Recently release federal regulations will bring TRICARE, the insurance plan for active and retired service members and their families, into compliance with the federal parity act. TRICARE has always had a comprehensive benefit package for mental health services, but was previously exempt from parity compliance. Until recently, there were higher copayments for outpatient behavioral health treatment than for other outpatient medical treatments and many other nonquantitative limitations that restricted the covered member’s ability to access care.
As of October 3, 2016 TRICARE will:
-decrease the copayment and co-insurance for both inpatient and outpatient mental health and substance use disorder care to bring them in alignment with copayments and co-insurance for medical care
-eliminate many restrictions on lengths of stay for inpatient behavioral healthcare
-remove day limits for partial hospitalization, residential substance use disorder care and other behavioral healthcare
-remove limits on the number of times a person can access a behavioral healthcare treatment (previously members who were dealing with substance use disorder had a limit of 3 courses of outpatient treatment in a lifetime)
-expand coverage of substance use disorder treatment, including outpatient counseling, medicaid assisted treatment with an authorized physician, and intensive outpatient programs
This is a huge win for mental health and substance use disorder advocates, but a life-saving rule change for service members and their families. For more information, you can access the final rule here and the recent TRICARE press release here.