DoD Interim Rule for TRICARE Select
The Department of Defense (DoD) has released an interim rule implementing TRICARE Select, changes mandated by last year’s (FY2017) National Defense Authorization Act (NDAA-S. 2943, Public Law 114-328). These changes impact 9.4 million beneficiaries. TRICARE Select, which was established by congress, incorporates TRICARE Standard and TRICARE Extra. “The rule also sets up an automatic enrollment process, so on January 1 beneficiaries in Prime will automatically be enrolled in Prime or automatically be enrolled in Select if they are enrolled in Standard or Extra,” said Navy Vice Admiral Raquel Bono, Director of the Defense Health Agency (DHA). She continued stating “The rule also sets up an automatic enrollment process, so on January 1, beneficiaries in Prime will automatically be enrolled in Prime or automatically be enrolled in Select if they are enrolled in Standard or Extra.”
The agency will establish an annual open-season enrollment period that beneficiaries can participate in each year to choose their health care plans. The open season will run much like the Federal Employee Health Benefit program works and will be held at the same time.
The interim rule also outlines the guidelines for qualifying “life events” that would allow beneficiaries to make necessary changes outside the open season. Qualifying life events trigger a 90-day opportunity to enroll in or change TRICARE purchased care coverage for the rest of the calendar year. These changes include marital status, births, adoptions, changes in service status and so on.
Bono said 2018 will be a transition year, “During that time, enrollment changes will be available throughout the year as beneficiaries adjust to the new process. We will also be broadening access for beneficiaries by setting out the requirements that at least 85 percent of our beneficiaries have access to network providers in TRICARE Select.”
The agency will switch administration of the program from fiscal year to calendar year to streamline the combined changes mandated by the National Defense Authorization Act and the new contracts for beneficiaries.
Included in the rule for TRICARE Prime beneficiaries are new requirements for timely appointments and new access to care. Bono said, “For Select beneficiaries seeking care within our broader network, it offers access to no cost preventive services now available to Prime enrollees. The rule also means a conversion from the current cost share from a percentage to a fixed dollar amount,” she said.
National Executive Director Thomas Snee and Legislative Program Healthcare Advisor Bob Washington have attended numerous meetings with DHA to provide input and advice for implementing the changes mandated by the FY2017 NDAA.