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Tricare Improves Mental Health and SUD Coverage

By Christine Cioppa

The Department of Defense (DoD) has essentially said “We got your six!” with the passing of a new rule that improves mental health care access and expands treatment for alcohol, drug and pain pill use disorders.   

The DoD’s new 32-page rule, “Tricare; Mental Health and Substance Use Disorder Treatment,” published in the Federal Register on Sept. 2, 2016, improves access to providers by changing the way providers get authorization to join the TRICARE network. The rule also expands the coverage of substance use disorder (SUD) treatment by removing certain limitations to coverage.    

“Major changes are underway that will improve access to mental health and substance use disorder treatment for Tricare beneficiaries, revise beneficiary cost-shares to align with cost-shares for medical and surgical care, and reduce administrative barriers to care by streamlining the requirements for institutional providers to become Tricare authorized providers,” said Dr. John Davison, Chief of the Condition-Based Specialty Care Section of Defense Health Agency’s Clinical Support Division, in a Tricare news release issued last month.

What’s changed?

According to TRICARE officials, changes include:

  • Removal of differential cost-shares and co-pays for mental health compared to medical/surgical care
  • Removal of quantitative limits (e.g., day limits) on mental health care
  • Substance use disorder (SUD) treatment by individual professional providers of care, including out-patient opioid treatment for opioid use disorder when prescribed by a qualified physician
  • Outpatient treatment of opioid use disorder with medication-assisted treatment (MAT) by qualified opioid treatment programs (OTPs) (to be implemented in 2017)
  • Authorization of intensive outpatient programs for mental health and substance use disorder treatment (to be implemented in 2017)
  • Streamlined process for institutional mental health providers to become TRICARE authorized providers (to be implemented in 2017)

What are the differential cost-shares and co-pays?

For more info, visit:

http://www.tricare.mil/Costs/MentalHealthCosts

http://www.tricare.mil/CoveredServices/Mental/MentalHealthCosts

Will access to on-base psychiatrists improve in locations where the wait is too long?

“These changes impact only mental health providers in the Tricare purchased care system. On-base psychiatrists are hired by personal services contracts with the military services. However, Tricare-authorized psychiatrists, psychologists and other individual providers of mental health care can now treat substance use disorders,” Tricare officials said.

“Also, guidelines are currently under development to streamline the requirements for institutional mental health providers to become TRICARE-authorized providers in the spring of 2017. These changes increase access to mental health care and provide beneficiaries additional options when selecting a mental health care provider.”

What will happen in locations a psychiatrist is not on staff?

“For military treatment facilities that do not have a psychiatrist on staff, the patient can be referred to a Tricare-authorized psychiatrist. Additionally, Tricare anticipates additional mental health providers will join the network following the streamlining of the Tricare authorization requirements for in-patient treatment facilities—freestanding residential treatment centers, substance use disorder rehabilitation facilities and partial hospitalization programs,” states Tricare officials.

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