TRICARE covers the use of secure video conferencing to provide medically and psychologically necessary services to beneficiaries at home. Specific technical requirements, outlined in TRICARE Policy Manual, Chapter 7, Section 22.1, must be met.
Note: Christian Science services are excluded from the telehealth benefit. To be considered for coverage under TRICARE, the beneficiary must be physically present when a Christian Science service is rendered.
Provider Licensing during COVID-19 Pandemic
Effective May 12, 2020, TRICARE expanded its telemedicine policy to allow TRICARE-authorized providers to render services across state lines as long as they comply with interstate policy in the state the beneficiary is receiving care. This temporary change does not replace state authority to regulate licensure, but assures providers who are in compliance with applicable state or federal law that they will be eligible for reimbursement under TRICARE when caring for beneficiaries during the COVID-19 pandemic. Providers must practice within the scope of their licensure (including temporary licenses) and maintain copies for claims auditing purposes.
Exception: Applied behavior analysis (ABA) providers are authorized under a demonstration authority, not the 32 Code of Federal Regulations, 199.6. As such, ABA providers must continue to comply with telemedicine guidelines outlined in TRICARE Policy Manual, Chapter 7, Section 22.1.
Audio-Only and Audio/Video Telehealth
Telehealth services may be synchronous (two-way audio and video, such as real-time video) or asynchronous (one direction at a time, such as submitting medical history from one party to another).
In response to COVID-19, TRICARE will allow for audio-only telehealth for medically or psychologically necessary office visits. Audio-only telehealth can be for provider-to-patient care or for clinical consultations between providers that is specific to a patient’s care. Providers should document in the medical records why audio only was chosen in lieu of an audio/video combination. Audio-only telehealth should not be used for care that normally requires a physical examination or a visual evaluation.
- Exception: Audio-only services are not allowed under the Autism Care Demonstration. Parent/caregiver guidance performed via telemedicine must be rendered using audio AND video platforms.
Telemedicine services do not include texting.
Services provided via telemedicine follow the same approval criteria and limitations that apply to in-person medical and psychological services. You do not need a new or separate approval to render already-authorized services via telemedicine.
Copayments and Cost-Shares
TRICARE is waiving copayments and cost-shares for covered audio-only or video telemedicine rendered by network providers on or after May 12, 2020. This waiver applies to covered in-network telehealth services, not just services related to COVID-19. Beneficiaries who seek telehealth from non-network providers are liable for their regular copayment or cost-share. TRICARE Prime beneficiaries who seek care from specialists without an approved referral when required are subject to Point of Service fees.
In response to the COVID-19 pandemic, the Defense Health Agency (DHA) is temporarily expanding telemedicine for specific benefits.
Video Conferencing Platforms
Video conferencing platforms used for telemedicine services must have the appropriate verification, confidentiality, and security parameters necessary to be properly utilized for this purpose and must meet the requirements of the Health Insurance Portability and Accountability Act (HIPAA). Video-chat applications (for example, Skype and Facetime) may not meet such requirements and should not be used unless appropriate measures are taken to ensure the application meets these requirements and that appropriate business associates agreements (if necessary) are in place to utilize such applications for telemedicine.
Telemedicine services provided through personal computers or mobile devices that use internet-based videoconferencing software programs must provide such services at a bandwidth and with sufficient resolutions to ensure the quality of the image and/or audio received is sufficient for the type of telemedicine services being delivered.
Privacy and Security
- Providers shall ensure audio and video transmissions used are secured using point-to-point encryption that meets recognized standards.
- Providers shall not utilize videoconference software that allows multiple concurrent sessions to be opened by a single user.
- Protected Health Information (PHI) and other confidential data shall only be backed up to or stored on secure data storage locations that have been approved for this purpose.
View the TRICARE Policy Manual, Chapter 7, Section 22.1 for additional information.