TRICARE is pleased to be implementing significant improvements to its mental health and substance use disorder (SUD) benefits to provide beneficiaries greater access to the full range of available mental health and SUD treatments.
These changes will make Tricare’s mental health care and SUD treatment benefits on par with other public and commercial health care programs.
Dr. Patricia Moseley, senior policy analyst for military child and family behavioral health at Defense Health Agency in Falls Church, Va., said being able to provide better care at a better cost was an important driving force for the changes.
“Being able to meet the principles of mental health parity and the Affordable Care Act for beneficiaries is very significant,” said Moseley.
Beginning Oct. 3, non-active duty dependent beneficiaries will pay $12 for outpatient visits relating to mental health and SUD benefits rather than the current rate of $25 per mental health visit and $17 per group outpatient visit.
Retirees, their family members and survivors will also pay $12 per day for inpatient mental health care instead of the current $40 per day rate. Active duty family members seeking inpatient mental health care will have their rates reduced from $20 per day to $18.20.
Although the new copayment rules are now underway, providers may not yet have the instructions on new copayments and may ask for the $25 copay they have paid in the past. Beneficiaries are asked to pay that copay; they will be reimbursed as soon as the new business instructions on copays are in place. Beneficiaries may need to save their receipts and file a claim later.
TRICARE already eliminated several restrictions relating to the length or number of visits allowed for mental health care and SUD treatment. The yearly limit of 30 days for adults and 45 days for children for inpatient psychiatric treatment and the 150-day limit for adolescent psychiatric residential treatment center care were removed in 2015.
The current 60-day limit for psychiatric partial hospitalization and the substance use disorder rehabilitation facility (SUDRF) partial hospitalization 60-day limit will be removed from policy in the coming months of 2017.
SUD treatment is also currently limited to TRICARE-authorized SUDRFs and hospitals only. This and other limitations, such as 18 face-to-face counseling sessions for those attempting to quit smoking, six hours of psychological testing, two sessions per week for outpatient therapies, and the number of visits for family and outpatient therapies will also be removed in the near future.
“Now, everything will be determined based on medical and psychological necessity,” said Dr. John Davison, chief of the Condition-Based Specialty Care section of DHA’s Clinical Support Division.
For example, a person struggling with alcoholism has a limit of three outpatient treatments in his lifetime under TRICARE’s current benefits. However, substance use can be a lifelong struggle. The changes will allow people to seek help as many times as they need it.
“We want to be sure that if our retirees and their family members or active duty family members face these issues that we’re going to be equipped and capable to provide that care for them,” said Moseley.
TRICARE will also expand its coverage to include treatment for opioid use, which can range from heroine to prescription drugs. This change will provide more treatment options, including outpatient counseling and intensive outpatient programs. Office visits may include medication-assisted treatment for this condition.
Once the changes are put into effect, the process for facilities to become TRICARE-authorized will become easier and faster as TRICARE seeks to make its regulations consistent with industry standards. These revisions will make mental health care and SUD treatment more community based, said Moseley.
“This move will help military members who relocate with their families multiple times during their careers and will help those retirees who may live in remote areas away from large cities where there’s greater access to care,” said Moseley.
Gender dysphoria – a condition in which a person experiences distress over the fact that their gender identity conflicts with their sex assigned at birth – will be the only exception to the timeline. Coverage for all nonsurgical treatment for this condition will be available in October. It will include psychotherapy, pharmacotherapy and hormone treatment.
Surgical care continues to be prohibited for all non-active duty dependents.