TRICARE Announces Lower ABA Reimbursement Rates

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How will lower ABA rates impact military families’ access to care?

On December 1, 2015, TRICARE announced they will lower reimbursement rates for Applied Behavior Analysis (ABA) providers effective in spring, 2016. Our Association appreciates that the Defense Health Agency (DHA) used a research based approach to determine appropriate reimbursement rates. We have asked DHA to monitor ABA network adequacy to ensure the lower rates don’t translate to access problems for military families.

Current ABA rates were set in 2008 when there was little national prevailing rate data available and were based on discussions with professional organizations. TRICARE has based the new ABA rates on two studies they commissioned on commercial insurance and Medicaid reimbursement for ABA – one study was done by RAND, another by a health policy research and consulting firm. The studies found TRICARE currently reimburses above Medicaid and most commercial plans.

The new rates will be based on prevailing Medicaid rates, adjusted upward by approximately 20%. According to DHA, this will put TRICARE rates in line with other commercial plans. To mitigate the potential negative impact, the Defense Department will phase in the new rates where reductions are more than 15%. For more information, including locality specific rates, please see DHA’s website and FAQs.

Please share your experiences with accessing ABA services.  Let us know if the new rates impact your access to care.

Posted December 18, 2015

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