Lawmakers seek answers on Tricare reimbursement policy

Posted by Debi Teter

Burr-Hagan-question-Tricare-policy_mililtaryauthority.comA 2013 move by Tricare that compels beneficiaries to get certain kinds of medical testing from military treatment facilities rather than through civilian medical providers, has finally drawn the attention of lawmakers concerned that the change may limit beneficiaries’ access to the tests.

In early 2013, Tricare changed its reimbursement policy by discontinuing payment for certain molecular pathology laboratory tests and other laboratory developed tests (LDTs) which were obtained from civilian providers rather than a military treatment facility (MTF). Among the procedures in question are tests used to detect conditions and diseases that may develop during pregnancy, including cystic fibrosis, fragile X syndrome and spinal muscular dystrophy.

A letter signed by a bipartisan group of 51 senators and representatives was sent to Defense Secretary Chuck Hagel on Feb. 27. It states in part: “We are concerned that Tricare’s refusal of coverage and reimbursement for certain LDTs outside of a MTF denied military families and patients access to care simply because they either choose to receive care at a civilian medical provider or are unable to access a MTF.”

Headed by North Carolina Republican Sens. Richard Burr and Kay Hagan, the group expressed concerns that “Tricare arbitrarily changed a reimbursement policy which negatively impacts a significant population of patients and military families.”

The lawmakers also questioned whether beneficiaries and providers were properly notified of the change. The members have asked for details on how Tricare came to the decision to change the policy, whether beneficiaries and providers were provided with opportunities to comment and provide input on the new policy, and whether patient access to care was considered in making the decisions.

The lawmakers have asked for a response by March 14.


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