In a recent Tricare telehealth policy update, the Department of Defense (DoD) addressed telehealth phone calls and telehealth copays in the Federal Register with this statement:
The Assistant Secretary of Defense for Health Affairs (ASD(HA)) issues this final rule …. Temporary coverage of telephonic office visits is made permanent in this final rule, with its adoption expanded beyond the pandemic; the temporary telehealth cost-share waiver is terminated.
Tricare Telehealth Policy Update: Telehealth Phone Calls
Telehealth services, including audio-only calls and video calls, became very popular during the pandemic as people were confined to their homes and could not visit hospitals or clinics. This resulted in state and federal regulators relaxing the rules to allow care providers to serve patients efficiently. However, opponents do not favor ‘phone telehealth services’ as they believe that the phone alone cannot be considered a reliable option. They argue that it does not meet the telehealth guidelines and cannot help establish a solid doctor-patient relationship.
With healthcare services gradually returning to normal, states have started limiting audio-only healthcare services, while some have made coverage permanent. On the other hand, the Centers for Medicare & Medicaid Services is looking at eliminating Medicare coverage for the modality. Still, with some specific behavioral health services exceptions, the federal PHE ends a few months later.
According to data published by the Department of Defense, 80,451 telehealth phone calls have been conducted since the waiver (March 2020 to September 2021). However, the report adds that these visits make up “a small portion of all telehealth claims. They were well-received by many involved organizations, such as the American College of Physicians and the American Medical Association.
“Furthermore, the DoD received positive public comments regarding telephonic office visits, including multiple requests for the agency to consider it as a permanent benefit,” the official statement noted.
Tricare Telehealth Policy Update: Telehealth Copays
The Department of Defense waived telehealth copays during the pandemic and permitted coverage for “medically necessary phone appointments” in May 2020. The change helped thousands of patients; however, according to the officials, it cost the Department of Defense nearly $100 million in lost payments.
“The Defense Health Plan faces significant budget shortfalls,” said the department in the final notice regarding reinstating telehealth copays. “Termination of this provision will save the DoD $4.8M for every month it expires before the end of the national emergency, allowing DoD to focus resources on testing, vaccination efforts, and treatment for COVID-19-positive patients,” the document added.
After providing free access for more than two years to military members and their families, Tricare started to charge telehealth copays for medical appointments through telehealth. Tricare has ended the fee waiver policy for medical visits via phone or video.
Originally expected to go into effect in the first week of July, the implementation has been delayed. The Department of Defense is yet to announce the new implementation date; however, experts believe the recent ruling may go into effect when the federal Public Health Emergency (PHE) expires in 2023.
Stakeholders seeking more information are encouraged to contact the parties listed below:
- Erica Ferron, Defense Health Agency, Medical Benefits, and Reimbursement Section, 303-676-3626 or firstname.lastname@example.org.
- Sharon Seelmeyer, Defense Health Agency, Medical Benefits, and Reimbursement Section, 303-676-3690 or Sharon.email@example.com
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