Monday, July 19, 2010
A few days ago I received a copy of the Complaint (lawsuit) filed in US District Court in Washington, DC, against the United States Government, the Department of Defense, Tricare Management Activity, and Secretary of Defense Robert M. Gates. You can read the Complaint HERE. Most of the letters cited in the complaint can be found in the Documents section here on Autism Salutes (scroll down on the left side).
As a parent who worked on and continually wrote about what was happening with the legislative efforts mentioned in the Complaint, I have been very aware for years that the reason the DoD set up the ECHO program the way they did was to avoid paying for the expensive therapy that benefit our children with autism. That would be ABA therapy.
Since the Complaint was filed in US District Court, TRICARE Management Activity issued a letter on June 30, 2010, to the CEO’s of all its’ contractor’s, one of which is Humana. You can read the letter HERE. The letter stated that TMA was reviewing its policy on whether or not they would provide ABA under the basic Tricare program and that they expected to have this review completed by September 20, 2010. The letter also stated the contractor’s for TMA were to hold in abeyance until the review was completed; claims filed and authorization requests, for ABA. That means NO MORE DENIAL LETTERS for claims or authorization requests are to be SENT until the review is complete. Keep in mind, the letter from TMA was issued June 30th. On July 8, 2010, a denial letter was issued by one of TMA’s healthcare contractor’s.
All I can think of after reading the Complaint is that what the DoD has gotten away with, for YEARS, is criminal. There has been a complete lack of “checks and balances”. I’ll tell you honestly, I think the DoD under estimated military spouses and members who have spoken up to bring this about. I also think they have under estimated parents of children with autism across the ranks, and when I say that I mean those in the civilian world as well. We don’t put up with perfidy, and we certainly don’t tolerate crimes against humanity, which is exactly what has been committed by the DoD, and against CHILDREN! As a good friend of mine stated in a comment post the other day, “the genie is out of the bottle”.
I am of the belief that those in government who have not supported our military families who have dependents with autism, these two “gentlemen” (pictured to the left), and the CEO’s of the healthcare contractor’s for TMA, should all be brought up on UCMJ charges or the civilian equivalent of such. Should this happen, they should each be sentenced to one year in the Brig or Prison for each child they; denied a claim for, denied an authorization for, and the number of years collectively that a child was not able to access ABA under their “ECHO” program because providers were not available under the program. Essentially, a life sentence for each of them; that’s what they’ve done to countless children, sentenced them to a life in the prison of autism.
This time, there is no more smoke screen, and the letter from TMA to the contractor’s was nothing more than that. If it was anything more, then every single employer at every Tricare contracted healthcare organization would be aware of what they had been instructed to do by DoD and TMA, and yet 20 days later they still don’t have a clue.
Yes indeed, "the genie is out of the bottle".
Thursday, July 8, 2010
Editor's Note: We parents will not back down because this is who we're fighting for; our children.
Yesterday morning I had the honor of being a guest on Curt and Kim Linderman's radio show on Autism One Radio; Linderman Live. You can listen to the archive of the show HERE
During the show we discussed the class action lawsuit being brought against the U.S. Government, The Department of Defense, Tricare Management Activity, and the Secretary of Defense. You can read some of the background HERE. We also discussed the reasons for the lawsuit and the challenges that military families who have children with autism face. It's an intense and vast topic of discussion and there is no way we could hit on everything that needs to be talked about in one hour. There will be more to come.
I talked to a few people yesterday who felt that we may have hit a little hard on the DoD, and I openly disagree, and I'll tell you why. Back in 2008 after the "Green Our Vaccines" Rally there was a video circulating on YouTube showing photo clips of the Rally with the backdrop music of THIS Now I am not going to convolute this issue with causation, but I so wanted to go to the Rally. I was deeply moved by this song on many different levels. Treatment works. ABA works and improves the functioning of children with autism, and YES can be the catalyst to RECOVERY. Yes, it can and does happen. I will not just shut up and sing the praises of our medical care like the DoD would have me. And, after what my own family has endured, and what I see and hear other families going through on a daily basis fighting for their kids, yes a daily basis; I am not ready to make nice, nor will I be until our Government does the right thing by our families and our children with autism. When they are ready to demonstrate a little integrity and do the right thing and move ABA under the Basic Tricare Program, I may be willing to forgive, but I will NEVER forget.
If you haven't already, please check out the Military Affidavits section at the top left of Autism Salutes, find the appropriate one and email it to Brendan Frey, Esq. at firstname.lastname@example.org by July 15 at the latest.
One last thing. If no one wants to pay for this, then as I said on the show yesterday, maybe someone needs to figure out what the hell is causing an epidemic of autism.
Military Families vs. United States of America, U.S. Department of Defense, TRICARE Management Activity, and Secretary of Defense Robert M. Gates
It does not feel good to bring a lawsuit against the very country and government that you took an oath to serve and protect, and knowing that to uphold that oath might possibly come at the expense of your own life. On the flip side, our families who take the oath to serve and protect this great country expect our government, to provide the medical care and family supports that our families require to, uphold our oath to serve and protect our great nation.
In spite of the lack of medical care and family supports, our men and women in uniform have upheld their oath. In spite of the lack of medical care and family supports, our spouses have held down the home fronts’ . We have upheld our end of the oath and in doing so we all have paid a heavy price, but none heavier than the price our children have paid. Over the years I have spoken with many service members who have been wounded in action; “wounded warriors’. Every single one of them has told me that what they have endured pales in comparison to what our children with autism endure. Our government has failed to provide medical care, and our military dependent children with autism have been the ones left laying wounded on the battlefield. The very government we swore to protect could care less, and we have simply had enough.
In the summer of 2005 TRICARE implemented the Extended Care Health Option (ECHO) Program, and acceptance into this program is the only way a military dependent child with autism can receive medically necessary Applied Behavior Analysis (ABA). Keep in mind the child must be accepted into this program and that determination is made by someone sitting behind a desk that has never met, let alone examined, your child. If your child is accepted into ECHO, there is no guarantee that they will receive ABA as the child’s program must be run and/or overseen by a BCBA or a BCABA who is a TRICARE provider. We all know BCBA’s and BCABA’s and are in high demand and short supply. To top all this off, TRICARE capped the annual benefit for ABA at $36,000. Retiree’s dependents are not eligible for ECHO, nor are those not on active duty, in the Guard and Reserve even though they are in most cases eligible to receive basic TRICARE benefits or have the option to purchase them as one would regular health insurance.
On June 24, 2010 I received a letter HERE put forth by Mantese, Honigman, Rossman & Williamson, P.C.(please see the affidavits listed at the end for one to print and sign – they have been further revised) I’ve been waiting a very long time to see this come about for our military dependent children with autism. What far too many don’t understand is that yes, on paper, our kids have the ABA benefit, but what most don’t realize is that consistently over the past five years, less than 10% of dependents with autism are enrolled in ECHO because of a laborious enrollment process, and confused people charged with not only getting the information out, but the enrollment process as well.
My feeling, simply speaking as a parent, is that TRICARE is just fine with that. It lowers their expenses by decreasing paid claims, and increases their bottom line. That makes the Department of Defense happy because we all know that no one wants to pay for medically necessary care related to autism. If you read the letter sent to military families from the Attorney’s you will see that the DoD claims that TRICARE Management Activity (TMA) “has not made a formal policy determination as to whether ABA services might be covered as a Basic [Tricare] Program medical benefit”.
Like I said, I’m just speaking as a parent, and one who has had a few conversations of her own with the General quoted in the letter from the Attorney’s, but I can not think of any way to make a more formal statement than DoD and TMA already have. TMA has clearly stated in their Policy Manual for YEARS that ABA is only available as a “special education benefit” through acceptance into the ECHO Program, which is completely separate from the basic TRICARE benefits. Any change to the TMA Policy Manual must be done through the National Defense Authorization Act (NDAA), and that requires legislation being passed typically in both the House and Senate and then the House and Senate versions are essentially meshed to provide something everyone is happy with that the President then signs into law. This happens every year; it is how we got an increase of $2,500 a month to $36,000 a year for ABA, and exactly why we have continually asked Congressional leaders to introduce and get passed, language that would move the ABA treatment under the basic TRICARE program, and do away with the annual cap. Forgive my sarcastic and somewhat jaded tone, but phaleeeze… The DoD just wants the Berge case dismissed because if it is, then the DoD won’t face the risk of having to compensate military families for what they should have been providing all along, which is access to medically necessary treatment for autism without the discrimination of the ECHO Program, equal access for Retiree’s dependents, and the option for Guard and Reserve to access these benefits as well.
There are four affidavits available for you to review; one for spouse’s of active duty members, one for spouse’s of retiree’s, one for active duty members, one for retired members, and one for members and spouses of the Reserve's and National Guard. Those are all located in the Military Affidavits section at the top left of Autism Salutes. If you can truthfully attest to and sign one of these affidavits, please do so and return it by July 5, 2010, to:
Brendan Frye, Esq.
Mantese, Honigman, Rossman, and Williamson, P.C.
1361 E. Big Beaver
Troy, MI 48083
Or email it to: email@example.com
The Department of Defense has already had an opportunity to correct this situation, multiple opportunities in fact, and the same is true for Tricare Management Activity. This is an opportunity for all military families who have dependents with autism to have their voices heard on behalf of all our children. As a parent who has lived this nightmare and been contacted by so many who have lived the same, at this point, I would trust a judge before I would trust the DoD and TMA. DoD and TMA left my boys on the battlefield. I had to go retrieve them on my own.
Disclosure: I have no idea if our family will be included in the class action, but hell yes I am signing the active duty spouse affidavit. I was made aware of this situation because I have been involved in the legislation pertaining to the issues for almost 3 years, and my son went without medical care in the form of ABA for 3 years due to TMA and DoD policies.