TRICARE RELEASES DETAILS OF URGENT CARE PILOT
May 2, 2016
On April 12, the Defense Health Agency (DHA) released details of a congressionally mandated three year pilot program that will determine if the requirement to obtain a referral influences where TRICARE beneficiaries seek care for non-emergency conditions. Specifically, the law directs the DHA to implement a pilot that allows TRICARE beneficiaries to access urgent care centers without pre-authorization.
Currently, DHA requires that TRICARE Prime enrollees obtain a referral for primary or urgent care if they seek that care from someone other than their primary care manager. Because seeking emergency care in an emergency department does not require authorization and because access to primary health care for acute episodic primary care continues to be in high demand, TRICARE enrollees often seek care in the emergency department for non-emergent reasons at a higher cost to the system.
Under the pilot:
UCAOA is in the process of acquiring details on how DHA will authorize urgent care center providers under the pilot. However, what is known is that for referral authorizations to be waived, providers from which the TRICARE beneficiary seeks care must have one of the following primary specialty designations:
Obstetricians/gynecologists, physician assistants, nurse practitioners, and certified nurse midwives can be considered primary care providers and may be designated primary care managers.
The pilot will begin May 23, 2016, and will continue until May 23, 2019.
Last year, UCAOA lobbied Congress in support of the urgent care pilot and met with DHA officials in January. To read about it, see the original post on the UCAOA website.