New Tricare mental health benefits, including expanded treatment for opioid and other substance-use issues, went live July 13, according to Kevin Dwyer, spokesman for the Defense Health Agency.
Benefits now in effect include:
- Emergency and nonemergency inpatient hospitalization.
- Psychiatric residential treatment care for children.
- Inpatient/residential substance-use disorder care.
- Partial hospitalization.
- Outpatient and office-based mental health and substance-use treatment.
The changes will give more flexibility to families to seek the right level of care for their mental health needs, officials said.
“If someone does well in inpatient psychiatric care and no longer requires 24-hour care, they could step down a level,” said Dr. Patricia Moseley, a senior policy analyst for military child and family behavioral health at the Defense Health Agency, in a statement announcing the new options that are available. “Their options may be a partial hospital program, an intensive outpatient program at six hours a day, or outpatient treatment with a Tricare-authorized provider,
”Now we have a continuum of care to meet our beneficiaries’ needs.”
Tricare officials have taken steps to increase the number of mental health treatment providers and substance use treatment providers, by streamlining the certification process. The changes will remove unique certification requirements, to become consistent with industry standards, officials said.
“We are hopeful the new regulations will increase the number of Tricare providers and give families more options for military kids who need inpatient behavioral health treatment,” said Karen Ruedisueli, deputy director of government relations for the National Military Family Association. “We regularly hear from families who struggle to find Tricare inpatient facilities for their children and adolescents. Some of them have had to send their kids out of state for care. Others have paid out of pocket to the tune of tens of thousands of dollars.”
Tricare has also removed the limits on the number of times per week that patients can receive substance use treatment, smoking cessation counseling and outpatient treatment. And Tricare removed the requirement for authorization after the eighth outpatient mental health or substance use visit, officials said.
Opioid use disorder can range from addiction to heroin to addiction to prescription drugs. Tricare has added options for treatment for this disorder.
Patients who have been diagnosed with an opioid use disorder may qualify for Medication Assisted Treatment, which combines drug and mental health therapies. It’s covered if the Tricare provider has a special certification from the Drug Enforcement Agency to prescribe buprenorphine. Tricare will cover an opioid treatment program when the patient has been diagnosed with the opioid use disorder, requires medically monitored detoxification with direct access to medical services, and needs medical support, but doesn’t need a 24-hour medical environment.
Tricare will also cover office-based opioid treatment by providers that follow federal, state and local regulations.
The July 13 implementation follows an announcement last year that the mental health coverage would be expanded, effective last Oct. 3. In an announcement in the Federal Register last year, defense officials said previously Tricare benefits at the time didn’t fully reflect the full range of substance use disorder treatment approaches that are now endorsed by the American Society of Addiction Medicine, the Department of Health and Human Services Substance Abuse and Mental Health Services Administration, and VA/DoD Clinical Practice Guidelines for substance use disorders.
Senior reporter Karen Jowers covers military families, quality of life and consumer issues for Military Times. She can be reached at kjowers@militarytimes.com.
Karen has covered military families, quality of life and consumer issues for Military Times for more than 30 years, and is co-author of a chapter on media coverage of military families in the book "A Battle Plan for Supporting Military Families." She previously worked for newspapers in Guam, Norfolk, Jacksonville, Fla., and Athens, Ga.
