Tricare to Start Charging for Telehealth Appointments But Makes Phone Visits Permanent

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Virtual cystoscopy telehealth procedure.
Lt. Cdr. Kathryn Lipscomb, the Urology department head at USNH Rota, Spain, waves to staff in USNH Naples, Italy during the first virtual cystoscopy between both hospitals, Jan 22, 2021. (U.S. Navy Photo by Cmdr. Ryan Nations).

After more than two years, Tricare again will charge copayments for medical appointments via telehealth, but the start date for the new requirement has yet to be announced.

In changes to the Tricare health program manual Tuesday, as well as a final rule published in the Federal Register in June, the Department of Defense announced the end of the fee waiver for medical visits via video or phone that went into effect early in the pandemic.

The DoD also has made telephone-only telehealth appointments, something that only began being offered to military retirees, active duty service members and their families at the beginning of the pandemic on a temporary basis, a permanent benefit as part of the rule change.

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In May 2020, the DoD instituted coverage for medically necessary phone appointments and waived fees for telemedicine appointments via video or phone to ensure that beneficiaries could access medical care, including mental health services, during lockdowns and reduce exposure to COVID-19.

Since then, Tricare has spent nearly $100 million to cover the shortfall from the waived cost shares and copayments, including $20.6 million in fiscal 2020 and $71.4 million in 2021.

"The Defense Health Plan faces significant budget shortfalls. Termination of this provision will save the DoD $4.8M for every month it expires prior to the end of the national emergency, allowing DoD to focus resources on testing, vaccination efforts, and treatment for COVID-19-positive patients," officials wrote in the final notice.

When exactly those who use Tricare for medical coverage will be required to make copayments for telehealth visits has yet to be determined, however. The rule itself says that the requirement went into effect July 1, although a spokesman for the Defense Health Agency said the effective date will be later, with the copays yet to take effect.

"Tricare Health Plan will set a date when copays will start being collected for telehealth appointments and will not bill for telehealth services prior to that start date," said Defense Health Agency spokesman Peter Graves in an email to Military.com.

Tricare's contractors, Humana Military and Health Net Federal Services, will be instructed when they should begin billing for copays, but a letter has not gone out yet, Graves added.

Cost shares will be the same as for an in-person visit and are determined by Tricare plan and sponsor status. Beneficiaries can find their copay amounts for 2022 by using Tricare's online research tool.

The new requirement does not apply to beneficiaries who use Tricare for Life, the DoD's program for Medicare-eligible beneficiaries. Those who use Tricare for Life will continue to not pay any cost shares for telehealth under temporary changes to Medicare under the declaration of a national emergency, which was extended by the Biden administration in April.

Under the new rule, medically necessary telephone-only provider visits will be covered permanently. These types of calls were authorized in the pandemic mainly to ensure that patients who didn't have access to a computer or the ability to link to a video visit could receive care.

According to the DoD, 80,541 telephone office visits took place from March 2020 through September 2020.

In a blog post June 15, the Military Officers Association of America's Director of Government Relations for Health Affairs Karen Ruedisueli said her organization understands that policies put in place early in the pandemic "must be revisited," but she has concerns about continued access to medical care.

"We remain concerned about mental health copays and fear the expiration of the telehealth cost sharing waiver will present a barrier to access to those receiving mental health care via telehealth," Ruedisueli wrote.

In the final rule, DoD officials said the changes should not have an impact on treatment access as "beneficiaries will continue to have access to telehealth services and will be able to choose to continue using such services, or to visit their provider in-person, with the same cost-share applied to the service regardless of the modality through which it was delivered."

-- Patricia Kime can be reached at Patricia.Kime@Military.com. Follow her on Twitter @patriciakime.

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