COVID-19 Emergency Periods End: Impacts to TRICARE
Tuesday, May 16, 2023
Please review these important TRICARE policy updates resulting from the expiration of the President’s and U.S. Department of Health and Human Services (HHS) COVID-19 emergency periods:
As of April 11, 2023 (due to the end of the President’s national emergency period on April 10):
- Treatment use of investigational drugs: TRICARE will no longer cover investigational drugs under FDA-approved expanded access programs for the treatment of COVID‐19 or associated conditions.
- Skilled nursing facility (SNF) three‐day prior hospital stay requirement: The requirement for a qualifying hospital stay of three consecutive days or more prior to a SNF admission is no longer waived.
- Provider licensure flexibilities: Providers must again be licensed in the state where practicing and where the patient resides.
- COVID-19 clinical trials: TRICARE will no longer cover National Institute of Allergy and Infectious Disease (NIAID)-sponsored COVID-19 clinical trials. 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 so long as TRICARE requirements are met.
As of May 12, 2023 (due to the end of HHS’ Public Health Emergency on May 11):
- COVID-19 testing cost-shares: TRICARE will no longer waive cost-shares for medically necessary COVID-19 testing. Normal cost-sharing will apply.
- Coverage of temporary hospitals: With the expiration of Medicare’s Hospitals without Walls initiative, facilities will again have to meet all requirements of Title 32, Code of Federal Regulations, Part 199.6(b).
- Temporary payment adjustment on inpatient claims for COVID‐19 patients: Reimbursement for inpatient claims for COVID-19/coronavirus patients will no longer reflect the temporary 20% increase to the diagnosis-related group (DRG) weighted rate.
- Long-term care hospital (LTCH) reimbursement: Claims for LTCH admissions will be reimbursed at the site-neutral payment rate instead of the LTCH prospective payment system (PPS) standard federal rate.
Note: Intensive outpatient programs, medication assistance treatment, and opioid treatment programs may continue to be rendered via telemedicine when medically necessary or appropriate and within the scope of the provider’s license. The Drug Enforcement Administration will allow for the prescription of controlled medications via telemedicine through Nov. 11, 2023, or through Nov. 11, 2024, if the practitioner-patient telemedicine relationship was established on or before Nov. 11, 2023.