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DHA increases access to telehealth during COVID-19 pandemic

Medical personnel sitting at desk talking into laptop monitor U.S. Air Force Lt. Col. Brendt Feldt, a surgeon at Landstuhl Regional Medical Center’s Ear, Nose and Throat Clinic, conducts a virtual health appointment via synchronous video. Innovations in virtual health, particularly telehealth, have been essential to continuing quality care for beneficiaries during the COVID-19 pandemic. DHA has made temporary changes to TRICARE regulations to expand telehealth care and prevent the spread of COVID-19. (Photo by Marcy Sanchez)

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Innovations to telehealth are essential to patient care during the COVID-19 pandemic. The Military Health System recognizes the importance of telehealth to prevent in-person spread of the novel coronavirus while still providing quality care to beneficiaries. As a result, the Defense Health Agency is making three temporary revisions to TRICARE regulations regarding telehealth with unprecedented speed.

DHA published an interim final rule in the Federal Register May 12, 2020. The rule invoked temporary changes to how beneficiaries and providers receive and provide telehealth care. These changes to the TRICARE telehealth rules were not Congress-directed. DHA acknowledged the need to make temporary changes to telehealth policy and took action to expand access to care during the COVID-19 pandemic.

Changes to regulation that require publication to the Federal Register usually take six months to a year to implement. However, DHA sought to expedite the process due to the urgency to continue providing care during the pandemic. DHA recognizes that both beneficiaries and providers may have technical and capacity limitations to the expansive telehealth demand created by both social distancing recommendations and restrictions to person-to-person interactions.

“The speed in which the DHA was able to respond to an identified need of expanding telehealth opportunities and get a rule change published is credit to the dedication of our great staff working tirelessly for our beneficiaries,” said Christopher Priest, deputy assistant director, Health Care Operations, DHA. “These are challenging times, but every day I see colleagues striving to improve how we deliver the TRICARE benefit under unprecedented conditions.”

The agency hopes to implement changes to beneficiaries worldwide in 30-90 days. Once implemented, changes made through the interim final rule will stand as long as the country remains in a state of national emergency, as declared by the president March 13, 2020.

The first change gives beneficiaries access to audio-only telephone visits with their providers. TRICARE will permit audio-only health care visits to improve access to care for beneficiaries that cannot access audio-visual care. Beneficiaries that cannot access audio-visual care due to lack of in-home technology, such as smartphones or computers, or who live in remote areas without the bandwidth for video conferencing, can take advantage of this service.

DHA is also increasing the provider access to care with the second regulatory change: TRICARE will reimburse providers that practice interstate telehealth where permitted by federal or state law, even if the provider is not licensed in the state where they are remoting in. Usually, providers that offer telehealth must be licensed in both the state where they practice and the state where their beneficiaries reside. This requirement will be temporarily modified to allow providers to expand their telehealth reach and still qualify for reimbursement. The rule also applies to providers overseas as long as a provider holds an equivalent license in another nation, and the host nation permits such practice.

The third change temporarily waives cost-shares and copayments for covered, in-network telehealth services. This change doesn’t cover just services related to COVID-19, but all telehealth services inside of the network. DHA hopes that by removing these costs, beneficiaries take advantage of telehealth and reduce exposure of others to TRICARE beneficiaries who may have the novel coronavirus.

Although the new rules are effective May 12, it will take time for all of the changes to be fully implemented. Beneficiaries may still be assessed a copay for telehealth services over the next few months, but adjudicated claims will either be pended or copays may be reimbursed. Some changes may remain in effect beyond the national emergency for overseas locations. DHA will reevaluate telehealth changes in the long term once the threat of COVID-19 diminishes.

DHA remains dedicated to transparency, while working to swiftly to reduce inconvenience for their beneficiaries and providers. Future updates will be posted to Health.mil and TRICARE.mil as they are finalized.

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