New TRICARE Rule May ‘Risk the Health of Military Kids’

New TRICARE Rule May ‘Risk the Health of Military Kids’
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MOAA continued its efforts to protect military kids’ access to health care at children’s hospitals by spearheading a May 8 letter from The Military Coalition (TMC) outlining concerns about slashed TRICARE reimbursement rates.


TMC’s letter urges House and Senate Armed Services Committee leadership to protect access to pediatric specialty care by ensuring TRICARE provides fair and sustainable reimbursement to children’s hospitals.


“The demand for expert pediatric care already outstripped the supply near key military installations nationwide even before [the Defense Health Agency] finalized these reimbursement cuts,” the letter states. “This rule therefore has the potential to risk the health of military kids, harm quality of life for those serving our nation, and ultimately undermine mission readiness.”


[TAKE ACTION: Protect Military Families’ Access to Care at Children’s Hospitals]


TMC is a coalition of military and veterans service organizations representing a combined 5.5 million members. MOAA co-chairs TMC and many of its committees, including the health care committee.


‘World Class’ Care?

DoD leadership made its health care mission clear in a recent joint statement to the Senate Armed Services Committee: “For their willingness to lay their lives on the line, our promise to Service members is to provide world-class healthcare across the spectrum of care needs to Service members and their families.”


Providing this “world-class” care must include access to children’s hospitals – indispensable regional providers of pediatric specialty care that treat the most complex pediatric cases. There is no substitute for much of this care within military treatment facilities (MTFs) or civilian general hospitals.


However, access to pediatric specialty care is threatened by a recent TRICARE policy change which applies a Medicare reimbursement model (the outpatient prospective payment system, or OPPS) to outpatient care at children’s hospitals. Until now, TRICARE policy aligned with guidance from the Centers for Medicare & Medicaid Services (CMS) that protects children’s hospitals from OPPS-related reimbursement cuts in recognition of the higher cost structure for delivering pediatric specialty care stemming from higher staff-to-patient ratios, greater costs for supplies/equipment to treat preemies to fully grown teens, and other factors.


[RELATED: Graduation Season Brings Health Care Challenges for Military Families]


Similar to the slashed TRICARE retail pharmacy network, this is another example of a behind-the-scenes cut that could threaten access to care for TRICARE beneficiaries.


The impact is particularly pronounced in areas with a significant military presence – such as Colorado Springs, Colo., and Hampton Roads, Va. – that have become hubs for Exceptional Family Member Program (EFMP) families thanks to the pediatric specialty care available at nearby children’s hospitals.


With capacity constraints across the U.S. health care system, military families already report long wait times for many types of pediatric specialty care. If children’s hospitals must cut back on their services or limit the number of TRICARE patients seen, it will compound existing access problems for military families.


[RELATED: TRICARE Program Change Designed to Improve Care for New Moms, Moms-to-Be]


Access to appropriate care for military kids plays a vital role in supporting military readiness. We cannot allow reduced reimbursements to threaten access to vital specialty care provided by children’s hospitals.


Please join us by contacting your lawmakers and urging them to protect military kids’ access to this care.


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About the Author

Karen Ruedisueli
Karen Ruedisueli

Ruedisueli is MOAA’s Director of Government Relations for Health Affairs and also serves as co-chair of The Military Coalition’s (TMC) Health Care Committee. She spent six years with the National Military Family Association, advocating for families of the uniformed services with a focus on health care and military caregivers.