Notice2022-20149
TRICARE Expansion of the Department of Defense and Department of Veterans Affairs Hearing Aid Ordering Model to Private Sector Care for Active Duty Service Members Receiving Care Through the Supplemental Health Care Program
Primary source
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Published
September 19, 2022
Effective
January 1, 2023
Issuing agencies
Defense Department
Abstract
The Acting Assistant Secretary of Defense for Health Affairs (ASD(HA)) issues this notice of demonstration to authorize the Defense Health Agency (DHA) to expand the DoD and Department of Veterans Affairs (VA) Hearing Aid Program (HAP) utilized throughout the Military Health System to a limited segment of the private sector care network of the TRICARE Managed Care Support Contractors (MCSCs). The intent is to replicate, to the fullest extent possible, the VA's Community Care Network model for delivery of prescribed hearing aids and associated devices to Veterans, for Active Duty Service Members (ADSMs) receiving care through the Supplemental Health Care Program (SHCP) in designated states, as well as to qualifying Prime Active Duty Family Members (ADFMs) diagnosed with profound hearing loss. This demonstration will be effective for the period of two years and conducted in three tiered phases: Phase One covers ADSMs in the state of California from January 1, 2023 until the completion of the demonstration; Phase Two covers ADSMs in the state of Texas from January 1, 2024 until the completion of the demonstration; and Phase Three covers qualifying Prime ADFMs in the states of California and Texas from July 1, 2024 through completion of the demonstration. These changes are intended to standardize the hearing aid ordering process and reduce the cost variability for hearing aids and associated devices prescribed for treatment under TRICARE by private sector care providers in network.
Full Text
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<title>Federal Register, Volume 87 Issue 180 (Monday, September 19, 2022)</title>
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[Federal Register Volume 87, Number 180 (Monday, September 19, 2022)]
[Notices]
[Pages 57184-57186]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2022-20149]
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DEPARTMENT OF DEFENSE
Office of the Secretary
TRICARE Expansion of the Department of Defense and Department of
Veterans Affairs Hearing Aid Ordering Model to Private Sector Care for
Active Duty Service Members Receiving Care Through the Supplemental
Health Care Program
AGENCY: Office of the Assistant Secretary of Defense for Health
Affairs, Department of Defense (DoD).
ACTION: Notice of demonstration project.
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SUMMARY: The Acting Assistant Secretary of Defense for Health Affairs
(ASD(HA)) issues this notice of demonstration to authorize the Defense
Health Agency (DHA) to expand the DoD and Department of Veterans
Affairs (VA) Hearing Aid Program (HAP) utilized throughout the Military
Health System to a limited segment of the private sector care network
of the TRICARE Managed Care Support Contractors (MCSCs). The intent is
to replicate, to the fullest extent possible, the VA's Community Care
Network model for delivery of prescribed hearing aids and associated
devices to Veterans, for Active Duty Service Members (ADSMs) receiving
care through the Supplemental Health Care Program (SHCP) in designated
states, as well as to qualifying Prime Active Duty Family Members
(ADFMs) diagnosed with profound hearing loss. This demonstration will
be effective for the period of two years and conducted in three tiered
phases: Phase One covers ADSMs in the state of California from January
1, 2023 until the completion of the demonstration; Phase Two covers
ADSMs in the state of Texas from January 1, 2024 until the completion
of the demonstration; and Phase Three covers qualifying Prime ADFMs in
the states of California and Texas from July 1, 2024 through completion
of the demonstration. These changes are intended to standardize the
hearing aid ordering process and reduce the cost variability for
hearing aids and associated devices prescribed for treatment under
TRICARE by private sector care providers in network.
DATES: This demonstration has an effective and implementation date of
the January 1, 2023. The demonstration authority will remain in effect
until December 31, 2024, unless terminated or extended by the DoD via a
subsequent Federal Register Notice. Phase One (ADSM in California) has
a target effective date of care delivery of January 1, 2023. Phase Two
(ADSM in Texas) has a target effective date of care delivery of January
1, 2024. Phase Three (qualifying Prime ADFM in California and Texas)
has a target effective date of care of July 1, 2024. If the Acting
ASD(HA), in collaboration with VA leadership, determines it would be
appropriate to make expansion of the DoD-VA HAP permanent, the Acting
ASD(HA) will follow-up with interim and final rulemaking, if required.
FOR FURTHER INFORMATION CONTACT:
Amy Boudin-George, AuD, CCC-A, Defense Health Agency, (210) 215-
9200, <a href="/cdn-cgi/l/email-protection#9bfaf6e2b5f5b5f9f4eefff2f5b5f8f2eddbf6faf2f7b5f6f2f7"><span class="__cf_email__" data-cfemail="33525e4a1d5d1d515c46575a5d1d505a45735e525a5f1d5e5a5f">[email protected]</span></a>.
Joe Mirrow, Defense Health Agency, (571) 217-9470,
<a href="/cdn-cgi/l/email-protection#80eaefe5aee2aeede9f2f2eff7aee3e9f6c0ede1e9ecaeede9ec"><span class="__cf_email__" data-cfemail="f59f9a90db97db989c87879a82db969c83b598949c99db989c99">[email protected]</span></a>.
SUPPLEMENTARY INFORMATION:
A. Executive Summary
This notice is to advise all parties of a DHA demonstration project
under the authority of Title 10, United States Code (U.S.C.), Section
1092, entitled ``TRICARE Expansion of the Department of Defense and
Department of Veterans Affairs Hearing Aid Procurement Model to Private
Sector Care for Active Duty Service Members Receiving Care through the
Supplemental Health Care Program and qualifying Prime Active Duty
Family Members.'' The demonstration will monitor whether cost
variability can be decreased and efficiency increased using the DoD-VA
HAP in the TRICARE MCSCs private sector care networks. The DoD Hearing
Center of Excellence (HCE), in collaboration with the TRICARE Health
Plan (THP) and the VA's Denver Logistics Center (DLC) and Central
Audiology Office, will conduct and evaluate a demonstration of the use
of the VA National Hearing Aid and Wireless Systems contract for the
purchase of hearing aids and associated devices prescribed for ADSMs
and qualifying Prime ADFMs seen by private sector care network
audiologists in designated states. The proposed demonstration will help
DHA assess whether use of these contracts will impact access to care,
improve efficiency to care completion, decrease billing errors to
increase cost avoidance for TRICARE and its beneficiaries, and improve
patient experience in quality of care.
The demonstration will develop and evaluate a system for TRICARE
MCSCs private sector care network audiologists to request hearing aids
for ADSMs and qualifying ADFMs through a centralized audiology team
supported by the DoD HCE. The devices will be ordered through the VA
Remote Order Entry System (ROES), purchased from the VA via a DHA
Military Interdepartmental Purchase Request (MIPR), and delivered to
the prescribing audiologist's practice for fitting and dispensing to
the beneficiary. This demonstration will integrate the Military and
civilian health care systems per Section 705(c) of the National Defense
Authorization Act for Fiscal Year 2017. Conducted under the purview of
the DHA, it will be administered through the MCSCs (Health Net Federal
Services (HNFS) and Humana Government Business (HGB), Inc. at time of
publication) in three phases, applicable to ADSM beneficiaries
receiving care authorized under the SHCP and qualifying Prime ADFMs.
The DoD HCE will measure several outcome metrics, including but not
limited to:
<bullet> Access to care for ADSMs and Prime ADFMs impact, positive
or negative, by delivering care through this model, which will be
measured through appointment data and shifts in number of providers
available in demonstration states (ADSMs in California, Phase One;
ADSMs in California and Texas, Phase Two, and qualifying ADFMs in
California and Texas, Phase Three) vs. similarly sized non-
demonstration states
[[Page 57185]]
(Texas and Florida, Phase One; Florida, Phase Two, Florida; Phase
Three).
Cost effectiveness will be measured by comparing:
<bullet> Financial costs incurred to THP for ADSMs and Prime ADFMs
receiving audiology care in states excluded from Phases One, Two, and
Three of the demonstration, to the cost incurred using this model,
based on procedural coding and reimbursement data.
<bullet> Financial costs incurred to the VA under this model. The
source of additional costs, opportunities for mitigation, and options
for cost sharing between the Departments will be evaluated.
<bullet> Efficiency and convenience of the ordering system through
the HCE centralized team and the VA DLC, by measuring the days elapsed
between hearing aid evaluation visits, as billed, and the dispensing of
hearing aids, as billed, in demonstration states vs non-demonstration
states.
Patient satisfaction will be evaluated to determine positive or
negative impacts of this program. Metrics will be based on patient
questionnaire data through the Joint Outpatient Experience Survey
(JOES) in Phase One, Two, and Three demonstration states compared to
the JOES in non-demonstration states.
B. Background
Hearing aids and associated devices for ADSMs seen at military
medical treatment facilities (MTFs) are more economically procured
through interagency collaboration between the DoD HCE and the VA DLC.
For ADSMs and qualifying Prime ADFMs receiving private sector care,
audiologists order hearing aids and associated devices for these
TRICARE beneficiaries directly from companies at a significant markup
over the VA contract price.
The purchase of the same devices for ADSMs treated at MTFs has been
economically achieved through collaboration between the DoD HCE and VA
per DoD policy established in 2013 to formalize the DoD-VA hearing aid
procurement collaboration originating in the mid-1990s. In October
2014, the DoD issued policy authorizing referral of ADSMs to network
audiologists when the ADSM either resides outside the catchment area or
the specific audiology service is unavailable at their assigned MTF.
Private sector care network audiologists prescribe and order hearing
aid devices and accessories, when indicated for treatment, for their
ADSM and qualifying ADFM patients, directly from companies at a
significant markup over the VA contract price. In April 2018, the
Office of the Secretary of Defense Chief Management Officer-led Reform
Management Group endorsed exploration of a DoD-VA hearing aid
procurement expansion initiative as a component of the Acting ASD (HA)
approved THP Reform Implementation Plan.
C. Authority
Use of TRICARE private sector care providers for ADSMs is
authorized by 10 U.S.C. 1074(c) (1), as implemented by 32 CFR 199.16
through the SHCP. Subject to special rules specified in 32 CFR
199.16(d) or waivers authorized in paragraph 199.16(f), neither of
which apply to DoD providing hearing aids through the VA ROES, ADSM
hearing aids are currently provided by TRICARE private sector care
providers and reimbursed under the SHCP. Hearing aids for qualifying
Prime ADFMs are currently provided by TRICARE private sector care
providers and reimbursed under 32 CFR 199.4(e)(24). Authority under 10
U.S.C. 1092 will have to be exercised to authorize this hearing aid
pilot as a demonstration to test the efficient and economical delivery
of hearing aids through the TRICARE private sector care program.
D. Description
The two-year demonstration will be conducted in three phases (Phase
One and Two expanding annually; Phase Three six months after
commencement of Phase Two) for ADSMs and qualifying Prime ADFMs meeting
the criteria for profound hearing loss according to TRICARE law and
policy to receive hearing aids and associated devices through private
sector care audiologists in network in the state of California (Phase
One), followed by the addition of ADSMs in the state of Texas (Phase
Two), and qualifying Prime ADFMs in both states in Phase Three.
Mandatory participation in utilizing the procedures established with
TRICARE MCSCs will be required of all private sector care network
audiologists prescribing hearing aids and associated devices for ADSMs
and Prime ADFMs during the timeframe of this demonstration, in
accordance with the provider's geographical area of state licensure
during the applicable phase. It will require no changes to the manner
in which audiology services, hearing aids, and their associated
accessories are delivered to the beneficiary. Approximately one-third
of the audiology private sector care network providers in the states of
California and Texas bundle the cost of a hearing aid and related
services, while two-thirds bill for the hearing aid devices, and
separately bill for the related services (e.g., hearing aid dispensing,
fitting, and programming). Under this demonstration the providers will
not be responsible for the cost of the hearing aids and associated
devices that are a TRICARE benefit under the SHCP for ADSM
beneficiaries, and special benefit for Prime ADFMs under 32 CFR
199.4(e)(24); therefore, those who bundle their care episodes will be
required to unbundle their billing. The contract changes will apply to
the audiologists in the HNFS and HGB TRICARE networks. The MCSCs will
provide education to, and receive acknowledgement of acceptance by, all
network audiologists regarding process and reimbursement differences
prior to the effective implementation date of each phase of the
demonstration.
Through the current process for ordering and reimbursement, the
audiologist orders the prescribed hearing aids and associated
accessories (hereafter referred to as ``devices'') directly through the
device manufacturer and delivers the hearing aids to the ADSM or ADFM.
The audiologist then bills HGB or HNFS a bundled fee that includes a
markup for the devices and the estimated cost of services that will be
required over the life of the hearing aid (e.g., follow-up visits,
repairs). Through the DoD-VA HAP demonstration, the devices will be
ordered by the dispensing audiologist through audiologists at the HCE,
to the DLC, which processes all VA contract orders for these devices.
During this demonstration, the HCE audiologists will use the existing
centralized MIPR within DHA to commit funds to the order in the ROES.
The devices will then be delivered directly to the dispensing
audiologist's practice in order to dispense to the beneficiary and
continue follow-up care. HGB and HNFS will continue to reimburse the
in-network audiologists for all covered benefits for eligible ADSMs and
Prime ADFMs. For all hearing aid services, prescribed Common Procedural
Terminology (CPT) code will be provided for use by the audiologists to
ensure appropriate reimbursement for the services rendered. Health care
received within the demonstration will match the current TRICARE PRIME
benefit for ADSMs authorized through the SHCP, and Prime ADFMs
authorized in the Prime benefit.
E. Communications
The DHA will proactively educate audiologists, beneficiaries, and
other stakeholders about this change through the TRICARE MCSCs.
Provider engagement will commence following the publication of this
notice. Materials will explain the demonstration benefit
[[Page 57186]]
and the process changes to the network audiologists and beneficiaries
as applicable.
F. Evaluation
This demonstration will assist the DHA in determining the program's
future course of action based on an in-depth analysis. This will
include at a minimum: determination if the use of the existing VA
hearing aid purchase contract by DoD is an effective approach for ADSMs
and qualifying Prime ADFMs who receive hearing aid services in the
TRICARE network; measurement of the program's effectiveness in reducing
cost variation; the maintenance of access to care; Defense Health
Program cost avoidance, with measured cost increases for the VA; and
subjective quality of care assessment from patient feedback. Monthly
reports and a full analysis of the demonstration outcomes will be
conducted throughout and for each phase of the demonstration to monitor
the access to care, financial costs incurred, and program
effectiveness.
Costs and performance will be analyzed by the DoD HCE and compared
to previous periods of the demonstration. Additionally, to measure
overall impact, the California and Texas markets will be compared to
markets of similar size, such as Florida, taking into account
previously fluctuating trends in all three markets with regard to the
number of network audiologists, financial costs incurred, and number of
ADSM and Prime ADFM patients fit with these devices.
Access to care will be measured using encounter data, showing the
time between the hearing aid evaluation and the dispensing of the
devices to the patient, as billed through CPT Codes, comparing the
average time per patient in California and Texas to average time per
patient in the non-demonstration states of Texas and Florida (Phase
One), and Florida (Phases Two and Three). Cost effectiveness will be
measured by comparing: (1) financial costs incurred to DHP for ADSMs
receiving audiology care in states excluded from Phases One, and Two,
and ADFM in states excluded from Phase Three of the demonstration, to
the cost incurred using this model, based on procedural coding and
reimbursement data, and; (2) financial costs incurred to the VA under
this model. The source of additional costs, opportunities for
mitigation, and options for cost sharing between the Departments will
be evaluated. Program effectiveness will be measured by the established
workflow for the receipt of orders by the HCE audiologists, the
continued service of the contracted audiologists (i.e., audiologists
elected to continue as network audiologists even after implementation
of this process), time between ordering and dispensing the device, and
decrease in costs of billed devices. Quality of care will be assessed
through patient satisfaction data from the JOES.
The DHA Director reserves the right to terminate the demonstration
early if the enrollment, cost, or quality do not support continuation
of the demonstration. Based on the success of this program within MTFs
and the VA Community Care Network, DHA will seek regulatory action to
implement the program in the TRICARE private sector program concurrent
with the demonstration. If the demonstration is successful, the DHA
Director may recommend extension of the demonstration pending
regulatory action. If regulatory action is successful and accomplished
prior to the demonstration completion, the DHA Director reserves the
right to terminate the demonstration and implement the program
throughout the TRICARE private sector program.
G. Reimbursement
Under this demonstration the providers will not be responsible for
the cost of the hearing aids and associated devices that are a TRICARE
benefit under the SHCP for ADSM beneficiaries and Prime benefit for
qualifying Prime ADFMs; therefore, those who bundle their care episodes
will be required to unbundle their billing. The contract changes will
apply to the audiologists in MCSC TRICARE networks in the demonstration
states. MCSCs will continue to reimburse the in-network audiologists
for all covered benefits for eligible ADSMs and qualifying Prime ADFMs.
For all hearing aid services, prescribed CPT codes will be provided for
use by the audiologists to ensure appropriate reimbursement for the
services rendered.
H. Implementation
The demonstration is effective January 1, 2023, continuing for a
duration of two years: Phase One (ADSM in California) has a target
effective date of care delivery of January 1, 2023; Phase Two (ADSM in
Texas) has a target effective date of care delivery of January 1, 2024;
and Phase Three (ADFMs in California and Texas) has a target date of
delivery of care of July 1, 2024. If successful, the Director, DHA, may
recommend extension of the demonstration until appropriate necessary
action has been taken to implement the program in the TRICARE private
sector care program.
Dated: September 13, 2022.
Aaron T. Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2022-20149 Filed 9-16-22; 8:45 am]
BILLING CODE 5001-06-P
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