TRICARE Soon To Comply With Federal Parity Law

On February 1st, the Department of Defense (DOD) published a Proposed Rule on the Federal Register to update TRICARE mental health and substance use disorder (MH/SUD) benefits, bringing them in compliance with the Federal Parity Law. The rule proposes broad revisions to the TRICARE regulations, reducing administrative barriers to access mental health and substance use disorder (SUD) treatment for TRICARE beneficiaries. The 2008 Federal Parity Law specifically exempts DOD and TRICARE plans, but the Administration has decided to bring the TRICARE benefit into compliance.

 The DOD’s summary states four main objectives, listed below with some additional details:

 (1) “To eliminate quantitative and qualitative treatment limitations on SUD and mental health benefit coverage and align beneficiary cost-sharing for mental health and SUD benefits with those applicable to medical/surgical benefits.”

They propose to eliminate the following treatment limitations:

  • All inpatient mental health day limits (consistent with the FY 15 Defense Authorization Act).
  • 60 day partial hospitalization and SUD rehabilitation facilities (SUDRF) treatment limits.
  • Annual and lifetime limits on SUD treatment.
  • Presumptive limits on outpatient treatment services including the 6-hours per week limit on psychological testing; limit of 2 sessions per week for outpatient therapy; and limits for family therapy (15 visits) and outpatient therapy (60 visits) provided in a free-standing or hospital based SUDRF.
  • Limitations on smoking cessation program.

 The proposed rule also eliminates any discrepancies in cost-sharing between mental health and SUD benefits and medical/surgical benefits. This reduces financial barriers to both outpatient and inpatient mental health and SUD benefits while minimizing out-of-pocket risk for those beneficiaries in a manner consistent with statutory requirements.

(2) Expand covered mental health and SUD treatment under TRICARE to include coverage of intensive outpatient programs and treatment of opioid use disorder.

 The rule states, “Once the changes proposed in this rule are implemented, TRICARE beneficiaries will have ready access to Medication-Assisted Treatment (MAT) on an outpatient basis as recommended by the American Society of Addiction Medicine (ASAM) and clinical practice guidelines developed jointly by the Department of Veterans Affairs and DOD.”

(3) Streamline the requirements for mental health and SUD institutional providers to become TRICARE authorized providers.

These revisions should result in an increase in the number and geographic coverage areas of participating institutional providers of MH/SUD treatment for TRICARE beneficiaries.

(4) Develop TRICARE reimbursement methodologies for newly recognized intensive outpatient (IOP) MH/SUD programs and opioid treatment programs.

Previously, broad language and a requirement that all IOP level of care be rendered by a TRICARE certified partial hospitalization, led to limited access to this treatment and confusion over coverage. The proposed regulatory language explicitly authorizing IOP treatment and establishing an authorized provider category should resolve this.

Comments on the rule are due April 1. 

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