The Defense Department is expanding mental health coverage under Tricare, eliminating annual limits on inpatient mental health and residential treatment stays and increasing substance abuse services to include outpatient treatment for opioid addiction.
Under the new policy, which goes into effect Oct. 3, lifetime limits for substance use disorder treatment also are lifted as are some restrictions on smoking cessation and presumed restrictions for psychotherapy and family counseling.
In an announcement in the Federal Register earlier this month, the Defense Department said the new rule brings the Pentagon's mental health coverage in line with laws that govern the civilian health care industry, including the 2008 Mental Health Parity and Addiction Equity Act and the Patient Protection and Affordable Care Act.
Defense officials added that the changes were needed to ensure that troops, family members and retirees could access the most up-to-date treatment options for mental health and substance abuse.
"The Department of Defense remains intently focused on supporting the mental health of our service members and their families, as this continues to be a top priority," officials wrote.
The new rule also changes the requirements for mental health professionals to become Tricare providers and develops reimbursement policies for newly covered programs, such as intensive outpatient programs for substance abuse and medical therapy for opioid abuse.
Officials called the previous standards "overly restrictive and at times inconsistent with [industry] standards and organization."
"There are currently several geographic areas that are inadequately served because providers in those regions did not meet TRICARE certification requirements, though they may have met the industry standard. This final rule will streamline TRICARE regulations to be consistent with industry standards for authorization of qualified institutional providers of mental health and SUD treatment," they wrote.
Tricare first announced the changes in January seeking comment on the proposals, which also included lifting restrictions on treating gender dysphoria, the mental distress a patient may have as a result of being born a gender to which they don't identify.
The new policy allows for transgender individuals to receive hormonal therapy and counseling, but it stops short of covering sex reassignment surgery.
During the comment period, the department received input from 189 groups or individuals, many of whom praised the department for broadening access to inpatient care and attempting to increase the provider pool.
One woman, the wife of a Navy retiree and identified only as Bonnie, said the changes would come too late to help one son but she hoped they would be made so another son with substance abuse issues and mental health problems could benefit.
"As devastating as the psychological and physical effects of these diseases have been for my sons and our family, the most difficult and dangerous aspect of coping with their illnesses has been lack of access to timely treatment," she wrote.
She added that most Tricare-approved residential treatment programs were three to six hours from the family's home and follow-on treatment, such as partial hospitalization programs, also were difficult to reach, and the family has drained its savings to help their children.
"Substance abuse treatment is a Tricare benefit but when there are no providers Tricare will certify, it’s a benefit in name only," she wrote.
Nearly 30 respondents found an error in the proposal: The interim rule eliminated inpatient mental health services or partial hospitalization for children under age 13. Tricare admitted the gaff, saying several documents had been combined to create the new proposal, which applies to all beneficiaries regardless of age.
The proposal on gender dysphoria treatment generated nearly a third of the comments, with 19 objecting strongly to the proposal citing cost concerns, inappropriate use of government funds or the impact on military readiness, 16 expressing support and numerous others taking issue with surgical coverage from both viewpoints as well as the controversy of whether treatment works.
The Defense Department responded that a decision was made to add treatment as a benefit because it is "no longer justifiable to categorically exclude and not cover current medical and psychologically necessary and appropriate proven treatments that are not otherwise excluded by law."
An independent government cost estimate found that the new regulation will carry an annual cost of about $58 million.
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Patricia Kime covers military and veterans health care and medicine for Military Times. She can be reached at pkime@militarytimes.com.
Patricia Kime is a senior writer covering military and veterans health care, medicine and personnel issues.
