Sestak Amendment Included in National Defense Authorization Act
Yesterday, the U.S. House of Representatives passed legislation expanding services for autism treatment for military families. The National Defense Authorization Act includes an amendment authored by Congressman Joe Sestak (D-PA) expanding insurance coverage for the children of service personnel under the military’s healthcare program (TRICARE).
“We are thrilled about this bill’s passage, which will expand much-needed quality care to families that have made tremendous sacrifices for our country,” said Lee Grossman, Autism Society President and CEO. “It also sets an example for insurance companies in the private sector, an important step toward getting all families and individuals affected by autism the appropriate, medically necessary care they need.”
The amendment including the autism provisions was introduced in the last session of Congress, and when it failed to pass then, our advocates in the autism and military communities refused to let the issue die. The ultimate passage of this important legislation would not have been possible without their tireless advocacy and the devotion of Congressman Sestak.
The current system providing autism services to military families, the Extended Care Health Option (ECHO), provides only limited coverage. Only five percent of eligible military children receive care because of excessive delays-- as long as two year waiting periods-- and arbitrary coverage denials. The new amendment will work to fix these problems by:
• Mandating coverage of autism spectrum disorders (ASD) under TRICARE, rather than the marginalized ECHO program.
• Requiring that treatment of ASDs be provided if a health care professional determines that it is medically necessary
• Ensuring that beneficiaries under the age of 5 who have developmental delays and are at risk for autism may not be denied access to medically necessary treatment.
• Requiring the Secretary of Defense to ensure that authorized providers of applied behavior analysis or other structured behavior programs are licensed or certified by a state, the Behavior Analyst Certification Board, or other accredited national certification board.
• Requiring the Secretary of Defense to ensure that all employees or subcontractors of authorized providers are also certified and meet minimum qualification standards.
• Quickly enacting the provisions 180 days after passage.