TRICARE; Notice of TRICARE Plan Program Changes for Calendar Year 2023, 65195-65197 [2022-23465]

Agencies

• DEPARTMENT OF DEFENSE
• Office of the Secretary

[Federal Register Volume 87, Number 208 (Friday, October 28, 2022)]
[Notices]
[Pages 65195-65197]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2022-23465]


=======================================================================
-----------------------------------------------------------------------

DEPARTMENT OF DEFENSE

Office of the Secretary


TRICARE; Notice of TRICARE Plan Program Changes for Calendar Year 
2023

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

ACTION: TRICARE plan program changes for calendar year 2023.

-----------------------------------------------------------------------

SUMMARY: This notice provides information regarding TRICARE plan 
program changes for Calendar Year 2023.

DATES: TRICARE health plan information in this notice is valid for 
services during calendar year (CY) 2023 (January 1, 2023-December 31, 
2023).

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

FOR FURTHER INFORMATION CONTACT: Ms. Debra Fisher, (703) 275-6224.

SUPPLEMENTARY INFORMATION: A final rule published in the Federal 
Register (FR) on February 15, 2019 (84 FR 4326-4333) established the 
requirement for the Director, Defense Health Agency (DHA), to provide 
public notice to TRICARE program beneficiaries with a summary of 
changes to the TRICARE program each calendar year in connection with 
the annual open season enrollment period.

Announcement of Open Season

    Open Season is an annual period when beneficiaries can enroll in or 
make changes to their healthcare, dental and vision coverage for the 
next calendar year.
    The TRICARE Open Season runs from November 14, 2022, through 
December 13, 2022, during which time beneficiaries can enroll in or 
change their TRICARE Prime or TRICARE Select plan.
    The Federal Employee Dental and Vision Insurance Program (FEDVIP) 
Open Season runs from November 14, 2022, through December 12, 2022. The 
U.S. Office of Personnel Management offers FEDVIP enrollment to 
qualified beneficiaries of the Military Health System, including 
TRICARE for Life beneficiaries. During the FEDVIP Open Season 
beneficiaries may enroll in or make changes to their dental and vision 
plans.
    Any changes beneficiaries make during open season will take effect 
on January 1, 2023. If a beneficiary remains eligible and does not make 
any changes during Open Season, then their coverage will stay the same 
for 2023.

Annual Announcements

    The following TRICARE program features are subject to a year-to-
year determination and are announced each year prior to the annual 
TRICARE Open Season.
    Urgent Care Visits: Except for most Active Duty Service members, 
there continues to be no limit to the number of urgent care visits a 
TRICARE Prime enrollee may receive without a referral for Plan Year 
2023. They may receive urgent care from any TRICARE-authorized urgent 
care center (UCC), either network or non-network. They may also receive 
urgent care from any TRICARE network provider. If the TRICARE Prime 
enrollee seeks care from a non-network TRICARE authorized provider 
(outside of a TRICARE-authorized UCC), the usual TRICARE Prime Point of 
Service deductible and cost-shares shall apply. Beneficiaries may also 
call the Military Health System Nurse Advice Line (NAL) for health care 
guidance from a specially trained registered nurse. The NAL is 
available 24/7 to all TRICARE beneficiaries in the United States (U.S.) 
except those enrolled in the US Family Health Plan. Beneficiaries who 
live overseas can call the NAL for health care advice when traveling in 
the U.S., but must coordinate care with their Overseas Regional Call 
Center. For additional information, call the servicing TRICARE 
contractor or visit https://www.tricare.mil/ContactUs/CallUs/NAL.
    Prime Service Area Changes: Prime Service Areas (PSAs) are 
geographic areas around military Medical Treatment Facilities and Base 
Realignment and Closure sites. PSAs ensure medical readiness of active 
duty members by adding to the capability and capacity of military 
hospitals and

[[Page 65196]]

clinics. There is no change to geographic locations where TRICARE Prime 
will be offered.
    Coronavirus Disease 2023 (COVID-19) Continued Response: A temporary 
waiver to the referral requirement remains in effect for TRICARE Prime 
enrollees, not including Active Duty Service Members (ADSMs), so they 
may receive COVID-19 vaccines, a clinical preventive service, from any 
TRICARE Basic (medical) program authorized non-network provider without 
incurring POS charges where applicable. This waiver will expire when 
the President of the United States declares the national emergency is 
terminated. As part of the COVID-19 response, the following temporary 
changes for care and treatment continue to be in effect: temporary 
coverage of the treatment use of investigational drugs under expanded 
access when for the treatment of COVID-19; temporary coverage of 
National Institute for Allergy and Infectious Disease (NIAID) sponsored 
clinical trials when for the prevention or treatment of COVID-19 or its 
associated sequalae; temporary interstate and international licensing, 
which allows the temporary waiver of licensing requirements for 
providers practicing (both in person and via telehealth) in a state or 
host-nation in which they are not licensed, when licensed in another 
state or nation and such practice is permitted by state, federal, or 
host-nation law; and temporary coverage of temporary facilities 
registered with Medicare's Hospitals Without Walls initiative. These 
temporary changes remain in effect until the President of the United 
States issues a declaration that the Public Health Emergency has 
terminated, unless terminated, extended, or otherwise modified in a 
final rule published in the Federal Register.

What's New

    The following changes or improvements to the TRICARE program 
benefits apply to calendar year 2023 (although, some changes were 
implemented in 2022):
    Telephonic Office Visit: Introduced during the COVID-19 pandemic, 
the telephonic office visit (audio-only telehealth) benefit was made 
permanent for all TRICARE enrollees effective July 1, 2022. A 
telephonic office visit is a TRICARE-covered service provided via a 
telephone call between an established TRICARE patient and his or her 
TRICARE-authorized provider. TRICARE can cover telephonic office visits 
for otherwise covered medically necessary and appropriate care that 
does not require face-to-face, hands-on treatment or visual evaluation. 
However, not all TRICARE covered services are appropriate for 
telephonic office visits. For example, evaluation of a skin lesion 
would require visual evaluation that cannot be completed via a 
telephone-only visit. Similarly, the services rendered through an 
intensive outpatient program would likewise be inappropriate to 
administer via telephone only. Another example, removal of a cast, 
would require hands-on treatment and would not be suitable for a 
telephonic visit.
    Female Contraception and Sterilization: Active Duty service Members 
and TRICARE health plan enrollees enjoy access to a comprehensive range 
of contraceptive care under the TRICARE Program. Effective July 28, 
2022, DHA eliminated cost-shares and copayments for reversible medical 
contraceptives as preventive services under TRICARE Prime and TRICARE 
Select. Reversible medical contraceptives include the FDA-approved 
implant, shot, and intrauterine devices. Beneficiaries can request 
refunds from their servicing TRICARE contractor on or after October 17, 
2022, for any cost-share or copayment paid for these services performed 
on or after the effective date of July 28, 2022. DHA cannot eliminate 
cost-shares and/or copayments for daily use prescription birth control 
pills because TRICARE Pharmacy Program cost-sharing is mandated by law.
    However, effective January 1, 2023, TRICARE Prime and Select 
beneficiaries seeking female surgical sterilization services (i.e., 
surgical procedure where the fallopian tubes are cut, tied, or blocked 
to permanently prevent pregnancy) will also enjoy cost-share and 
copayment free access to these preventive services when performed by a 
TRICARE network provider.

Comprehensive Autism Care Demonstration

    The Comprehensive Autism Care Demonstration (ACD) for Applied 
Behavior Analysis (ABA) services for TRICARE beneficiaries diagnosed 
with Autism Spectrum Disorder (ASD) has been extended through December 
31, 2028. The ACD renders clinically necessary and appropriate ABA 
services for the core symptoms of ASD.

Planned Changes

    Effective January 1, 2023, the annual premium increase for 
Continued Health Care Benefit Program (CHCBP) will transition from a 
Fiscal Year basis (October 1 each year) to a Calendar Year basis 
(January 1 each year). This change aligns CHCBP with the premium-based 
TRICARE health plans for uniformity in premium collections and reduces 
complexity for beneficiaries.
    For more information, visit tricare.mil/changes or call the 
servicing TRICARE contractor.

Appendix A

    Certain TRICARE enrollee out-of-pocket costs (enrollment fees, 
premiums, catastrophic caps, deductibles, and copayments) are adjusted 
annually by Federal law and regulations based on the annual Cost of 
Living Adjustment (COLA) applied to Uniformed Service member retired 
pay. A difference in copayments remains between those who joined a 
Uniformed Service before January 1, 2018 (Group A), and those who 
joined on or after that date (Group B).
    The retiree COLA was announced October 2022. The COLA increase was 
8.7 percent. Beneficiary out-of-pocket expenses impacted by the 2023 
COLA will be posted to the tricare.mil/changes web page before TRICARE 
Open Season starts November 14, 2022.

                                         Premiums for Calendar Year 2023
----------------------------------------------------------------------------------------------------------------
                                        TRICARE Reserve Select  TRICARE Retired Reserve   Continued Health Care
      TRICARE Young Adult (TYA)                 (TRS)                    (TRR)           Benefit Program (CHCBP)
----------------------------------------------------------------------------------------------------------------
TYA Prime Individual $570.00 monthly.  TRS Member-Only $48.47   TRR Member-Only $549.35  CHCBP Single $1,654.00
                                        monthly.                 monthly.                 quarterly
TYA Select Individual $291.00 monthly  TRS Member & Family      TRR Member & Family      CHCBP Family $4,134.00
                                        $239.69 monthly.         $1,320.76 monthly.       quarterly
----------------------------------------------------------------------------------------------------------------


[[Page 65197]]

Pharmacy Out-of-Pocket Expenses for CY 2023

    TRICARE Pharmacy copayments continue January 1, 2023 unchanged from 
2022:

                                                      Pharmacy Copayments for Calendar Year 2023 *
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                            Retail network                                               Mail order &
                                                        Retail network        brand-name      Mail order generic  Mail order  brand-    retail network
                        Year                          generic  formulary   formulary 30-day     formulary 90-day  name  formulary 90-  non-formulary 90-
                                                         30-day supply          supply              supply            day supply          day supply
--------------------------------------------------------------------------------------------------------------------------------------------------------
2023................................................                $14                 $38                 $12                 $34              $68 **
--------------------------------------------------------------------------------------------------------------------------------------------------------
* Active Duty Service Members enjoy a $0 copay for covered drugs at any pharmacy.
** For all beneficiaries except active duty service members, select brand-name maintenance medications (taken for long-term conditions) may only be
  filled twice at retail and then must be filled via home delivery or military pharmacy.


    Dated: October 24, 2022.
Aaron T. Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2022-23465 Filed 10-27-22; 8:45 am]
BILLING CODE 5001-06-P