (ABA) parent or caregiver guidance services.

“This is to help support Autism Care Demonstration beneficiaries during social distancing and the COVID-19 response,” TRICARE stated on its website. Read more here.

Action News Jax received the below statement from TRICARE:

"We’re working in close partnership with the Defense Health Agency to explore various approaches, including telemedicine, to ensure access to care for TRICARE beneficiaries in this current environment.

Yesterday, the Defense Health Agency announced an exception to its policy regarding the use of telemedicine capabilities for Applied Behavior Analysis (ABA) services during this COVID-19 pandemic. As a result, effective March 31, 2020 through May 31, 2020, TRICARE is permitting the unlimited use of synchronous, real-time HIPAA compliant two-way audio and video services to beneficiaries for “Parent/Caregiver Guidance” rendered by Board Certified Behavior Analysts and assistant behavior analysts.

Ensuring TRICARE beneficiaries have access to the care they need is of the utmost importance to Humana Military. TRICARE is a federal health benefit. Humana’s role in this matter is as a TRICARE contractor for the TRICARE East Region. As a TRICARE contractor, we are required to process coverage authorizations within the guidelines of TRICARE policy and based on the beneficiary’s military status.

TRICARE currently covers certain telemedicine services and is actively pursuing ways to expand access during the pandemic. "

Original Story:

Action News Jax Investigates why as many as tens of thousands of special needs children from military families aren’t getting the care they need due to COVID-19.

Families tell Action News Jax that Tricare isn’t covering telehealth for behavioral therapy, which the children would normally get at school in-person.

Families said Tricare will cover their visit to a clinic or having someone come to their home for the therapy. But, these families said that goes against what we’re being advised of right now with social distancing and instructions to stay home, if possible.

They also said many of these children can’t necessarily verbalize if they started showing symptoms.

The family of Logan Howell, 11, said he has autism and is verbally and cognitively delayed.

He attends the Jacksonville School for Autism and relies on applied behavioral analysis, or ABA, therapy.

“When my child started JSA, he could speak five words,” Logan’s mother, Ashley Lucas said. “Now he speaks in sentences.”

Lucas and her husband are in the military and rely on Tricare.

She said now that school is closed, Logan has gone without ABA, and Tricare won’t pay for telehealth.

She said out of pocket it can cost upward of $200 per hour.

It’s why Kim Lucker-Greene, a board-certified behavior analyst, has volunteered her services in the short term to these military families not being covered.

“We are addressing very serious behavioral issues,” Lucker-Greene said. “Oftentimes, it could be severe physical aggression that these children engage in, as well as self-injury.”

Humana Military handles Tricare benefits for the eastern United States.

As of Friday, their website stated, “Telemedicine is not being covered for ABA services.”

Lucas said it leaves some of the most vulnerable among us to suffer.

“Every major insurance company currently is covering telemedicine for ABA therapy,” Lucas said. “Tricare is the only major insurance company that has held out and is not giving us the resources we need during this time.”

Action News Jax has reached out to Tricare and Humana Military and is awaiting their response.