CHA News Article

Proposed Rule Expands TRICARE Coverage for Mental Health, Substance Use Disorders

The Department of Defense (DoD) issued the attached proposed rule this month, expanding TRICARE coverage to include mental health and substance use disorder (SUD) benefits. The proposed rule, modeled after provisions of the Mental Health Parity Act of 2008 and the Affordable Care Act, removes existing statutory limits on TRICARE coverage of inpatient mental health services. Specifically, TRICARE coverage is no longer subject to an annual limit on stays in inpatient mental health facilities of 30 days for adults and 45 days for children. In addition, TRICARE coverage is no longer subject to a 150-day annual limit for stays at residential treatment centers (RTCs) for eligible beneficiaries.

The proposed rule also eliminates treatment limitations, consistent with mental health parity, including the 60-day partial hospitalization program (PHP) limitation; annual and lifetime limitations on SUD treatment; presumptive limitations on outpatient services, including the number of psychotherapy sessions per week and family therapy sessions for the treatment of SUD per benefit period; and limitations on the smoking cessation program. In addition, the proposed rule establishes reimbursement methodologies for providers that were not previously authorized by TRICARE, including intensive outpatient programs and qualified opioid treatment programs. The DoD notes that existing reimbursement methodologies for SUD rehabilitation facilities, RTCs and PHPs will continue to apply. Comments on the proposed rule are due April 1.