[Federal Register Volume 85, Number 209 (Wednesday, October 28, 2020)]
[Notices]
[Pages 68312-68314]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2020-23892]


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DEPARTMENT OF DEFENSE

Office of the Secretary


TRICARE; Notice of TRICARE Plan Program Changes for Calendar Year 
2021

AGENCY:  Office of the Secretary of Defense, Department of Defense 
(DoD).

ACTION: Notice.

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SUMMARY: This notice provides a notification of TRICARE Plan program 
changes for calendar year 2021. Changes or improvements to the TRICARE 
program benefits are provided in the supplementary information section.

DATES: TRICARE health plan information in this notice is valid for 
services during calendar year 2021 (January 1, 2021-December 31, 2021).

ADDRESSES: Defense Health Agency, TRICARE Health Plan, 7700 Arlington 
Boulevard, Suite 5101, Falls Church, Virginia 22042-5101.

FOR FURTHER INFORMATION CONTACT: Mr. Mark A. Ellis, (703) 681-0039.

SUPPLEMENTARY INFORMATION: An interim final rule published in the 
Federal Register (FR) on September 29, 2017 (82 FR 45438-45461) 
established the requirement for the Director, Defense Health Agency, to 
provide a public notice to TRICARE program beneficiaries with a summary 
of changes to the TRICARE program each calendar year in connection with 
the open season enrollment period.

[[Page 68313]]

    The following changes or improvements to the TRICARE program 
benefits apply for calendar year 2021:
     Improving what's covered:
    Coronavirus Disease 2019 (COVID-19) Response:
    [rtarr8] The following three temporary changes were made effective 
May 12, 2020, for care and treatment within the United States (US) and 
effective March 10, 2020, for the TRICARE Overseas Program: Temporary 
audio-only telephonic office visits; temporary waiver of cost-shares, 
co-pays and deductibles for all covered in-network telehealth services 
(for Prime and Select beneficiaries); and temporary interstate and 
international licensing. These changes will expire when the President 
of the US declares the national emergency is terminated. Overseas 
termination date may vary from the US date and will be determined by 
the Assistant Secretary of Defense for Health Affairs.
    [rtarr8] Flexibility was added for reinstatement of coverage for 
TRICARE Reserve Select (TRS) by expanding the three-month window to 
reinstate coverage for a beneficiary due to a lapse in coverage to a 
five-month window. This is in effect until the termination of the state 
of national emergency.
    Screenings:
    [rtarr8] Effective January 1, 2020, Digital Breast Tomosynthesis 
(DBT) for Breast Cancer (BC) Screening is covered under the Provisional 
Coverage Program. This three-dimensional mammography DBT for BC 
screening may be covered annually instead of conventional two-
dimensional screening mammography. It is covered for all women 
beginning at age 40 and covered annually beginning at age 30 for women 
who have a 15 percent or greater lifetime risk of breast cancer. No 
pre-authorization is required.
    [rtarr8] Effective December 2, 2019, and covered under the TRICARE 
Basic Program, this change allows for the separate reimbursement of 
instrument-based vision screening for children age one to age six when 
provided by a physician other than an ophthalmologist or optometrist as 
part of a regular preventive office visit under the well-child care 
program. No pre-authorization is required.
    Mental Health:
    [rtarr8] The Autism Care Demonstration is focused on ensuring 
TRICARE beneficiaries diagnosed with autism spectrum disorder (ASD) and 
their families receive high-value care and services that will help them 
reach their maximum potential. During the COVID-19 period, DHA has 
authorized the temporary use of unlimited applied behavior analysis 
parent/training guidance (Current Procedural Terminology Code 97156) 
only via telehealth to ensure Military children diagnosed with ASD and 
their families continue to receive support during the crisis. This 
exception to policy allows parents to maintain elements of the 
treatment plan during the crisis, which has in many cases made 
provision of in- person services impossible or unsafe.
    [rtarr8] Effective March 5, 2019, but implemented in 2020, 
SpravatoTM is covered under the Basic Medical Program for treatment-
resistant depression. This drug is administered intra-nasally under the 
supervision of a TRICARE-authorized provider during an office visit. 
Pre-authorization under the medical benefit is required. Off-label use 
of Spravato is excluded.
    Demonstrations, Programs & Pilots:
    [rtarr8] The existing Laboratory Developed Test (LDT) demonstration 
ensuring beneficiaries continue to have access to safe and effective 
non-FDA approved LDTs has been extended for an additional three years. 
Additionally, TRICARE Overseas Program (TOP) beneficiaries may now 
receive tests covered under the LDT demonstration from either Clinical 
Laboratory Improvement Amendments of 1988-certified laboratories or 
laboratories otherwise approved by the TOP contractor in conjunction 
with specific government-directed standards.
    [rtarr8] Effective January 1, 2020, TRICARE implemented a three-
year Home Health Value-Based Purchasing demonstration designed to 
improve the quality and delivery of home health services by rewarding 
providers with incentive payments that give higher quality and more 
efficient care. This demonstration applies to home health agencies that 
provide services in the following nine states: Arizona, Florida, Iowa, 
Maryland, Massachusetts, Nebraska, North Carolina, Tennessee, and 
Washington.
    [rtarr8] Launched on May 1, 2020, the TRICARE Select Navigator 
Program provides a health care assistance service to certain covered 
beneficiaries enrolled in TRICARE Select using purchased care to 
improve health outcomes and patient experience for covered 
beneficiaries with complex medical conditions.
    [rtarr8] Humana Military continues to partner with Kaiser 
Permanente to offer care and coverage to TRICARE Prime eligible 
beneficiaries in the Atlanta, Georgia area through the TRICARE 
Accountable Care Pilot. The pilot began on January 1, 2020, and will 
continue through 2022.
    Other Significant Changes:
    [rtarr8] Effective January 1, 2020, and covered under the TRICARE 
Basic Medical Program, Continuous Glucose Monitor Systems (CGMS) are 
now covered for Type 2 diabetes in addition to Type 1 diabetes. Smart 
phones and watches used in conjunction with CGMS are not covered.
    [rtarr8] Effective November 21, 2019, and covered under the TRICARE 
Basic Medical Program, this benefit enhancement adds coverage for non- 
implantable bone conducting hearing devices for infants and toddlers 
who are too young (typically age 5 and younger) for implants. These 
devices are considered a prosthetic bridge to transplantation for 
patient whose skull development will not yet support an implant, and 
are also covered as prosthetic devices for Active Duty Family Members 
who meet criteria for hearing aid coverage. No preauthorization is 
required.
    [rtarr8] Effective April 16, 2020, TRICARE reimburses for care 
provided by Physical Therapist Assistants (PTAs) and Occupational 
Therapist Assistants (OTAs) who are supervised by physical therapists 
and occupational therapists, increasing the provider pool available to 
care for TRICARE beneficiaries.
    [rtarr8] A Move Away From Lower-Value-Care Interventions: (1) 
Vitamin D Screening for otherwise healthy/asymptomatic individuals is 
excluded as the screening has no impact on health outcomes. (2) 
Transcutaneous Electrical Nerve Stimulators are excluded for acute, 
subacute and chronic low back pain because there is increasing evidence 
that this treatment is not effective.
     Out-of-Pocket Costs:
    Certain beneficiary out-of-pocket costs (enrollment fees, premiums, 
catastrophic caps, deductibles, and copayments) are annually adjusted 
based on federal law and regulations, most notably by the annual 
retiree cost of living adjustment, or Cost of Living Adjustment (COLA). 
Currently there is a difference in copayments between those who joined 
the military before January 1, 2018, (Group A), and those who joined 
after that date (Group B). The retiree COLA will not be announced until 
mid-October 2020. As of August 31, 2020, the projected COLA increase is 
1.3 percent. Beneficiary out-of-pocket expenses impacted by the 2020 
COLA will be posted to the tricare.mil/changes web page before the 
start of TRICARE Open Season.
    Pharmacy Out-of-Pocket Expenses for CY 2021 remain the same. See 
table below for TRICARE Pharmacy out-of-pocket expenses that take 
effect on January 1, 2021.

[[Page 68314]]



                                                   Table 1--Pharmacy Copayments for Calendar Year 2021
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                                                                                      Copayment amount for   Copayment amount for   Copayment amount for
                                        Copayment amount for   Copayment amount for   a 90-day supply of a   a 90-day supply of a   a 90-day supply of a
                 Year                   a 30-day supply of a   a 30-day supply of a    mail order generic    mail order formulary     mail order non-
                                         retail generic is:    retail formulary is:           is:                    is:               formulary is:
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2021.................................                   $13                    $33                    $10                    $29                    $60
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     For more information, visit tricare.mil/changes or call 
your regional TRICARE contractor.

    Dated: October 22, 2020.
Aaron T. Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2020-23892 Filed 10-27-20; 8:45 am]
BILLING CODE 5001-06-P