FEDweek

TRICARE Expands Coverage

TRICARE, the military’s managed health-care system, is expanding services it will cover for mental-health and substance-use disorder (SUD) conditions.

These services are now covered:

* Emergency and non-emergency inpatient hospital stays;
* Psychiatric care for children at residential treatment centers;
* Inpatient and in-home care for substance-use disorder;
* Partial hospitalization;
* Outpatient and office-visit treatment for mental-health and substance-use cases.

TRICARE also will:

* Increase options for substance use disorder, to include office visits with TRICARE-authorized providers and prescriptions for opioid addiction;

* Easing limits on the number of treatments patients can receive for substance use, smoking cessation, and outpatient visits. Patients no longer would need authorization for an eighth outpatient visit;

* Lower copayments and cost-shares. For example, each visit for SUD patients now costs $12 – down from $25 a year ago. The lower copayments began taking effect for non-active duty dependents, retirees, family members and survivors last October. A full set of copayments and cost-shares is available on the TRICARE web site, at www.tricare.mil;

* A streamlined process for authorized providers and facilities, with the intent of providing more options for beneficiaries.
The changes were spurred at least in part by concerns about the epidemic of opioid abuse, and the desire to provide appropriate levels of service to beneficiaries.

“If someone does well in inpatient psychiatric care and no longer requires 24-hour care, they could step down a level,” said Dr. Patricia Moseley, a senior analyst for the Defense Health Agency. “Now we have a continuum of care to meet our beneficiaries’ needs,” she said.
The new guidelines put beneficiaries’ costs for substance-use and mental-health treatment at a level equivalent to that of medical and surgical care, Moseley said. Local TRICARE providers also can provide more details.