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Tricare Reinstates Telehealth Copays, But Makes Phone Calls Permanent

Analysis  |  By Eric Wicklund  
   August 04, 2022

The Defense Department's health plan will require copays for telehealth services used by military members and their families after waiving those charges for more than two years, while continuing to allow patients and their care providers to conduct some healthcare services by phone.

Military members and their families will soon be charged copays for telehealth visits again, after more than two years of free use, but they'll be able to continue using the telehealth for certain healthcare services.

The news comes from the Department of Defense, which announced changes to its Tricare health plan in a notice published in the Federal Register this past June and included those amendments in the health program manual published this month.

The DoD waived copayments and allowed coverage for "medically necessary phone appointments" beginning May 12, 2020, expanding the virtual health platform during the height of the pandemic. That cost the DoD roughly $100 million in lost copayments, officials said.

"The Defense Health Plan faces significant budget shortfalls," they said in the final notice calling to reinstate copayments. "Termination of this provision will save the DoD $4.8M for every month it expires prior to the end of the national emergency, allowing DoD to focus resources on testing, vaccination efforts, and treatment for COVID-19-positive patients."

According to the final rule, the ruling was expected to go into effect on July 1 or when the federal public health emergency expires, but the DoD now says it will set a date at a later time. The PHE is expected to expire in 2023, though that isn't certain.

Telephone calls, or audio-only telehealth services, became popular during the height of the COVID-19 crisis, when both federal and state regulators relaxed the rules to enable care providers to conduct some services on the phone. Opponents have long argued that the phone isn't a reliable technology platform for telehealth services, and that it doesn't meet the guidelines to establish a doctor-patient relationship.

With the pandemic easing, some states have put restrictions back in place on audio-only telehealth services, while others have made coverage permanent. The Centers for Medicare & Medicaid Services, meanwhile, is planning to eliminate Medicare coverage for the modality, except for certain behavioral health services, six months after the federal PHE ends.

According to the DoD, 80,451 healthcare visits were conducted by phone between March of 2020 and September of 2021. In the final rule, officials said those visits were "a small portion of all telehealth claims," but they were well-received by both patients and physician organizations, including the American Medical Association and American College of Physicians.

"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 rule noted.

Eric Wicklund is the associate content manager and senior editor for Innovation, Technology, and Pharma for HealthLeaders.

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