Notice2023-22790
TRICARE; Notice of TRICARE Plan Program Changes for Calendar Year (CY) 2024
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
October 13, 2023
Issuing agencies
Defense Department
Abstract
This notice provides information regarding TRICARE Plan Program Changes for CY 2024.
Full Text
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<title>Federal Register, Volume 88 Issue 197 (Friday, October 13, 2023)</title>
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[Federal Register Volume 88, Number 197 (Friday, October 13, 2023)]
[Notices]
[Pages 70959-70961]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2023-22790]
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DEPARTMENT OF DEFENSE
Office of the Secretary
TRICARE; Notice of TRICARE Plan Program Changes for Calendar Year
(CY) 2024
AGENCY: Office of the Secretary of Defense, Department of Defense
(DoD).
ACTION: Notice; TRICARE plan program changes for CY 2024.
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SUMMARY: This notice provides information regarding TRICARE Plan
Program Changes for CY 2024.
DATES: TRICARE health plan information in this notice is valid for
services during CY 2024 (January 1, 2024-December 31, 2024).
ADDRESSES: Defense Health Agency, TRICARE Health Plan Division, 7700
Arlington Boulevard, Suite 5101, Falls Church, Virginia 22042-5101.
FOR FURTHER INFORMATION CONTACT: Ms. Debra Fisher, phone: (703) 275-
6224.
SUPPLEMENTARY INFORMATION: A final rule published in the Federal
Register (FR) on February 15, 2019, (84 FR 4326-4333) that established
the requirement for the Director, Defense Health Agency (DHA), to
provide public notice to Military Health System (MHS) beneficiaries
each calendar year in connection with the annual open season enrollment
period with a summary of changes to the TRICARE program. The following
changes or improvements to the TRICARE program benefits apply for CY
2024.
Announcement of Open Season
Open Season is an annual period when beneficiaries can enroll in or
make changes to their healthcare, dental, and vision coverage for the
next calendar year.
During the TRICARE Open Season that runs from November 13, 2023,
through December 12, 2023, qualified MHS beneficiaries may enroll in or
change their TRICARE Prime or TRICARE Select plan.
During the Federal Employee Dental and Vision Insurance Program
(FEDVIP) Open Season that runs from November 13, 2023, through December
11, 2023, qualified MHS beneficiaries, including TRICARE for Life
beneficiaries, may enroll in or make changes to their dental and vision
plans. FEDVIP is operated by the U.S. Office of Personnel Management.
Any changes MHS beneficiaries make during Open Season will take
effect on January 1, 2024. If a beneficiary remains eligible and does
not make any changes during Open Season, then their coverage will stay
the same for 2024. TRICARE enrollees can ensure they receive important
health plan information by promptly listing any change in address and
other information in the Defense Enrollment Eligibility Reporting
System (DEERS).
Annual Announcements
The following TRICARE program features are subject to a year-to-
year determination and are announced each year prior to the annual
TRICARE Open Season.
Urgent Care Visits: There continues to be no limit to the number of
urgent care visits a covered beneficiary enrolled in TRICARE Prime may
receive without a referral for Plan Year 2024. They may receive urgent
care from any TRICARE-authorized urgent care center (UCC), either
network or non-network, without a referral. They may also receive
urgent care from any TRICARE network provider. If the TRICARE Prime
enrollee seeks care from a non-network TRICARE authorized provider
(outside of a TRICARE-authorized UCC), the usual TRICARE Prime Point of
Service (POS) deductible and cost-shares shall apply. Private Sector
care for Active Duty Service Members is subject to different rules.
Covered beneficiaries who want assistance on decisions to seek urgent
care in the United States (U.S.), except those enrolled in the
Uniformed Services Family Health Plan (USFHP), may call the MHS Nurse
Advice Line (NAL) for health care guidance from a specially trained
registered nurse. The NAL is available 24/7 to all non-USFHP TRICARE
beneficiaries. Beneficiaries who live overseas can call the NAL for
health care advice when traveling in the U.S. but must coordinate care
with their Overseas Regional Call Center. For additional information,
call the servicing TRICARE contractor or visit <a href="https://www.tricare.mil/ContactUs">https://www.tricare.mil/ContactUs</a> and click on ``MHS Nurse Advice Line.''
Prime Service Area Changes: Prime Service Areas (PSAs) are
geographic areas around military medical treatment facilities and Base
Realignment and Closure sites. PSAs support the medical readiness of
active duty members of the Uniformed Services by adding to the
capability and capacity of military hospitals and clinics. There are no
changes to the existing PSAs for CY 2024.
[[Page 70960]]
What's New
The following changes or improvements to the TRICARE program
benefits apply to CY 2024 (although some changes were implemented in
2023):
Elimination of Cost-Sharing for Female Tubal Sterilization as
Preventive Care: Effective January 1, 2023, TRICARE eliminated cost-
sharing for female tubal sterilization as a preventive service when it
is performed by in-network TRICARE-authorized providers.
Preconception and Prenatal Carrier Screening: TRICARE covers
preconception and prenatal carrier screening tests for cystic fibrosis,
spinal muscular atrophy, fragile X syndrome, Tay-Sachs Disease,
hemoglobinopathies, and conditions linked with Ashkenazi Jewish descent
for beneficiaries with a limit of one test per condition per lifetime.
Breastfeeding Supplies: Effective January 25, 2023, in keeping with
industry norms of shipping packages of 100 versus the earlier-covered
90 breast milk bags, TRICARE began cost-sharing for 100 breast milk
bags every thirty days following the birth event for breastfeeding
TRICARE Prime and TRICARE Select enrollees.
USFHP: USFHP is an additional TRICARE Prime option available
through networks of community-based, not-for-profit health care systems
(designated providers) in six geographic areas of the U.S.
Beneficiaries are encouraged to review the information at <a href="https://www.tricare.mil/Plans/Enroll/USFHP">https://www.tricare.mil/Plans/Enroll/USFHP</a> and other available resources to
determine whether they are in a USFHP eligible ZIP Code.
TRICARE Prime enrollees who reside in a ZIP Code where a USFHP
service area and a PSA served by a TRICARE regional contractor overlap
may change between the two at any time. This will be considered a
Primary Care Manager (PCM) change and can be changed by phone, online,
or by mail. Beneficiaries who are not enrolled in TRICARE Prime but
wish to enroll in USFHP can contact the USFHP in their area to make
enrollment changes during Open Season or as a result of a Qualifying
Life Event (QLE). A QLE is a certain change in the beneficiary's life,
such as marriage, birth of a child, or retirement from active duty,
which may mean different TRICARE health plan options are available. A
QLE opens a 90-day period for beneficiaries to make eligible enrollment
changes.
TRICARE Managed Care Support Contracts for East and West Regions
Change: A set of new TRICARE Managed Care Support contracts that
facilitate health care in the private sector will serve beneficiaries
in the East and West regions. Under the new contracts, beneficiaries
residing in Arkansas, Illinois, Louisiana, Oklahoma, Texas, and
Wisconsin will shift from the East to the West region. Beneficiaries
with questions about this transition can seek more information at
<a href="https://newsroom.tricare.mil/News/TRICARE-News/Article/3254092/changes-to-tricare-expected-in-2024">https://newsroom.tricare.mil/News/TRICARE-News/Article/3254092/changes-to-tricare-expected-in-2024</a>.
Reimbursement and Coverage of Services Provided by Freestanding
End-Stage Renal Disease (ESRD) Facilities: Effective January 12, 2023,
TRICARE now recognizes freestanding end-stage renal disease facilities
as authorized institutional providers, with an accompanying
reimbursement methodology.
Planned Changes
Low Back Pain Physical Therapy Demonstration Ends: This three-year
demonstration operating in ten states ends on December 31, 2023. The
demonstration addresses the ongoing issue of low back pain among
TRICARE enrollees and was designed to test the impact of waiving cost-
shares associated with the first three physical therapy visits for low
back pain. Information can be found at <a href="https://www.tricare.mil/Plans/SpecialPrograms/LowBackPain">https://www.tricare.mil/Plans/SpecialPrograms/LowBackPain</a>.
Laboratory Developed Test Demonstration Extended: The Laboratory
Developed Test (LDT) Demonstration to assess whether submitted LDTs
without United States Food and Drug Administration approval or
clearance otherwise meet TRICARE coverage criteria, i.e., proven safety
and effectiveness for its intended use, was slated to terminate on July
18, 2023. However, DHA has opted to extend the LDT Demonstration
through July 18, 2028, to allow the Agency additional time to determine
how to address LDT coverage long-term and allow continued coverage of
these tests for TRICARE beneficiaries in the interim.
Coronavirus Disease (COVID-19) Response Changes: The U.S. National
Emergency responding to the COVID-19 pandemic, originally declared in
March 2020, ended on April 10, 2023. The Secretary of Health and Human
Services (HHS) then ended the corresponding Public Health Emergency
(PHE) on May 11, 2023. DoD had implemented certain flexibility for the
MHS for the pendency of the National Emergency and HHS PHE that were to
sunset with the termination of such emergency statuses.
On termination of the National Emergency, DoD resumed requiring a
three-day acute care hospital stay prior to admission to a skilled
nursing facility and requiring TRICARE Prime enrollees seek referrals
to acquire COVID-19 vaccines from non-network, authorized providers
without incurring point-of-services charges; and discontinued coverage
of National Institute of Allergy and Infectious Disease (NIAID)-
sponsored clinical trials (note: eligible beneficiaries who enrolled in
a covered trial on or before April 10, 2023 will continue to have their
care covered through the end of the trial). DoD also discontinued
coverage of the treatment use of investigational drugs under expanded
access for all new episodes of treatment and eliminated the temporary
waiver of certain interstate and international licensing requirements
for providers practicing both in person and via telehealth.
On termination of the HHS PHE, DoD discontinued its temporary
coverage of facilities registered with Medicare Hospitals Without Walls
initiative. DoD also discontinued its waiver of cost-sharing for COVID-
19 testing. Normal TRICARE copayments and cost-sharing apply to testing
and related services after May 11, 2023.
Additionally, for DoD beneficiaries receiving telehealth from the
Direct Care component via Facetime, Google Duo/Meet, Microsoft Skype or
other similar platforms, their telehealth services have moved to an
approved DHA Platform. For DoD beneficiaries receiving Private Sector
telehealth, any platform used by their provider must be HIPAA-
compliant.
Appendix A
Certain TRICARE enrollee out-of-pocket costs (enrollment fees,
premiums, catastrophic caps, deductibles, and copayments) are adjusted
annually by Federal law and regulations based on the annual Cost of
Living Adjustment (COLA) applied to Uniformed Service member retired
pay. A difference in copayments remains between those who joined a
Uniformed Service before January 1, 2018, (Group A), and those who
joined on or after that date (Group B).
The retiree COLA is typically announced after the Federal fiscal
year begins in October. Beneficiary out-of-pocket expenses impacted by
the 2024 COLA will be posted to the <a href="http://tricare.mil/changes">tricare.mil/changes</a> web page before
the start of TRICARE Open Season, November 13, 2023.
Pharmacy Out-of-Pocket Expenses for CY 2024
TRICARE Pharmacy copayments will increase on January 1, 2024:
[[Page 70961]]
Pharmacy Copayments for Calendar Year 2024 *
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Retail network
Retail network brand-name Retail network non- Mail order generic Mail order brand- Mail order non-
Year generic formulary formulary 30-day formulary 30-day formulary 90-day name formulary 90- formulary 90-day
30-day supply supply supply supply day supply supply
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2024............................ $16 $43 ** $76 $13 $38 $76
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* Active Duty Service Members enjoy a $0 copay for covered drugs at any pharmacy.
** For all beneficiaries except Active Duty Service Members, select brand-name maintenance medications (taken for long-term conditions) may only be
filled twice at retail and then must be filled through home delivery or military pharmacy.
Premium Based Plans
The CY 2024 monthly premiums for TRICARE Reserve Select, TRICARE
Retired Reserve, and TRICARE Young Adult and the quarterly premiums for
Continued Health Care Benefit Program will be posted to the
<a href="http://tricare.mil/changes">tricare.mil/changes</a> web page once announced.
Dated: October 11, 2023.
Natalie M. Ragland,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2023-22790 Filed 10-11-23; 4:15 pm]
BILLING CODE 6001-FR-P
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</html>Indexed from Federal Register on October 13, 2023.
This is legal information, not legal advice. Laws vary by jurisdiction and change frequently. Always verify current law with official sources and consult a licensed attorney in your jurisdiction for advice on your specific situation.