DoD Releases Interim Final Rule Telehealth TRICARE

The Department of Defense (DoD) issued an Interim Final Rule (IFR) on Friday, May 8, 2020, that provides additional flexibilities for telehealth services. Prior to the IFR, TRICARE had some limitations on telehealth that made it difficult for beneficiaries to access services during the public health emergency (PHE). The IFR acknowledged those limitations and enumerated a few key flexibilities that are meant to ease those hardships and prevent further spread of COVID-19.

The flexibilities permitted during the PHE include:

1. Allowing providers to deliver care via telehealth to beneficiaries wherever they are located without meeting TRICARE’s current requirement that providers to be licensed in the state where services were both provided and received. This change permits authorized TRICARE providers to be reimbursed for services provided to beneficiaries if the provider holds an equivalent license from any state. However, practitioners must still adhere to applicable state or federal law, comply with any provisions for interstate practice in the state, and not be barred or restricted from practice in any state. It should be noted that this temporary change does not override a state’s ability to regulate licensure, but rather allows practitioners to be reimbursed for telehealth services if the licensure requirements are relaxed in any state or by the federal government. Similarly, this flexibility would also be extended to beneficiaries who are overseas, if allowed by the host country.
2. Providing an exception to the prohibition of audio-only telehealth services to TRICARE beneficiaries during the PHE. In order to limit exposure to COVID-19, TRICARE will permit audio-only services “for the purpose of providing assessment, diagnosis, clinical care, or formal patient education from an authorized provider…” where audio-visual communication is not possible. The services provided must be a covered benefit under TRICARE and must be medically necessary. Because occupational therapy is a TRICARE covered benefit, occupational therapy practitioners must use their clinical judgment to determine whether audio-only is appropriate, and they should document the reasons for audio-only provision of services. The DoD will provide additional guidance for audio-only encounters.
3. Waiving cost-sharing (including deductibles) and copayments for in-network, authorized telehealth services for the duration of the PHE. The hope is that this will incentivize TRICARE beneficiaries to use telehealth services whenever possible to limit exposure to and spread of COVID-19.

These temporary changes are only in effect during the PHE. However, the DoD may make the provision of audio-only telehealth services a permanent change after reviewing benefits, risks, and costs to the program, among other considerations. Practitioners should thoroughly review state licensure requirements for telehealth, including temporary COVID-19 accommodations, in the state where a beneficiary is located before proceeding with providing services via telehealth. It is important to document that the telehealth services meet the beneficiary’s needs and preferences and are consistent with the plan of care.

Comments are due on June 11, 2020, at www.regulations.gov. AOTA will submit a comment letter supporting these TRICARE flexibilities, and we also encourage practitioners to write comments to demonstrate their support for this policy during the PHE period, including examples of interventions utilized and how they contributed to good patient outcomes in the context of the PHE.