Temporary Policy Makes Using Telehealth Easier for Tricare Beneficiaries and Providers 

May 13, 2020 guidance issued by the office of the Secretary of Defense this week will allow Tricare providers to receive reimbursement for medical appointments that occur online and over the telephone.  

The Assistant Secretary of Defense for Health Affairs issued the temporary policy change, called an Interim Final Rule (IFR), in order to encourage patients and providers to use telehealth services during the COVID-19 pandemic to reduce the risk of the spreading the virus. The rule change begins immediately and will last until President Trump announces the end of the national emergency. 

Under the interim rule, Tricare beneficiaries living CONUS and OCONUS, will be able to receive care via online video conferencing platforms and over the telephone. The interim rule will also suspend copays and costshares for telehealth appointments for Tricare Prime and Tricare Select beneficiaries receiving care from in-network providers in all geographic areas. The policy change will not, however, apply to other Tricare-reimbursed or ancillary services, including durable medical equipment or prescriptions.  

Tricare Prime beneficiaries will still need a referral from their Primary Care Manager (PCM) for a specialty care visit. However, under this rule modification, both the PCM visit and the specialty care visit (if performed via in-network telehealth) will have no cost-share or copay. 

The interim rule will also loosen existing restrictions on provider licenses. Prior to the interim rule, providers had to be licensed in both the state where the provider practices and the state where the patient resides. This temporary change will allow providers who are licensed and in good standing in any state to be reimbursed for services provided to patients who may reside in a different state. Tricare providers will also be able to be reimbursed for services provided to patients in another country, if the host nation allows that and if the provider is licensed and in good standing.  

On a call with the Defense Health Agency this afternoon, senior officials mentioned that while the IFR was published in the Federal Register and began on May 12, the OCONUS effective date will be March 10 and it is retroactive, so it may be worthwhile to contact Tricare regarding any out-of-pocket costs that may have been avoided under this interim rule. 

The full document explaining the temporary policy can be viewed here