Full opinion text
MEMORANDUM OPINION REGGIE B. WALTON, District Judge. The named plaintiffs, Kenneth Berge and Dawn Berge, on behalf of themselves and all other individuals similarly situated, filed Plaintiffs’ First Amdended [sic] Class Action Complaint (“Am. Compl.”) on December 13, 2010, against the following defendants: the United States of America, the United States Department of Defense (the “DoD” or “Agency”), the TRICARE Management Activity (the “TMA”), and Robert M. Gates, then United States Secretary of Defense. The First Amdended [sic] Complaint, brought under the Administrative Procedure Act (“APA”), 5 U.S.C. § 702 (2006), challenges the TMA’s position “that ABA [Applied Behavioral Analysis] therapy is a covered benefit only under [a supplemental program for active duty members] and is not a covered benefit pursuant to the TRICARE Basic health benefits program,” which covers both active duty and retired members of the United States Armed Services. Am. Compl. ¶ 168; 10 U.S.C. § 1086; see also Defendants’ Memorandum in Support of Their Cross-Motion For Summary Judgment and In Opposition to Plaintiffs’ Motion for Summary Judgment (“Defs.’ Mem.”) at 1. This case is now before the Court on the parties’ cross-motions for summary judgment. See Plaintiffs’ Renewed Motion for Summary Judgment (“Pis.’ Renewed Mot.”); Defendants’ Motion for Summary Judgment (“Defs.’ Mot.”). For the following reasons, the Court will grant the plaintiffs’ motion for summary judgment and deny the defendants’ cross-motion for summary judgment. I. Background A. The Class Plaintiffs The class plaintiffs are active duty and retired uniformed service members of the United States Armed Services and their dependent children who have been diagnosed with some form of autism, and who, at some point, have had payment reimbursement requests refused for the ABA intervention provided to these children. Am. Compl. ¶¶ 1-11. As beneficiaries of the DoD’s health care system (“TRI-CARE,” id. ¶ 40, also known as “CHAMPUS,” id. ¶ 96), the plaintiffs assert that “TRICARE wrongfully refuses to provide coverage pursuant to the TRICARE Basic [P]rogram for ABA therapy,” id. ¶ 41. B. Statutory and Regulatory Framework Congress enacted Section 1079 of Title 10 of the United States Code in order to “assure that medical care is available for dependents ... of members [and “former members”] of the uniformed services.” 10 U.S.C. § 1079 (2006). The statute instructs the Secretary of Defense, “after consulting with other administering [Agency] Secretaries,” to contract “for medical care for those persons under such insurance, medical service, or health plans as he considers appropriate.” Id. In accordance with this mandate, the DoD adopted a regulation to implement-the statute. See generally 32 C.F.R. § 199 (2011). The TRICARE Basic Program, which, as noted earlier, is a health benefits program for current and retired members of the United States Armed Services, “is similar to private insurance programs, and is designed to provide financial assistance to ... beneficiaries for certain prescribed medical care obtained from civilian sources.” Id. § 199.4(a). In addition to paying for medical services for active and retired, military members, the Basic Program also provides coverage for the members’ dependents, including spouses, id. § 199.3(b)(2)®, and children, id. § 199.3(b)(2)(ii). The TMA is the component of the DoD that administers the Basic Program. Defs.’ Mem. at 4. Under the Basic Program, the term “medical” refers “to the diagnosis and treatment of illness, injury, pregnancy, and mental disorders by trained and licensed or certified, health professionals.” 32 C.F.R. § 199.2(b). The Basic Program defines “mental disorder” as “a nervous or mental condition that involves a clinically significant behavioral or psychological syndrome or pattern that is associated with a painful symptom, such as distress, and that impairs a patient’s ability to function in one or more major life activities.” Id. Central to this case is the limitation imposed under the Basic Program' authorizing payment for only “medically or psychologically necessary” treatments. See id. §§ 199.4(a)(1)®, 199.4(g)(1). “Medically or psychologically necessary” is defined by the TRICARE regulation as “[t]he frequency, extent, and types of medical services or supplies which represent appropriate medical care and that are generally accepted by qualified professionals to be reasonable and adequate for the diagnosis and treatment of illness, injury, pregnancy, and mental disorders.” Id. § 199.2(b), For services to qualify as “[appropriate medical care,” they must satisfy the following requirements: (i) Services performed in connection with the diagnosis or treatment of ... [a] mental disorder ... which are in keeping with the generally accepted norms for medical practice in the United States; (ü) The authorized individual professional provider rendering the medical care is qualified to perform such medical services ... and[;] (iii) The services are furnished economically. Id. In addition to requiring that covered treatments be medically or psychologically necessary, the Basic Program expressly excludes coverage for certain forms of medical treatments and procedures. Specifically, the TRICARE regulation provides that “[a]ny drug, device, or medical treatment or procedure, the safety and efficacy of which have not been established, ... is unprove[n] and cannot be cost-shared by [the Basic Program].” Id. § 199.4(g)(15). Under the Basic Program (i)[a] drug, device, or medical treatment or procedure is unproven: (C) Unless reliable evidence shows that any medical treatment or procedure has been the subject of well-controlled studies of clinically meaningful endpoints, which have determined its maximum tolerated dose, its toxicity, its safety, and its efficacy as compared with standard means of treatment or diagnosis. (D) If reliable evidence shows that the consensus among experts regarding the medical treatment or procedure is that further studies or clinical trials are necessary to determine its maximum tolerated doses, its toxicity, its safety, or its effectiveness as compared with the standard means of treatment or diagnosis.... Id. § 199.4(g)(15)(i). Under this standard, only “reliable evidence” can be considered in determining whether a medical treatment or procedure is unproven, and therefore excluded from Basic Program coverage. Id. In compliance with this regulation, the TMA must determine whether a certain treatment or procedure satisfies the reliable evidence standard before deciding to approve or deny it. See id. § 199.4(g)(15)(i)(C). The DoD regulation further provides that the term reliable evidence means only: (i) Well controlled studies of clinically meaningful endpoints, published in refereed medical literature. (ii) Published formal technology assessments. (iii) The published reports of national professional medical associations. (iv) Published national medical policy organization positions; and (v) The published reports of national expert opinion organizations. Id. § 199.2(b). Moreover, “[t]he hierarchy of reliable evidence of proven medical effectiveness, established by [the above-listed categories], is the order of the relative weight to be given to any particular source.” Id. “Specifically not included in the meaning of reliable evidence are reports, articles, or statements by providers or groups of providers containing only abstracts, anecdotal evidence or personal professional opinions.” Id. Finally, “the fact that a provider or a number of providers have elected to adopt a ... medical treatment or procedure as their personal treatment or procedure of choice” is not considered a reliable indicator of the effectiveness of a treatment. Id. In addition to the Basic Program, the DoD administers the TRICARE Extended Care Health Option (“ECHO”) program, which “is essentially a supplemental program to the TRICARE Basic Program.” Id. § 199.5(a)(1). The ECHO program “provide[s] an additional financial resource for an integrated set of services and supplies designed to assist in the reduction of the disabling effects of the ECHO-eligible dependent’s qualifying condition.” Id. § 199.5(a)(2). The ECHO program is limited to dependents of active duty personnel who have a qualifying condition. See 10 U.S.C. § 1079(d)(3) (2006). Although the ECHO program does not require that the medical treatment be medically or psychologically necessary to be covered, see id. § 1079(e)(7) (granting the Secretary of Defense discretion to provide coverage under the ECHO program even if the treatment is not medically or psychologically necessary), it does exclude unproven drugs, devices, and medical treatments in the same manner as the Basic Program, see 32 C.F.R. § 199.5(d)(12) (excluding from ECHO coverage unproven “[d]rugs, devices, medical treatments, diagnostic, and therapeutic procedures for which the safety and efficacy have not been established in accordance with [the relevant provisions of the Basic Program]”). C. Factual and Procedural Background Autism “is a complex developmental disability, which adversely affects, among other things, verbal and nonverbal communication and social interactions, a child’s educational performance, and the overall ability of a person who suffers from the condition to function in society.” Pis.’ Mem. at 49; see also Administrative Record (“A.R.”), Volume (Vol.) Ill, Tab 8-2-13, (NIMH, Autism Spectrum Disorders Pervasive Development Disorders (2008) (“NIMH: Development Disorders”)) at 477-78. Common symptoms exhibited by individuals with autism include “impaired social interaction, impaired communication abilities, ... decreased motor skills, tantrums, ... and unusual responses to sensory experiences.” Pis.’ Mem. at 49; see also A.R., Vol. Ill, Tab 8-2-13 (NIMH: Development Disorders) at 477. In 2007, the United States Marine Corps “count[ed] 784 active duty family members (of all ages) with a diagnosis of [autism] enrolled in its” Exceptional Family Member Program. A.R., Vol. Ill, Tab 8-2-7 (2007 Report and Plan on Services to Military Dependant Children with Autism (“DoD 2007 Report”)) at 411. The plaintiffs allege, without directing the Court to any support, that “[t]he Department of Defense estimates that 1 in every 88 members of the armed services has a dependent with [autism].” Am. Compl. ¶ 31. Although there is no cure for autism, ABA therapy has emerged as an intervention that can help children cope with the disorder. A.R., Vol. Ill, Tab 8-2-13 (NIMH: Development Disorders) at 491. ABA therapy is “a systemized process of collecting data on a child’s behaviors and using a variety of behavioral conditioning techniques to teach and reinforce desired behaviors while extinguishing harmful or undesired behaviors.” Pis.’ Mem. at 1; see also A.R., Vol. I, Tab 4 (Hayes Report Dated October 25, 2010 (“2010 Hayes Directory”)) at 55. “ABA therapy is an intensive, extremely detailed and enormously nuanced psychosocial, behavioral intervention ... [and] is, therefore, expensive.” Am. Compl. ¶ 32; see also A.R., Vol. I, Tab 4 (2010 Hayes Directory) at 55. “Effective ABA treatment requires 25-40 hours per week of services, usually over a period of years.” Am. Compl. ¶ 33; see also A.R., Vol. I, Tab 4 (2010 Hayes Directory) at 55. The named plaintiffs of the class in this case are the parents of Z.B., “a minor child [who has been diagnosed] with autism.” Am. Compl. ¶ 40. “On April 11, 2007, ... [Z.B.’s pediatrician ... diagnosed [the then] two-year old ... with Autistic Disorder Infantile, Full Syndrome.” Plaintiffs’ Statement of Points and Authorities in Support of Motion for Class Certification (“Pis.’ Mem. to Certify”) at 10. The day after Z.B.’s diagnosis, his mother “contacted TRICARE’s Managed Care Support Contractor for the Southeast Region, Value Options” and was informed that because Z.B.’s father had retired from active service with the United States Air Force, Z.B. was eligible only to receive benefits under the Basic Program, and not the ECHO program. Id. at 11. Because Z.B. was ineligible for ECHO benefits, the family was infoxmed “that Z.B. [was] ineligible for benefits related to ABA sexvices.” Id. Thereafter, Z.B.’s parents continually sought to obtain reimbursement for Z.B.’s ABA intervention services but their requests were repeatedly denied. Id. at 11-12. For example, in one denial letter the parents were given the following explanation: After careful reconsideration of this case, including all additional information, the second physician reviewer agrees with the Outpatient Psychiatric initial denial. Based upon the opinion expressed by the second physician reviewer, the initial denial is upheld. This determination was based on: The sponsor of the beneficiary in not on active duty. ABA therapy cannot be authorized unless the beneficiary is enrolled in the ECHO program. A requirement for participation in the ECHO program is that the sponsor be on active duty. In this case, the sponsor is retired and therefore the beneficiary is not eligible for the ECHO program. The requested ABA therapy services cannot be authorized. Pis.’ Mem., Exhibit (“Ex.”) 11 (June 18, 2007 Z.B. Denial Letter) at 3. On March 5, 2010, the plaintiffs filed this action in this Court under the APA, challenging the June 18, 2007 decision by the TMA denying coverage for Z.B.’s ABA therapy, which, as noted, was based on the conclusion that the plaintiffs did not qualify for ABA therapy reimbursement because they were not eligible to participate in the ECHO program. Defs.’ Mem. at 9. “On June 22, 2010[,] the [Agency] moved to dismiss [this action] for lack of a final agency action, or, in the alternative, moved to stay the proceedings until a final decision ... was issued.” Id. The Agency argued that the June 18, 2007 decision was not final because the TMA reopened the decision to consider whether ABA therapy is covered under the Basic Program. Id. (arguing that “[a]n initial determination for a claim for reimbursement under TRI-CARE is final unless ... the initial determination is reopened”) (internal quotation marks and citation omitted). Agreeing with the Agency that there had been no final agency action, the Court allowed the Agency additional time to review the plaintiffs’ request for benefits but declined to dismiss this case. Ultimately, “[o]n October 29, 2010, the Chief of TRICARE Appeals issued a formal review decision denying reimbursement to [the] plaintiffs for ABA therapy under the TRICARE Basic Program for their dependent’s [autism].” Id. at 11. As a result of that decision, the Court ordered the plaintiffs to file an amended complaint challenging the October 29, 2010 decision. See Order, Nov. 19, 2010 (Dkt. # 71), at 1 (ordering the Agency to produce the complete administrative record and ordering the plaintiffs to file an amended complaint). On December 13, 2010, the plaintiffs filed their amended complaint, alleging that the “denial of coverage pursuant to the TRICARE Basic [P]rogram is arbitrary, capricious, and contrary to law and regulation.” Am. Compl. ¶ 169. Following the defendants’ submission of the administrative record, the plaintiffs filed their motion for summary judgment on December 17, 2010. See generally Pis.’ Renewed Mot. In their motion, the plaintiffs argue that: (1) the DoD’s policy denying ABA therapy under the Basic Program is not entitled to deference under Chevron USA, Inc. v. Natural Resources Defense Council, Inc., 467 U.S. 837, 104 S.Ct. 2778, 81 L.Ed.2d 694 (1984), Pis.’ Mem. at 7; (2) ABA therapy satisfies the definition of medical care under the Basic Program, id. at 31-32; (3) ABA therapy is medically or psychologically necessary under the Basic Program, id. at 38; and for these reasons the Court should conclude that the October 29, 2010 decision denying the plaintiffs coverage for ABA is contrary to law, id. at 75. In response, the Agency filed a cross-motion for summary judgment, along with a memorandum in opposition to the plaintiffs’ motion. See generally Defs.’ Mot. The Agency argues that: (1) under Chevron, the Court should accord deference to the DoD’s decision, Defs.’ Mem. at 14-15; (2) ABA therapy is an educational intervention rather than medical care under the Basic Program, id. at 30-31; (3) even if ABA therapy qualifies as medical care, it is not proven medical care under the Basic Program, id. at 34; and, therefore, the Court should conclude that the October 29, 2010 decision “was based upon a rational connection to the” administrative record, id. at 39. II. Standard of Review “Because this case involves a challenge to a final administrative action, the Court’s review is limited to the administrative record.” Muwekma Ohlone Tribe v. Kempthorne, 452 F.Supp.2d 105, 113 (D.D.C.2006) (Walton, J.) (quoting Fund for Animals v. Babbitt, 903 F.Supp. 96, 105 (D.D.C.1995)). Furthermore, “summary judgment is the proper mechanism for deciding, as a matter of law, whether an agency action is supported by the administrative record and consistent with the APA standard of review.” Loma Linda Univ. Med. Ctr. v. Sebelius, 684 F.Supp.2d 42, 52 (D.D.C.2010) (citing Stuttering Found. of Am. v. Springer, 498 F.Supp.2d 203, 207 (D.D.C.2007)); see also Richards v. INS, 554 F.2d 1173, 1177 & n. 28 (D.C.Cir.1977). However, due to the “limited role of [a] court in reviewing the administrative record,” the typical summary judgment standard set forth in Rule 56(c) is not applicable. Stuttering, 498 F.Supp.2d at 207 (citation omitted). Rather, “[u]nder the APA, it is the role of the agency to resolve factual issues to arrive at a decision that is supported by the administrative record, [and] ‘the function of the district court is to determine whether or not as a matter of law the evidence in the administrative record permitted the agency to make the decision it did.’ ” Id. (quoting Occidental Eng’g Co. v. INS, 753 F.2d 766, 769-70 (9th Cir.1985)). The APA entitles a person who has suffered “legal wrong because of agency action, or [who has been] adversely affected or aggrieved by agency action,” to judicial review. 5 U.S.C. § 702 (2006). Under the APA, a final agency decision must be set aside by a court if it is “arbitrary, capricious, an abuse of discretion, or otherwise not in accordance with law.” Id. § 706(2)(A). “The arbitrary and capricious standard of the APA is a narrow standard of review.” Millican v. United States, 744 F.Supp.2d 296, 302 (D.D.C.2010) (internal quotation marks and citation omitted). In Motor Vehicle Manufacturers Ass’n of U.S. v. State Farm Mutual Automobile Insurance Co., the Supreme Court explained the scope of a court’s APA “arbitrary and capricious” review as follows: [A] court is not to substitute its judgment for that of the agency. Nevertheless, the agency must examine the relevant data and articulate a satisfactory explanation for its action including a rational connection between the facts found and the choice made. In reviewing that explanation, [a court] must consider whether the decision was based on a consideration of the relevant factors and whether there has been a clear error of judgment. Normally, an agency rule would be arbitrary and capricious if the agency has relied on factors which Congress has not intended it to consider, entirely failed to consider an important aspect of the problem, offered an explanation for its decision that runs counter to the evidence before the agency, or is so implausible that it could not be ascribed to a difference in view or the product of agency expertise. 463 U.S. 29, 43, 103 S.Ct. 2856, 77 L.Ed.2d 443 (1983) (internal quotation marks and citations omitted); see also BellSouth Corp. v. FCC, 162 F.3d 1215, 1222 (D.C.Cir.1999) (“Where the agency has failed to provide a reasoned explanation, or where the record belies the agency’s conclusion, [the court] must undo its action.”). In conducting this review, considerable deference must generally be accorded to the agency. See Citizens to Pres. Overton Park, Inc. v. Volpe, 401 U.S. 402, 416, 91 S.Ct. 814, 28 L.Ed.2d 136 (1971). Accordingly, “there is a presumption in favor of the validity of administrative action.” Bristol-Myers Squibb Co. v. Shalala, 923 F.Supp. 212, 216 (D.D.C.1996) (quoting Ethicon, Inc. v. FDA, 762 F.Supp. 382, 386 (D.D.C.1991)). Thus, so long as the agency explains “why it chose to do what it did,” Tourus Records, Inc. v. DEA, 259 F.3d 731, 737 (D.C.Cir.2001) (internal quotation marks and citation omitted), and the court can “reasonably ... discern[ ]” the agency’s path, it must uphold the agency’s decision, Pub. Citizen, Inc. v. FAA, 988 F.2d 186, 197 (D.C.Cir.1993) (citing Bowman Transp., Inc. v. Arkansas-Best Freight Sys., Inc., 419 U.S. 281, 286, 95 S.Ct. 438, 42 L.Ed.2d 447 (1974)). In making the determination of whether the agency’s action should be upheld, courts review the administrative record as it existed at the time the agency made its decision. See Florida Power & Light Co. v. Lorion, 470 U.S. 729, 743-44, 105 S.Ct. 1598, 84 L.Ed.2d 643 (1985). Finally, “the burden of showing that agency action violates the APA falls on the plaintiff[s].” Banner Health v. Sebelius, 715 F.Supp.2d 142, 153 (D.D.C.2010) (Walton, J.). As the Supreme Court has made clear, when a court assesses an agency’s interpretation of “the statute which it administers,” it must apply Chevron’s two-step framework. Chevron, 467 U.S. at 842, 104 S.Ct. 2778. At Chevron step one, the reviewing court must first attempt to determine whether “the intent of Congress is clear.” See id. If “Congress has directly spoken to the precise question at issue,” the reviewing court must be faithful to the clear congressional intent. Id. Thus, if Congress has “unambiguously foreclosed the agency’s statutory interpretation[,]” the agency’s interpretation must be rejected. Catawba Cnty. v. EPA, 571 F.3d 20, 35 (D.C.Cir.2009). However, if the reviewing court finds that “statutory ambiguity has left the agency with a range of possibilities and that the agency’s interpretation falls within that range, then the agency will have survived Chevron step one.” Village of Barrington v. Surface Transp. Bd., 636 F.3d 650, 660 (D.C.Cir.2011). At Chevron step two, a reviewing court must defer to an agency’s interpretation of a statute, but only if the agency engaged in “reasoned decision[ ]making,” which has been recognized to include “well-known factors almost in the nature of a checklist ... [,] such as consideration of meaningful alternatives, a reasoned explication of the choice made, demonstrating a reasonable connection between the facts found and the option selected,” that along with other “like” factors “are all in the nature of reasonableness-checking.” Cont’l Air Lines, Inc. v. Dep’t of Transp., 843 F.2d 1444, 1451 (D.C.Cir.1988) (internal quotation marks and citation omitted). Considering only the rationales the agency furnished as the basis for its decision, courts must also “determine whether [the agency’s] interpretation is ‘rationally related to the goals’ of the statute.” Barrington, 636 F.3d at 660 (quoting AT & T Corp. v. Iowa Utils. Bd., 525 U.S. 366, 388, 119 S.Ct. 721, 142 L.Ed.2d 835 (1999)). III. Legal Analysis A. Is Deference Owed to the Agency Decision (Chevron Step One)? As an initial matter, the Court must address the plaintiffs’ arguments that the DoD’s decision to deny reimbursement for Z.B.’s ABA therapy is not entitled to Chevron deference. The plaintiffs make five arguments in support of this position: (1) The Agency’s policy of excluding ABA therapy from coverage under the military health benefits statute because it “is [not] medically or psychologically ' necessary, and appropriate medical care for [Autism Spectrum Disorder (“ASD”) ] that has been proven safe and effective in accordance with the reliable evidence standard as required by TRICARE regulations ...,” A.R., Vol. I, Tab 1 (Formal Review Decision) at 7 (footnotes omitted), is not entitled to deference because the statute “is unambiguous in light of its plain meaning, its legislative history, its internal [TRICARE] structure, the regulations promulgated under it, and the canons of [legislative] construction,” Pis.’ Mem. at 7; (2) the Agency “[h]as [t]aken inconsistent [positions [Regarding ABA [t]herapy, including [s]hifting [fits [position [p]ost[h]oc [i]n [Response to [the current] [l]itigation,” id. at 9; (3) no deference is deserved “[b]ecause Multiple [a]gencies [a]dminister the Military Health Benefits [s]tatute,” id. at 15; (4) “[b]ecause the Military Health Benefits [s]tatute [s]trips the [Agency] of [a]ll [discretion to [e]liminate or [r]educe [n]ecessary [h]ealth [c]are,” id. at 17, “the Court [s]hould [n]ot [d]efer to” the Agency’s decision in this case because it “[e]liminates a [h]ealth [c]are [b]enefit,” id.; and (5) “[u]nder the ‘Major [q]uestion’ [exception to Chevron, an [a]gency [i]s [n]ot [e]ntitled to [deference when, as in the instant [c]ase, the Agency [violates a [s]tatute’s [c]ore [purposes, [w]hich [a]re Matters of [g]reat Moral, [e]conomie .and/or [p]olitical [consequence,” id. at 21. In the alternative, the plaintiffs contend that “[e]ven if [s]ome [d]eference [a]pplie[s], ... [the Agency]’s [p]olicy [sh]ould [r]eceive the [m]ost Minimal [d]eference [b]ecause [i]t was informally [a]dopted.” Id. at 8. The Court will address the plaintiffs primary argument, the unambiguousness of the Military Health Benefits Statute, below. 1. The Unambiguousness of the Military Health Benefits Statute The plaintiffs first argue that the Agency’s policy is not entitled to deference because the governing statute is unambiguous. Id. at 7-8. They contend “[i]t is crystal clear that Congress did not intend to exclude (as ‘not medically or psychologically necessary’ and not ‘medical/health care’) a medically and psychologically necessary, intensive, and enormously effective therapy like ABA, which is designed, supervised, and performed by highly trained and skilled professionals.” Id. at 7. Based on their view that the statute is unambiguous, the plaintiffs reason that the Court has no choice but to “ ‘give effect to Congress’s unambiguously expressed intent’ ” that ABA therapy must be provided to the dependents of members of the armed forces. Id. (quoting Beverly Health & Rehab. Servs. v. Nat’l Labor Relations Bd., 317 F.3d 316, 321 (D.C.Cir.2003) (internal quotation marks and citation omitted)). The Agency counters that “[t]he military health benefits statute does not unambiguously require ABA therapy to be covered under the TRICARE Basic Program,” Defs.’ Mem. at 14; rather, the Agency emphasizes that the statute states that therapies that are not “medically or psychologically necessary” are excluded from coverage under the statute. Id. at 14-15 (quoting Barnhart v. Walton, 535 U.S. 212, 218, 122 S.Ct. 1265, 152 L.Ed.2d 330 (2002) (stating that “[a] Court is to defer to the Secretary’s judgment unless the statutory text ‘unambiguously forbids’ his view or his interpretation ‘exceeds the bounds of the permissible’ for other reasons”)). The Agency asserts that because the statute does not expressly mandate coverage of ABA therapy, it is within the Agency’s discretion to determine whether ABA therapy is in fact “medically or psychologically necessary” health care. Id. at 14-15. The Agency states that in interpreting what is “medically necessary,” it “is restricted by the regulatory ‘reliable evidence’ standard.” Id. at 25. The Agency contends that after an exhaustive administrative review of the reliable evidence contained in the administrative record regarding the efficacy of ABA therapy, it reasonably concluded that ABA therapy (1) does not meet the definition of medical care, but rather is an “educational intervention” aimed at modifying behavior, and (2) is not “proven” medical care. Id. at 19, 21, 31. The Agency claims that the reliable evidence showed that ABA’s function is to modify social behavior rather than treat the underlying illness of autism spectrum disorder, thus precluding ABA therapy from satisfying the definition of the term “medical,” which is defined as pertaining to “the diagnosis and treatment of illness.” Id. at 31-32. Moreover, the Agency asserts that “a review of [reliable] medical literature [demonstrates] that there is not a consensus on the efficacy of ABA as a medical treatment for ASD at this time.” Id. at 35. Furthermore, the Agency argues that its conclusions are based on a “reasonable construction” of its regulation and that it is owed “substantial deference” in interpreting its own regulation. Id. at 15. The plaintiffs reply that only after the Court “draw[s] on all of ‘the traditional tools of statutory construction,’ ” is it permitted to conclude that the statute is unambiguous. See Plaintiffs’ Reply Memorandum in Support of Their Renewed Motion for Summary Judgment and Memorandum in Opposition to Defendants’ Cross-Motion for Summary Judgment (“Pis.’ Reply”) at 12. Moreover, the plaintiffs note that “[c]ourts, in their Chevron [s]tep [o]ne analysis, do not interpret statutory phrases in isolation, because the meaning or ambiguity of certain words or phrases may only become evident when placed in context.” Id. (internal quotation marks and citation omitted). The plaintiffs insist that the Agency commits a fundamental error by simply assuming that it is entitled to Chew'on deference “without employing any of the traditional tools of statutory interpretation” or refuting any of the plaintiffs’ arguments based on those tools. Id. at 13 (internal quotation marks omitted). The plaintiffs further argue that because the Agency has never “provided an interpretation of its most fundamentally applicable regulations,” the Agency’s position that it is entitled to “substantial deference” because it is “interpreting its own regulations” is baseless. Id. at 2-3. The Agency counters, arguing that it has interpreted the relevant regulation and notes that it did include an explanation for its conclusion that ABA therapy is not medically or psychologically necessary health care, or in the alternative, that it is “unproven” care, in its Formal Review Decision, which is supported by an administrative record totaling more than 3,000 pages. Defendants’ Reply to Plaintiffs’ Opposition to Defendants’ Motion for Summary Judgment (“Defs.’ Reply”) at 5-7. The initial issue presented by the parties is whether the Agency’s conclusion that ABA therapy is not medically or psychologically necessary medical care is entitled to deference by the Court. As noted earlier, where a court concludes that a statute is unambiguous, the court must reject an agency’s interpretation if it is inconsistent with clearly expressed congressional intent. See Chevron, 467 U.S. at 842-43, 104 S.Ct. 2778 (“If the intent of Congress is clear, that is the end of the matter; for the court, as well as the agency, must give effect to the unambiguously expressed intent of Congress.”). Ambiguity can be determined by asking “whether Congress has delegated authority to an agency by leaving a statutory gap for the agency to fill,” Nat’l Mining Ass’n v. Kempthorne, 512 F.3d 702, 707 (D.C.Cir.2008); see also Chevron, 467 U.S. at 843, 104 S.Ct. 2778 (“The power of an administrative agency to administer a congressionally created ... program necessarily requires the formulation of policy and the making of rules to fill any gap left, implicitly or explicitly, by Congress.”) (internal citation omitted), and the Court “Owe[s] the Agency no deference on the existence of ambiguity.” Am. Bar Ass’n v. FTC, 430 F.3d 457, 468 (D.C.Cir.2005). The District of Columbia Circuit has consistently required that, absent an explicit delegation of authority to an agency, there must be an implicit delegation of authority to the agency for Chevron deference to be accorded by the Circuit to an agency interpretation. See, e.g., Sea-Land Serv., Inc. v. Dep’t of Transp., 137 F.3d 640, 645 (D.C.Cir.1998) (“[Chevron ] deference comes into play ... if the revievong court finds an implicit delegation of authority to the agency.”); City of Kansas City, Mo. v. Dep’t of Housing & Urban Dev., 923 F.2d 188, 192-93 (D.C.Cir.1991) (“[I]mplicit delegation of interpretive authority,” in absence of explicit delegation, is required for Chevron deference to apply). Furthermore, where Congress has delegated to an agency the authority to administer a program, a court should take special care not to encroach on that agency’s implementation of the program, particularly in regards to the promulgation of program regulations. See Chevron, 467 U.S at 844, 104 S.Ct. 2778 (“We have long recognized that considerable weight should be accorded to an executive department’s construction of a statutory scheme it is entrusted to administer, and the principle of deference to administrative interpretations.”). In conducting the Chevron step one analysis, a court’s inquiry is not limited to the statutory text, but rather a court “must examine the meaning of certain words or phrases in context and ... exhaust the traditional tools of statutory construction, including examining the statute’s legislative history to shed new light on congressional intent.” Sierra Club v. EPA 551 F.3d 1019, 1027 (D.C.Cir.2008) (internal' quotation marks and citation omitted). With this precedent as its guide, the Court turns to the parties’ arguments regarding the clarity or ambiguity of the military health benefits statute and the scope of its delegation of authority to the Agency. As noted above, the plaintiffs argue that the Agency’s position is not entitled to deference because the statute unambiguously requires coverage of ABA therapy under the Basic Program. Pis.’ Mem. at 8. The Agency counters that the military health benefits statute does not unambiguously mandate ABA therapy coverage under the TRICARE Basic Program; rather, the statute provides a general guarantee of coverage unless the care is not “medically or psychologically necessary.” Defs.’ Mem. at 14. The relevant statutory text at issue is 10 U.S.C. § 1079(a), which states: To assure that medical care is available for dependents ... of members of the uniformed services ... the Secretary of Defense ... shall contract ... for medical care for those persons.... The types of health care authorized under this section shall be the same as those provided under section 1076 of this title,[] except ... [a]ny service or supply which is not medically or psychologically necessary to prevent, diagnose, or treat a mental or physical illness, injury, or bodily malfunction.... See 10 U.S.C. § 1071 (“The purpose of this chapter is to create and maintain high morale in the uniformed services by providing an improved and uniform program of medical and dental care for members and certain former members of those services, and for their dependents.”) (emphasis added). Because the Agency is correct in stating that the statute does not explicitly mandate coverage for ABA therapy, but instead contains a general guarantee of health care-related coverage unless the care is “not medically or psychologically necessary,” see 10 U.S.C. § 1079(a), the question the Court must resolve is whether Congress intended to delegate authority to the Agency to interpret the phrase “not medically or psychologically necessary,” and thus allow it to determine which services fall under this exclusion. See National Mining Ass’n, 512 F.3d at 707 (“Chevron analysis begins with asking whether Congress has delegated authority to an agency by leaving a statutory gap for the [Ajgency to fill.”). The Court must begin its inquiry by examining the plain language of the statute. See Am. Bankers Ass’n v. Nat’l Credit Union Admin., 271 F.3d 262, 267 (D.C.Cir.2001) (“Chevron step one analysis begins with the statute’s text....”). The specific words selected by Congress in a statute may be instructive in assessing whether it intended to delegate interpretive authority of the terms in question through the adoption of regulations. See Nat’l R.R. Passenger Corp. v. Boston & Me. Corp., 503 U.S. 407, 418, 112 S.Ct. 1394, 118 L.Ed.2d 52 (1992) (“The existence of alternative dictionary definitions of the word ‘required,’ each making some sense under the statute, itself indicates that the statute is open to interpretation.”) (internal citation omitted). Here, 10 U.S.C. § 1079 does not define what the phrase “not medically or psychologically necessary” care entails, nor does it provide definitions of these terms. The very ambiguity of these terms indicates Congress’s intent to delegate authority to the Agency to interpret them. In National Mining Ass’n, the District of Columbia Circuit evaluated whether the phrase “valid existing rights” in the Surface Mining Control and Reclamation Act was ambiguous. 512 F.3d at 704. The Secretary of the Interior interpreted the phrase narrowly, requiring mining operators seeking to mine coal on federal land to satisfy two stringent conditions. Id. at 705.. Satisfaction of these requirements had the effect of essentially foreclosing surface mining operations on federal lands designated as sensitive areas. Id. The plaintiff argued that the Agency’s interpretation of the phrase was too narrow and shielded more land from surface mining than Congress intended. Id. at 706. The District of Columbia Circuit began its analysis by concluding that the term “valid existing rights” was ambiguous, observing that “[t]he [plaintiff], reaching for its dictionary, notes that the word ‘right’ could be taken to mean ‘property right[,]’ ... [b]ut according to the same dictionary on which the [plaintiff] relies, this is not the only meaning the word will bear.” Id. at 708. Given the ambiguity of the word “rights,” the Circuit reasoned that it was “hard for [it] to conclude that” “Congress ha[d] directly spoken to the precise question at issue.” Id. (internal citation omitted); see also Nat’l Cable & Telecomms. Ass’n v. Brand X Internet Servs., 545 U.S. 967, 989, 125 S.Ct. 2688, 162 L.Ed.2d 820 (2005) (“[W]here a statute’s plain terms admit of two or more reasonable ordinary usages, the [Agency’s] choice of one of them is entitled to deference.”); AFL-CIO v. FEC, 333 F.3d 168, 174 (D.C.Cir.2003) (“[T]he fact that the provision can support two plausible interpretations renders it ambiguous for purposes of Chevron analysis.”). Here, to determine whether the terms— medically, psychologically, necessary, and medical — are ambiguous and subject to multiple definitions, the Court consults the same source considered by the Circuit in National Mining Ass’n: dictionaries. 512 F.3d at 707; see also AKM LLC v. Sec’y of Labor, Dept, of Labor, 675 F.3d 752, 755 (D.C.Cir.2012); Nat’l R.R. Passenger Corp., 503 U.S. at 418, 112 S.Ct. 1394. Based on its review of dictionary definitions of each term, the Court finds that the phrase “not medically or psychologically necessary” suffers from ambiguity in the same manner that the phrase “valid existing rights” did in National Mining Ass’n. In National Mining Ass’n, the “major source of ... ambiguity [was] the word ‘rights.’ ” 512 F.3d at 708. The Circuit noted that, among other definitions, a “right” could mean “an interest or title in an object of property” or a “legally enforceable claim that another will do or will not do a given act.” Id. (internal quotation marks and citations omitted). Moreover, a “right” can “do service more generally,” standing for “[something that is due to a person by just claim, legal guarantee, or moral principle.” Id. The word “medically” is a derivative of and has the same meaning as the word “medical.” Similar to the definition of the word “right” in National Mining Ass’n, “medical” and “necessary” both have multiple definitions and are thus subject to the same ambiguity, which is magnified when the words are interpreted together as a phrase. “Medical” can mean “relating to, or concerned with physicians or the practice of medicine” or “requiring or devoted to medical treatment,” Medical Definition, Merriam-Webster Online Dictionary, http://www.merriam-webster.com/ dietionary/medically, while “necessary” can mean “of an inevitable nature,” “absolutely needed,” “compulsory,” or “determined or produced by the previous condition of things,” Necessary Definition, Merriam-Webster Online Dictionary, http://www. merriam-webster.com/dictionary/ necessary. For example, the stark difference between a treatment that is “determined or produced by the previous condition of things” and a treatment that is “compulsory” illustrates this ambiguity. Id. It is therefore uncertain whether a treatment must be compulsory, or merely “determined ... by the previous condition of things” in order for it to be covered under the Basic Program. Id. Both words lend themselves to multiple interpretations, thus “render[ing the words] ambiguous for purposes of Chevron analysis.” Nat’l Mining Ass’n, 512 F.3d at 708 (internal quotations marks and citation omitted). Especially in the context of the circumstances underlying the dispute in this case, either definition could lead to different conclusions that fall within “a range of possibilities” under the statute. Barrington, 636 F.3d at 660. Moreover, when viewing the two terms collectively as a phrase, the determination of which forms of medical or psychological care are necessary is also subject to interpretation, particularly here, where Congress left each of the terms, and the phrase itself, undefined. In the absence of such definitions, this Court, like the Circuit in National Mining Ass’n, 512 F.3d at 708, cannot conclude that Congress has directly answered the question of what types of health care are not medically or psychologically necessary. With the adoption of the Dependents’ Medical Care Act statute, Congress created a military health care system to “provid[e] an improved and uniform program of medical and dental care for members of the uniformed services and their dependents.” Pub.L. No. 84-569, 70 Stat 250 (1956). The authority to implement this health care program was, moreover, delegated to the Secretary of Defense by Congress. See 10 U.S.C. § 1079(a) (“[T]he Secretary of Defense, after consulting with the other administering Secretaries, shall contract, under the authority of this section, for medical care for those persons under such insurance, medical service, or health plans as he considers appropriate.”); see also Ike Skelton National Defense Authorization Act for Fiscal Year 2011, Pub. L. No. 111-383, § 711,124 Stat. 4137, 4246 (2011) (“[T]he Secretary of Defense shall have responsibility for administering the TRICARE program and making any decision affecting such program.”). Because Congress specifically delegated authority to the DoD to implement and make decisions affecting the military’s health care program, this Court must take care to avoid infringing on the Agency’s authority. See Morion v. Ruiz, 415 U.S. 199, 231, 94 S.Ct. 1055, 39 L.Ed.2d 270 (1974); see also Chevron, 467 U.S. at 844, 104 S.Ct. 2778 (“We have long recognized that considerable weight should be accorded to an executive department’s construction of a statutory scheme it is entrusted to administer....”). In their Renewed Motion for Summary Judgment, the plaintiffs argue that the DoD’s interpretation of the types of services that are not medically or psychologically necessary is owed no deference by the Court because “[t]he statute here is unambiguous in light of its plain meaning, legislative history, its internal structure, the regulations promulgated under it, and the canons of construction.” Pis.’ Mem. at 7. Specifically, the plaintiffs posit that “[i]t is crystal clear that Congress did not intend to exclude ... a medically and psychologically necessary, intensive, and enormously effective therapy like ABA, which is designed, supervised, and performed by highly trained and skilled professionals.” Id. The plaintiffs note that the congressionally declared purpose of the statute is to “create and maintain high morale in the uniformed services by providing an improved program of medical ... care,” id. at 26 (citing 10 U.S.C. § 1071), and argue that the Agency’s “conclusion that ABA therapy is excluded from Basic coverage[ ] as ‘not medically or psychologically necessary’ ... is not in harmony with the ‘design of the statute as a whole and ... its object and policy,’ ” id. at 27. However, in arguing that the Agency’s ABA therapy exclusion is contrary to the core purposes of the military health benefits statute, the plaintiffs erroneously conflate the Chevron step one and Chevron step two analyses. As noted above, the key inquiry in Chevron step one is whether the statute is ambiguous and whether Congress delegated authority to the Agency to fill those statutory ambiguities. See FDA v. Brown & Williamson Tobacco Corp., 529 U.S. 120, 159, 120 S.Ct. 1291, 146 L.Ed.2d 121 (2000) (“Deference under Chevron [step one] to an agency’s construction of a statute that it administers is premised on the theory that a statute’s ambiguity constitutes an implicit delegation from Congress to the agency to fill in the statutory gaps.”). Only after a court determines that deference is warranted due to statutory ambiguity or silence will a court proceed to Chevron step two to assess whether an agency’s interpretation of a statute is contrary to its core purpose. Am. Bankers Ass’n, 271 F.3d at 267 (“Only if we find the statute either silent or ambiguous with respect to ‘the precise question at issue’ do we proceed to Chevron’s second step, asking ‘whether the agency’s answer is based on a permissible construction of the statute.’ ”) (quoting Chevron, 467 U.S. at 842-44, 104 S.Ct. 2778). Therefore, the question of whether the statute’s core purpose of providing improved health care to military families conflicts with the Agency’s construction of the statutory language, as the plaintiffs argue, is irrelevant for purposes of Chevron step one, and is only appropriate for the Court’s consideration under Chevron step two. In summary, with regard to Chevron step one, the Court concludes that the disputed language of the statute is ambiguous because it is subject to more than one definition. Moreover, the statutory language expressly delegates sole authority to the Agency to implement and make decisions with respect to the Basic Program. See 10 U.S.C. § 1079(a); see also § 711, 124 Stat. at 4246. Congress’s delegation of authority to the Agency to administer the TRICARE health care program, coupled with Congress’s use of undefined and ambiguous language, i.e., the phrase “not medically or psychologically necessary,” is persuasive evidence that Congress left a gap in the statutory language for the Agency to fill. See Menkes v. U.S. Dep’t of Homeland Sec., 637 F.3d 319, 330 (D.C.Cir.2011) (“The power of an administrative agency to administer a congressionally created program necessarily requires the formulation of policy and the making of rules to fill any gap left, implicitly or explicitly, by Congress.”). Accordingly, because the phrase “medically or psychologically necessary” introduces ambiguity into the statute, the Court will advance to step two of the Chevron analysis, and will defer to the Agency’s conclusion if reasonable and permissible under the statute. B. Is The Agency’s Interpretation Arbitrary and Capricious or Contrary to Law (ChevronStep Two)? The Court, having determined “that statutory ambiguity has left the [A]gency with a range of possibilities and that the [A]gency’s interpretation falls within that range, ... the [A]gency ... ha[s] survived Chevron step one,” and the Court must now proceed to Chevron step two. Barrington, 636 F.3d at 660. “At [this second step of the] Chevron [analysis, the Court must] defer to the agency’s permissible interpretation, but only if the agency has offered a reasoned explanation for why it chose th[e] interpretation,” id. (emphasis added), that explanation “is rationally related to the goals of the statute,” id. at 665 (internal quotation marks and citation omitted), and there has not been “a clear error of judgment,” New Life Evangelistic Ctr., Inc. v. Sebelius, 753 F.Supp.2d 103, 113 (D.D.C.2010). Furthermore, “unlike [the review at] Chevron step one[,] ... at this stage [the standard of review] is highly deferential” to the agency. Barrington, 636 F.3d at 665 (internal quotation marks and citation omitted). 1. Arbitrary and Capricious Analysis At Chevron step two, the Court may not disturb an agency rule unless it is “arbitrary or capricious in substance, or manifestly contrary to the statute.” Household Credit Servs., Inc. v. Pfennig, 541 U.S. 232, 242, 124 S.Ct. 1741, 158 L.Ed.2d 450 (2004). In reviewing a case under the arbitrary and capricious standard of review, a court “must consider whether the [Agency’s] decision was based on a consideration of the relevant factors and whether there has been a clear error of judgment.” Marsh v. Or. Natural Res. Council, 490 U.S. 360, 378, 109 S.Ct. 1851, 104 L.Ed.2d 377 (1989) (internal quotation marks and citation omitted). At a minimum, the Agency decision must have been based on a consideration of the relevant data and the “explanation of the basis for its decision must include ‘a rational connection between the facts found and the choice made.’ ” Bowen v. Am. Hosp. Ass’n, 476 U.S. 610, 626, 106 S.Ct. 2101, 90 L.Ed.2d 584 (1986) (internal citation omitted). An agency action will [njormally ... be arbitrary and capricious if the agency has relied on factors which Congress has not intended it to consider, entirely failed to consider an important aspect of the problem, offered an explanation for its decision that runs counter to the evidence before the agency, or is so implausible that it could not be ascribed to a difference in view or the product of agency expertise. Motor Vehicle Mfrs. Ass’n of U.S., 463 U.S. at 43, 103 S.Ct. 2856 (emphasis added); see also BellSouth Corp., 162 F.3d at 1222 (“Where the agency has failed to provide a reasoned explanation, or where the record belies the agency’s conclusion, [the court] must undo its action.”). As noted, the “requirement that agency action not be arbitrary and capricious includes a requirement that the agency adequately explain its result.” Pub. Citizen, Inc. v. FAA, 988 F.2d 186, 197 (D.C.Cir.1993). a. Did The Agency Rely On Relevant Factors, Or Did It Rely On Factors Its Regulations Did Not Intend To Be Considered, or Did It Fail To Consider An Important Aspect Of The Problem? The Agency asserts that its “assessment that ABA [is] not ‘medically or psychologically necessary’ was based on a consideration of the relevant factors needed to make such a decision and was a rational decision given the record before it.” Defs.’ Mem. at 21-22. On the other hand, the plaintiffs assert the following: In its October 2010 denial decision, [the] DoD simply concluded that ‘ABA is an educational intervention and does not meet the TRICARE definition of medical care,’ without actually exploring and applying the statutory and regulatory definitions of ‘medical’ and ‘health care.’ Instead of utilizing all of the language contained in the statutory and regulatory definitions for ‘medical’ and ‘health care,’ [the] DoD just sought out sources that used variations of three key words: ‘education,’ ‘teach,’ and ‘instruction.’ [The] DoD then declared, without any analysis, that ABA therapy is ‘educational,’ and, therefore, it cannot be ‘medical.’ ” At the outset, [the] DoD did acknowledge the broad and liberal definition of ‘medical’ — but then refused to apply it. Pis.’ Mem. at 32-33. As noted in Part III.A.1 of this opinion, supra at 19, 10 U.S.C. §' 1071 authorizes a “uniform programf, TRICARE, for] medical [benefits] ... for members and certain former members of [the Uniformed Services], and for their dependents.” Specifically, the “[TRICARE program] is authorized at Sections 1079, 1086, and 1091 [of Title 10] to contract with civilian providers for the health care program benefits authorized under Section 1077.” A.R., Vol. I, Tab 1 (Formal Review Decision) at 22. Under the TRICARE statute, medical care is available to dependents under Section 1079(a), which provides: To ensure that medical care is available for dependents, ... the Secretary of Defense, after consulting with the other administering Secretaries, shall contract, under the authority of this section, for medical care for those persons under such insurance, medical service, or health plans as he considers appropriate. The types of health care authorized under this section shall be the same as those provided under section 1076. 10 U.S.C. § 1079(a). Section 1076 of the statute provides that the medical care to which a dependent is entitled shall be the same as that prescribed under Section 1077, which states: (a) Only the following types of health care may be provided under section 1076 of this title: (1) Hospitalization. (2) Outpatient care. (3) Drugs. (4) Treatment of medical and surgical conditions. (5) Treatment of nervous, mental, and chronic conditions. (6) Treatment of contagious diseases. (7) Physical examinations, including eye examinations, and immunizations. (8) Maternity and infant care, including well-baby care that includes one screening of an infant for the level of lead in the blood of the infant. (9) Diagnostic tests and services, including laboratory and X-ray examinations. (10) Dental care. (11) Ambulance service and home calls when medically necessary. (12) Durable equipment, which may be provided on a loan basis. (13) Primary and preventive health care services for women (as defined in section 1074d(b) of this title). (14) Preventive health care screening for colon or prostate cancer, at the intervals and using the screening methods prescribed under section 1074d(a)(2) of this title. (15) Prosthetic devices, as determined by the Secretary of Defense to be necessary because of significant conditions resulting from trauma, congenital anomalies, or disease. (16) A hearing aid, but only for a dependent of a member of the uniformed services on active duty and only if the dependent has a profound hearing loss, as determined under standards prescribed in regulations by the Secretary of Defense in consultation with the administering Secretaries. (17) Any rehabilitative therapy to improve, restore, or maintain function, or to minimize or prevent deterioration of function, of a patient when prescribed by a physician. 10 U.S.C. § 1077(a)(l-17). The plaintiffs assert that “[t]he treatment of autism by ABA therapy falls within at least three categories of ‘heath care’ or ‘mental health care’ that are provided as TRICARE Basic [P]rogram benefits” under the statute: “[t]he treatment of a ‘medical condition,’ pursuant to 10 U.S.C. 1077(a)(4); [t]he treatment of a ‘nervous, mental, and chronic condition,’ pursuant to 10 U.S.C. 1077(a)(5); and [a] ‘rehabilitative therapy’ to improve, restore, or maintain function, or to minimize or prevent deterioration of function, of the patient when prescribed by a physician,’ pursuant to 10 U.S.C. 1077(a)(17).” Pis.’ Mem. at 31. On the other hand, the Agency states that “[b]ased on the[ ] definition! ] and reliable evidence, [the] DoD concluded that ABA did not meet the definition of medical care, but rather found ABA to be an educational intervention aimed at modifying social behavior.” Defs.’ Mem. at 31. The plaintiffs maintain that despite the DoD’s exclusive reliance on the “reliable evidence standard” as the basis for assessing what coverage is available under the Basic Program, the regulatory definitions of “medically or psychologically necessary” are “only tangentially related” to the reliable evidence standard. Pis.’ Mem. at 43-44. Rather, the plaintiffs contend that “[a]s provided in 32 C.F.R. 199.2(b), the ‘general acceptance’ standard is what first and foremost defines whether a treatment is ‘medically or psychologically necessary’ for purposes of the military health benefits statute.” Id- at 44. They further contend that “the regulatory definitions of [what is] ‘medically or psychologically necessary’ and ‘medical [care]’ do not- even rely on the ‘reliable evidence’ standard, but rather rely on common-sense notions of ‘general acceptance’ and ‘pertaining’ to a mental disorder.” Pis.’ Reply at 7. The Court agrees with the plaintiffs. Pursuant to 32 C.F.R. §§ 199.2 and 199.4(g)(15), “[t]he TMA Deputy Director tasked the Chief [of the Medical Benefits and Reimbursement Branch (‘MB & RB’) ] to determine' whether ABA satisfies the ... criteria for medically or psychologically necessary treatment, and appropriate medical care.” A.R., Vol. I, Tab 1 (Formal Review Decision) at 9. The MB & RB Chief “concluded, in pertinent part, that: ... ABA is not medically or psychologically necessary and appropriate medical care for ASD and that the reliable evidence reviewed indicates that ABA is an educational intervention and does not meet the TRICARE ‘ definition of medical care.” Id. at 9-10. In conducting this assessment, the MB & RB Chief undertook “an in depth review' of the reliable evidence, such as medical literature and technology assessments, along with all documentation submitted by the Beneficiary.” Id. at 9. The assessment was then forwarded to the TMA Director, who concurred with the findings of the MB & RB Chief based on the evidence that had been reviewed and “a report by Hayes, Inc. (Hayes), a nationally recognized health technology assessment entity.” Id. at 10. Specifically, “the Director of TMA reached the conclusion that ABA is not ... covered under the Basic Program because it is (1) an ‘educational intervention’ rather than ‘medical’ care as contemplated by the [A]geney’s regulations, and, alternatively, (2) not ‘proven’ medical care even if considered to be medical care.” Defs.’ Mem. at 26-27. The plaintiffs argue that the Agency’s explanation is insufficient because it fails to “meaningfully address[ ] its own regulations defining ‘medically or psychologically necessary’ or ‘medical,’ ” but instead, “focuses selectively on the ‘reliable evidence’ regulation.” Pis.’ Reply at 7. Moreover, as noted earlier, the plaintiffs opine that “the regulatory definitions of knedieally or psychologically necessary’ and ‘medical’ do not even rely on the ‘reliable evidence’ standard, but rather rely on common-sense notions of ‘general acceptance’ and ‘pertaining’ to a mental disorder.” Id. As an initial matter, the Court agrees with the plaintiffs that the Agency has failed to meaningfully address its own regulations and instead has concentrated on factors that the regulations do not contemplate in its determination of whether ABA is “medically and psychologically necessary” “medical care.” The Basic Program covers “medically necessary services and supplies required in the diagnosis and treatment of illness or injury, including maternity care and well-baby care.” 32 C.F.R. § 199.4(a)(l)(i). Furthermore, the term “medical” is defined as [t]he generally used term which pertains to the diagnosis and treatment of illness, injury, pregnancy, and mental disorders by trained and licensed or certified health professionals. For purposes of CHAMPUS, the term “medical” should be understood to include “medical, psychological, surgical, and obstetrical,” unless it is specifically stated that a more restrictive meaning is intended. 32 C.F.R. § 199.2(b). Finally, the term “medically or psychologically necessary” is defined as follows: The frequency, extent, and types of medical services or supplies which represent appropriate medical care and that are generally accepted by qualified professionals to be reasonable and adequate for the diagnosis and treatment of illness, injury, pregnancy, and mental disorders or that are reasonable 'and adequate for well-baby care. Id. (emphasis added). The reg