Extension of the Comprehensive Autism Care Demonstration for TRICARE Eligible Beneficiaries Diagnosed With Autism Spectrum Disorder, 47731-47733 [2022-16742]

Download as PDF Federal Register / Vol. 87, No. 149 / Thursday, August 4, 2022 / Notices Requests for copies of the information collection proposal should be sent to Ms. Duncan at whs.mc-alex.esd.mbx.dddod-information-collections@mail.mil. Dated: August 1, 2022. Aaron T. Siegel, Alternate OSD Federal Register Liaison Officer, Department of Defense. [FR Doc. 2022–16759 Filed 8–3–22; 8:45 am] BILLING CODE 5001–06–P DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID DoD–2022–OS–0052] Submission for OMB Review; Comment Request Cost Assessment and Program Evaluation (CAPE), Department of Defense (DoD). ACTION: 30-Day information collection notice. AGENCY: The Department of Defense has submitted to OMB for clearance the following proposal for collection of information under the provisions of the Paperwork Reduction Act. DATES: Consideration will be given to all comments received by September 6, 2022. SUMMARY: Written comments and recommendations for the proposed information collection should be sent within 30 days of publication of this notice to www.reginfo.gov/public/do/ PRAMain. Find this particular information collection by selecting ‘‘Currently under 30-day Review—Open for Public Comments’’ or by using the search function. FOR FURTHER INFORMATION CONTACT: Angela Duncan, 571–372–7574, whs.mcalex.esd.mbx.dd-dod-informationcollections@mail.mil. SUPPLEMENTARY INFORMATION: Title; Associated Form; and OMB Number: Software Resource Data Reports; DD Forms 3026–1, 3026–2, 3026–3; OMB Control Number 0704– SRDR. Type of Request: New request. ADDRESSES: jspears on DSK121TN23PROD with NOTICES DD 3026–1 Number of Respondents: 12. Responses per Respondent: 12. Annual Responses: 144. Average Burden per Response: 16 hours. Annual Burden Hours: 2,304. DD 3026–2 Number of Respondents: 11. Responses per Respondent: 14. Annual Responses: 154. VerDate Sep<11>2014 17:25 Aug 03, 2022 Jkt 256001 47731 Average Burden per Response: 16 hours. Annual Burden Hours: 2,464. DEPARTMENT OF DEFENSE DD 3026–3 Extension of the Comprehensive Autism Care Demonstration for TRICARE Eligible Beneficiaries Diagnosed With Autism Spectrum Disorder Number of Respondents: 12. Responses per Respondent: 11. Annual Responses: 132. Average Burden per Response: 16 hours. Annual Burden Hours: 2,112. Needs and Uses: The intent of the Software Resource Date Reports is to capture software resource and effort data, at the Software Release and Computer Software Configuration Item levels that are significant either for a current program, or when a similar effort may be required for a future program. The collected data is the primary data source utilized when completing cost estimates. Respondents are any weapon system contractor or government entity with contracts, subcontracts, or agreements that are required to provide Cost and Software Data Reports based on all anticipated costs that individually or collectively surpass the corresponding dollar thresholds established in DoDI 5000.73. Affected Public: Business or other forprofit. Frequency: Annually. Respondent’s Obligation: Voluntary. OMB Desk Officer: Ms. Jasmeet Seehra. You may also submit comments and recommendations, identified by Docket ID number and title, by the following method: • Federal eRulemaking Portal: https:// www.regulations.gov. Follow the instructions for submitting comments. Instructions: All submissions received must include the agency name, Docket ID number, and title for this Federal Register document. The general policy for comments and other submissions from members of the public is to make these submissions available for public viewing on the internet at https:// www.regulations.gov as they are received without change, including any personal identifiers or contact information. DOD Clearance Officer: Ms. Angela Duncan. Requests for copies of the information collection proposal should be sent to Ms. Duncan at whs.mc-alex.esd.mbx.dddod-information-collections@mail.mil. Dated: August 1, 2022. Aaron T. Siegel, Alternate OSD Federal Register Liaison Officer, Department of Defense. [FR Doc. 2022–16761 Filed 8–3–22; 8:45 am] BILLING CODE 5001–06–P PO 00000 Frm 00043 Fmt 4703 Sfmt 4703 Office of the Secretary Department of Defense. Notice of an extension of the Comprehensive Autism Care Demonstration (ACD) for all Applied Behavior Analysis (ABA) services for all TRICARE eligible beneficiaries diagnosed with Autism Spectrum Disorder (ASD). AGENCY: ACTION: This notice provides a fiveyear extension to the Military Health System’s (MHS) demonstration project entitled Comprehensive ACD (the ‘‘Demonstration’’), which is authorized to render clinically necessary and appropriate ABA services for the core symptoms of ASD. The purpose of the Demonstration is to analyze and evaluate the appropriateness of the ABA services tiered delivery model under TRICARE (the medical benefit) in light of current and anticipated practice guidelines. In addition to a pending independent research study and a Congressionally-required independent National Academies of Sciences, Engineering, and Medicine analysis, based on the agency’s experience in administering ABA services under the Demonstration (including engagements with beneficiaries, providers, advocates, associations, and other payers), more data collection and analysis is required to determine the appropriate structure of implementing ABA services as either a medical treatment or other modality, under the TRICARE program coverage requirements. SUMMARY: The Demonstration will continue through December 31, 2028. 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 Ms. Valerie Palmer at (303) 676–3557. SUPPLEMENTARY INFORMATION: On June 16, 2014, Department of Defense published a Notice in the Federal Register (FR) (79 FR 34291), as amended by 80 FR 30664 (May 29, 2015), of a TRICARE demonstration to further analyze and evaluate the appropriateness of the ABA tiered delivery model under TRICARE. The purpose of the Demonstration was to DATES: E:\FR\FM\04AUN1.SGM 04AUN1 jspears on DSK121TN23PROD with NOTICES 47732 Federal Register / Vol. 87, No. 149 / Thursday, August 4, 2022 / Notices determine the appropriate provider qualifications for the proper diagnosis of ASD and for the provision of ABA services, assess the feasibility and advisability of establishing a beneficiary cost share for ABA services for the treatment of ASD, and develop more efficient and appropriate means of increasing access to and delivery of ABA services under TRICARE while creating a viable economic model and maintaining administrative simplicity. The Demonstration was implemented on July 25, 2014, with the original authority set to expire on December 31, 2018; however, an extension of the authority for the Demonstration until December 31, 2023, was granted, as documented via a FR notice published on December 11, 2017 (82 FR 58186). The notice stated that additional analysis and experience were required to determine the appropriate characterization of ABA services as a medical treatment, or other modality, under the TRICARE program coverage requirements. While much has been learned about ABA services administration under the TRICARE program, additional data are required to support a final determination regarding the appropriate provider qualifications for the proper diagnosis of ASD and for the provision of ABA services, the individual characteristics for patient/ beneficiary improvement, and the appropriate clinical ABA services under the TRICARE benefit. ABA services are currently provided through the Demonstration and managed by existing TRICARE regional Managed Care Support Contractors (MCSCs). Under the Demonstration, the Department implemented a provider model that allows reimbursement for ABA services rendered by providers who are not otherwise eligible for reimbursement. Approximately 16,000 beneficiaries diagnosed with ASD participate in the program annually with Demonstration enrollment continually fluctuating with new and terminating participants. Unlike the TRICARE Basic medical benefit, many TRICARE standards had to be modified and exceptions to policy made due to the unique and evolving nature of ABA service provision or Congressional direction, such as: diagnosis and referral procedures; ABA provider qualifications and credentialing/certification; utilization management reviews; and reimbursement rate methodology. Since implementation of the Demonstration, Congress directed the agency to add outcome measures as a requirement to the program. Outcome measures were implemented on January 1, 2017, and VerDate Sep<11>2014 17:25 Aug 03, 2022 Jkt 256001 are aimed at assessing individual progress for each beneficiary, as well as evaluating program effectiveness with the beneficiary population participating in the Demonstration. Preliminary outcome findings for one of three outcome measures were first reported in Quarter 1, Fiscal Year (FY) 2019. Subsequent quarterly and annual reports continued to highlight findings based on only one outcome measure. Inconsistencies in data collection methods and reporting from participating providers limited the Department’s ability to analyze the other two outcome measures. In addition to the Demonstration’s outcome measures, a grant was awarded under the Congressionally Directed Medical Research Program (CDMRP) to the University of Rochester in September 2018 that is evaluating traditional intensive ABA services compared to a modified ABA service delivery model (https:// clinicaltrials.gov/ct2/show/study/ NCT04078061). Early intensive behavioral intervention (EIBI) for toddlers and preschoolers diagnosed with ASD typically involves 20 or more hours per week of individualized instruction based on ABA principles. Although research to date does not yet meet TRICARE’s hierarchy of reliable evidence standards for proven medical care, research suggests that EIBI accelerates development of cognitive and adaptive skills in many children diagnosed with ASD. However, the evidence base has significant gaps, notably a shortage of randomized controlled trials (RCTs), limited data on whether EIBI reduces ASD symptoms, and few studies on outcomes of EIBI in community settings such as private agencies where most children with ASD receive services. Recently, research suggests that less intensive, time limited ABA interventions can effectively target specific core and associated features of ASD. The investigators in the CDMRP study are evaluating if combining targeted interventions via an individualized, adaptive, and modular ABA (MABA) approach (10 hours per week) could be at least as effective as EIBI (20 hours per week) over the course of a 24-week RCT at follow-ups conducted 24 weeks after intervention and 90 weeks after intervention. It is anticipated that the results of the CDMRP study will not only further the Department’s understanding of the impact of ABA services delivered to the Demonstration participants, but also that findings from this study may benefit the larger community of individuals diagnosed with ASD and their families. The findings will leverage PO 00000 Frm 00044 Fmt 4703 Sfmt 4703 clinical outcomes while informing program development, structure, and long term impacts. Additionally, the findings may offer more clinical program choices to families, potentially identifying variables beneficial to clinical success. Findings may also lead to lowering costs to families and payers while also increasing access to effective and targeted ABA services. This study is scheduled to conclude at the end of 2023. Further impacting the Demonstration, Congress directed that, via enactment of the National Defense Authorization Act for FY 2022, Department of Defense enter into an agreement with the National Academies of Sciences, Engineering, and Medicine (‘‘National Academies’’) to conduct an analysis on the effectiveness of the ACD and develop recommendations for the Department based on such analysis. The analysis would include, among other goals, a review of the expected health outcomes for an individual who has received ABA services over time, and other analyses to measure the effectiveness of the Demonstration. At the conclusion of the study, the National Academies will develop and provide the Department a list of findings and recommendations related to the measurement, effectiveness, and increased understanding of the Demonstration and its effect on beneficiaries under the TRICARE program. The National Academies study will take significant time to complete, and the Department will then require additional time to evaluate the National Academies’ recommendations and make any appropriate and authorized changes. Experience from administering the Demonstration to date informed the Department’s ability to publish a significant policy update (March 23, 2021) to address the clinical needs of the beneficiary population as well as revise program oversight requirements. This policy update focused on providing enhanced beneficiary and family support; improving clinical outcomes; encouraging parental involvement; and improving utilization management controls. These revisions are anticipated to improve the quality of, and access to, clinically necessary and appropriate care and services, and will also improve management and accountability of both the MCSCs and ABA providers. Based on the above factors, at this time, making any determination regarding the efficacy of ABA services as a medical benefit, or other coverage options, under TRICARE is premature, and it is necessary for the Department E:\FR\FM\04AUN1.SGM 04AUN1 Federal Register / Vol. 87, No. 149 / Thursday, August 4, 2022 / Notices to extend the Demonstration beyond its expiration on December 31, 2023. While much information has been learned about ABA while administering services under the Demonstration authority, the Department needs time to further evaluate the goals of the Demonstration, collect and evaluate outcome measures, incorporate the results of the CDMRP study award, and address recommendations from the National Academies. In addition, by extending the Demonstration, the Department will not only be able to fully implement the program improvements, but also will continue to gain greater insight and understanding of the effectiveness of ABA services being delivered to TRICARE beneficiaries based on outcome data. As the Department is pending a benefit determination, this extension will determine whether the Demonstration meets its stated purpose and will provide the Department with consistent and reliable information necessary to make a formal decision regarding the provision of the ABA services benefit. The Demonstration continues to be authorized by Title 10, United States Code, Section 1092. Dated: July 29, 2022. Aaron T. Siegel, Alternate OSD Federal Register Liaison Officer, Department of Defense. [FR Doc. 2022–16742 Filed 8–3–22; 8:45 am] BILLING CODE 5001–06–P DEPARTMENT OF DEFENSE Department of the Navy [Docket ID USN–2022–HQ–0013] Submission for OMB Review; Comment Request Department of the Navy, Department of Defense (DoD). ACTION: 30-day information collection notice. AGENCY: The Department of Defense has submitted to OMB for clearance the following proposal for collection of information under the provisions of the Paperwork Reduction Act. DATES: Consideration will be given to all comments received by September 6, 2022. ADDRESSES: Written comments and recommendations for the proposed information collection should be sent within 30 days of publication of this notice to www.reginfo.gov/public/do/ PRAMain. Find this particular information collection by selecting ‘‘Currently under 30-day Review—Open jspears on DSK121TN23PROD with NOTICES SUMMARY: VerDate Sep<11>2014 17:25 Aug 03, 2022 Jkt 256001 for Public Comments’’ or by using the search function. FOR FURTHER INFORMATION CONTACT: Angela Duncan, 571–372–7574, whs.mcalex.esd.mbx.dd-dod-informationcollections@mail.mil. SUPPLEMENTARY INFORMATION: Title; Associated Form; And OMB Number: United States Marine Corps Suicide Prevention Stakeholder Survey; OMB Control Number 0703–SPSS. Type of Request: New collection. Number of Respondents: 7,215. Responses per Respondent: 1. Annual Responses: 7,215. Average Burden per Response: 15 minutes. Annual Burden Hours: 1,803.75. Needs and Uses: Marine and Reserve Affairs, Marine and Family Programs is evaluating its suicide prevention capability. One component of this effort involves gathering information from various stakeholders who contribute directly or indirectly to suicide prevention efforts in the U.S. Marine Corps (USMC). Stakeholders will be asked about priorities in suicide prevention, job duties related to suicide prevention, communication with other stakeholders, and perceived successes and perceived barriers in suicide prevention. The USMC Suicide Prevention Stakeholder Survey will provide information vital for continuous process improvement. Information collected from this effort will be used to support Marines experiencing critical stressors, identify gaps in the suicide prevention system, and identify best practices and collaboration efforts between suicide prevention stakeholders. Affected Public: Individuals or households. Frequency: Once. Respondent’s Obligation: Voluntary. OMB Desk Officer: Ms. Jasmeet Seehra. You may also submit comments and recommendations, identified by Docket ID number and title, by the following method: • Federal eRulemaking Portal: https:// www.regulations.gov. Follow the instructions for submitting comments. Instructions: All submissions received must include the agency name, Docket ID number, and title for this Federal Register document. The general policy for comments and other submissions from members of the public is to make these submissions available for public viewing on the internet at https:// www.regulations.gov as they are received without change, including any personal identifiers or contact information. PO 00000 Frm 00045 Fmt 4703 Sfmt 4703 47733 DOD Clearance Officer: Ms. Angela Duncan. Requests for copies of the information collection proposal should be sent to Ms. Duncan at whs.mc-alex.esd.mbx.dddod-information-collections@mail.mil. Dated: August 1, 2022. Aaron T. Siegel, Alternate OSD Federal Register, Liaison Officer, Department of Defense. [FR Doc. 2022–16760 Filed 8–3–22; 8:45 am] BILLING CODE 5001–06–P DEPARTMENT OF EDUCATION [Docket No. ED–2022–SCC–0098] Agency Information Collection Activities; Comment Request; GEPA Section 427 Guidance for All Grant Applications Office of the Secretary (OS), Department of Education (ED). ACTION: Notice. AGENCY: In accordance with the Paperwork Reduction Act of 1995, ED is proposing a revision of a currently approved information collection. DATES: Interested persons are invited to submit comments on or before OCTOBER 3, 2022. ADDRESSES: To access and review all the documents related to the information collection listed in this notice, please use https://www.regulations.gov by searching the Docket ID number ED– 2022–SCC–0098. Comments submitted in response to this notice should be submitted electronically through the Federal eRulemaking Portal at https:// www.regulations.gov by selecting the Docket ID number or via postal mail, commercial delivery, or hand delivery. If the regulations.gov site is not available to the public for any reason, ED will temporarily accept comments at ICDocketMgr@ed.gov. Please include the docket ID number and the title of the information collection request when requesting documents or submitting comments. Please note that comments submitted by fax or email and those submitted after the comment period will not be accepted. Written requests for information or comments submitted by postal mail or delivery should be addressed to the PRA Coordinator of the Strategic Collections and Clearance Governance and Strategy Division, U.S. Department of Education, 400 Maryland Ave. SW, LBJ, Room 6W208B, Washington, DC 20202–8240. FOR FURTHER INFORMATION CONTACT: For specific questions related to collection SUMMARY: E:\FR\FM\04AUN1.SGM 04AUN1

Agencies

[Federal Register Volume 87, Number 149 (Thursday, August 4, 2022)]
[Notices]
[Pages 47731-47733]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2022-16742]


-----------------------------------------------------------------------

DEPARTMENT OF DEFENSE

Office of the Secretary


Extension of the Comprehensive Autism Care Demonstration for 
TRICARE Eligible Beneficiaries Diagnosed With Autism Spectrum Disorder

AGENCY: Department of Defense.

ACTION: Notice of an extension of the Comprehensive Autism Care 
Demonstration (ACD) for all Applied Behavior Analysis (ABA) services 
for all TRICARE eligible beneficiaries diagnosed with Autism Spectrum 
Disorder (ASD).

-----------------------------------------------------------------------

SUMMARY: This notice provides a five-year extension to the Military 
Health System's (MHS) demonstration project entitled Comprehensive ACD 
(the ``Demonstration''), which is authorized to render clinically 
necessary and appropriate ABA services for the core symptoms of ASD. 
The purpose of the Demonstration is to analyze and evaluate the 
appropriateness of the ABA services tiered delivery model under TRICARE 
(the medical benefit) in light of current and anticipated practice 
guidelines. In addition to a pending independent research study and a 
Congressionally-required independent National Academies of Sciences, 
Engineering, and Medicine analysis, based on the agency's experience in 
administering ABA services under the Demonstration (including 
engagements with beneficiaries, providers, advocates, associations, and 
other payers), more data collection and analysis is required to 
determine the appropriate structure of implementing ABA services as 
either a medical treatment or other modality, under the TRICARE program 
coverage requirements.

DATES: The Demonstration will continue through December 31, 2028.

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 Ms. Valerie Palmer at (303) 676-
3557.

SUPPLEMENTARY INFORMATION: On June 16, 2014, Department of Defense 
published a Notice in the Federal Register (FR) (79 FR 34291), as 
amended by 80 FR 30664 (May 29, 2015), of a TRICARE demonstration to 
further analyze and evaluate the appropriateness of the ABA tiered 
delivery model under TRICARE. The purpose of the Demonstration was to

[[Page 47732]]

determine the appropriate provider qualifications for the proper 
diagnosis of ASD and for the provision of ABA services, assess the 
feasibility and advisability of establishing a beneficiary cost share 
for ABA services for the treatment of ASD, and develop more efficient 
and appropriate means of increasing access to and delivery of ABA 
services under TRICARE while creating a viable economic model and 
maintaining administrative simplicity. The Demonstration was 
implemented on July 25, 2014, with the original authority set to expire 
on December 31, 2018; however, an extension of the authority for the 
Demonstration until December 31, 2023, was granted, as documented via a 
FR notice published on December 11, 2017 (82 FR 58186). The notice 
stated that additional analysis and experience were required to 
determine the appropriate characterization of ABA services as a medical 
treatment, or other modality, under the TRICARE program coverage 
requirements. While much has been learned about ABA services 
administration under the TRICARE program, additional data are required 
to support a final determination regarding the appropriate provider 
qualifications for the proper diagnosis of ASD and for the provision of 
ABA services, the individual characteristics for patient/beneficiary 
improvement, and the appropriate clinical ABA services under the 
TRICARE benefit.
    ABA services are currently provided through the Demonstration and 
managed by existing TRICARE regional Managed Care Support Contractors 
(MCSCs). Under the Demonstration, the Department implemented a provider 
model that allows reimbursement for ABA services rendered by providers 
who are not otherwise eligible for reimbursement. Approximately 16,000 
beneficiaries diagnosed with ASD participate in the program annually 
with Demonstration enrollment continually fluctuating with new and 
terminating participants. Unlike the TRICARE Basic medical benefit, 
many TRICARE standards had to be modified and exceptions to policy made 
due to the unique and evolving nature of ABA service provision or 
Congressional direction, such as: diagnosis and referral procedures; 
ABA provider qualifications and credentialing/certification; 
utilization management reviews; and reimbursement rate methodology. 
Since implementation of the Demonstration, Congress directed the agency 
to add outcome measures as a requirement to the program. Outcome 
measures were implemented on January 1, 2017, and are aimed at 
assessing individual progress for each beneficiary, as well as 
evaluating program effectiveness with the beneficiary population 
participating in the Demonstration. Preliminary outcome findings for 
one of three outcome measures were first reported in Quarter 1, Fiscal 
Year (FY) 2019. Subsequent quarterly and annual reports continued to 
highlight findings based on only one outcome measure. Inconsistencies 
in data collection methods and reporting from participating providers 
limited the Department's ability to analyze the other two outcome 
measures.
    In addition to the Demonstration's outcome measures, a grant was 
awarded under the Congressionally Directed Medical Research Program 
(CDMRP) to the University of Rochester in September 2018 that is 
evaluating traditional intensive ABA services compared to a modified 
ABA service delivery model (https://clinicaltrials.gov/ct2/show/study/NCT04078061). Early intensive behavioral intervention (EIBI) for 
toddlers and preschoolers diagnosed with ASD typically involves 20 or 
more hours per week of individualized instruction based on ABA 
principles. Although research to date does not yet meet TRICARE's 
hierarchy of reliable evidence standards for proven medical care, 
research suggests that EIBI accelerates development of cognitive and 
adaptive skills in many children diagnosed with ASD. However, the 
evidence base has significant gaps, notably a shortage of randomized 
controlled trials (RCTs), limited data on whether EIBI reduces ASD 
symptoms, and few studies on outcomes of EIBI in community settings 
such as private agencies where most children with ASD receive services. 
Recently, research suggests that less intensive, time limited ABA 
interventions can effectively target specific core and associated 
features of ASD. The investigators in the CDMRP study are evaluating if 
combining targeted interventions via an individualized, adaptive, and 
modular ABA (MABA) approach (10 hours per week) could be at least as 
effective as EIBI (20 hours per week) over the course of a 24-week RCT 
at follow-ups conducted 24 weeks after intervention and 90 weeks after 
intervention.
    It is anticipated that the results of the CDMRP study will not only 
further the Department's understanding of the impact of ABA services 
delivered to the Demonstration participants, but also that findings 
from this study may benefit the larger community of individuals 
diagnosed with ASD and their families. The findings will leverage 
clinical outcomes while informing program development, structure, and 
long term impacts. Additionally, the findings may offer more clinical 
program choices to families, potentially identifying variables 
beneficial to clinical success. Findings may also lead to lowering 
costs to families and payers while also increasing access to effective 
and targeted ABA services. This study is scheduled to conclude at the 
end of 2023.
    Further impacting the Demonstration, Congress directed that, via 
enactment of the National Defense Authorization Act for FY 2022, 
Department of Defense enter into an agreement with the National 
Academies of Sciences, Engineering, and Medicine (``National 
Academies'') to conduct an analysis on the effectiveness of the ACD and 
develop recommendations for the Department based on such analysis. The 
analysis would include, among other goals, a review of the expected 
health outcomes for an individual who has received ABA services over 
time, and other analyses to measure the effectiveness of the 
Demonstration. At the conclusion of the study, the National Academies 
will develop and provide the Department a list of findings and 
recommendations related to the measurement, effectiveness, and 
increased understanding of the Demonstration and its effect on 
beneficiaries under the TRICARE program. The National Academies study 
will take significant time to complete, and the Department will then 
require additional time to evaluate the National Academies' 
recommendations and make any appropriate and authorized changes.
    Experience from administering the Demonstration to date informed 
the Department's ability to publish a significant policy update (March 
23, 2021) to address the clinical needs of the beneficiary population 
as well as revise program oversight requirements. This policy update 
focused on providing enhanced beneficiary and family support; improving 
clinical outcomes; encouraging parental involvement; and improving 
utilization management controls. These revisions are anticipated to 
improve the quality of, and access to, clinically necessary and 
appropriate care and services, and will also improve management and 
accountability of both the MCSCs and ABA providers.
    Based on the above factors, at this time, making any determination 
regarding the efficacy of ABA services as a medical benefit, or other 
coverage options, under TRICARE is premature, and it is necessary for 
the Department

[[Page 47733]]

to extend the Demonstration beyond its expiration on December 31, 2023. 
While much information has been learned about ABA while administering 
services under the Demonstration authority, the Department needs time 
to further evaluate the goals of the Demonstration, collect and 
evaluate outcome measures, incorporate the results of the CDMRP study 
award, and address recommendations from the National Academies. In 
addition, by extending the Demonstration, the Department will not only 
be able to fully implement the program improvements, but also will 
continue to gain greater insight and understanding of the effectiveness 
of ABA services being delivered to TRICARE beneficiaries based on 
outcome data.
    As the Department is pending a benefit determination, this 
extension will determine whether the Demonstration meets its stated 
purpose and will provide the Department with consistent and reliable 
information necessary to make a formal decision regarding the provision 
of the ABA services benefit. The Demonstration continues to be 
authorized by Title 10, United States Code, Section 1092.

    Dated: July 29, 2022.
Aaron T. Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2022-16742 Filed 8-3-22; 8:45 am]
BILLING CODE 5001-06-P
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