Tricare Drops Telehealth Copays

Tricare will now cover telephone services for some medical appointments and will eliminate copayments for beneficiaries who use telehealth services in place of an in-person visit to the doctor during the COVID-19 pandemic.

Effective Wednesday, the Defense Department’s health program will cover audio-only remote services for office visits “when appropriate” and will not require copays for telemedicine, according to a notice in the Federal Register.

The coverage will extend through the end or suspension of the national emergency as declared by President Donald Trump, according to the ruling.

The ruling eliminates cost-sharing, including co-pays and deductibles, for in-network telehealth services for both Tricare Prime and Tricare Select beneficiaries in all geographic locations.

It also lifts Tricare’s prohibition on medical services via telephone, allowing physicians or other providers to evaluate a patient’s symptoms by phone. While the ruling is clear that appointments via telehealth — with audio and video capability — are preferred, phone calls are acceptable for those who may not have access to high-speed internet or a computer with Wi-Fi access.

The service applies to any illness or injury covered by Tricare, including COVID-19, but calls must be considered medically necessary and conducted by a network Tricare provider within the scope of his or her professional license.

To be eligible for reimbursement for a telephone consult, providers should determine that a phone call is “appropriate for accomplishing the clinical goals of the encounter” and must document it, according to the ruling.

Any visit requiring a physical exam would not be appropriate for a phone consultation and would not be covered, Tricare officials added.

The ruling also lifts some restrictions on providers practicing medicine across state lines. Under normal circumstances, Tricare requires that providers must be licensed in the state where they are practicing, and they can treat patients only in that state.

Under the temporary rule, providers will still be required to be licensed but can provide telehealth and audio medicine to patients across state lines. For example, in Washington, D.C., Tricare providers would be allowed to provide telemedicine to their patients who reside in Virginia. Previously, this was prohibited.

The change was made to ensure that providers can deliver care as needed to beneficiaries, regardless of where they are located.

The licensure change also would let Tricare providers treat beneficiaries in other nations, as long as the host nation allows it and is not on a sanctions list. Under such circumstances, the host nation will still regulate the provider’s ability to practice; the ruling simply ensures that it is allowable in places where it is permitted and would be reimbursable under Tricare.

The change could help Tricare beneficiaries who need mental health services during the pandemic; some military families living overseas have said they are unable to access quality behavioral health care because mental health treatment practices and availability vary widely across countries.

Source: Patricia Kime, article found on Military.com

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