March 03, 2014

Warner, Kaine Express Concerns Over Recent Changes To TRICARE

WASHINGTON, D.C. -- U.S. Senators Mark Warner and Tim Kaine joined 19 Senators and 30 Representatives to send the following letter to Secretary of Defense Chuck Hagel regarding a change to TRICARE's reimbursement policy that excludes more than 100 different Molecular Pathology Laboratory (MoPath) tests and other Laboratory Developed Tests (LDTs) with no notice to beneficiaries or to health care providers.

Despite such a large change in policy, which took place January 1, 2013, no notices were given to either beneficiaries or providers, and doctors continued to order the tests, while major laboratories shouldered the costs in hopes that the Defense Department would reverse the policy.

In their letter, the Senators highlight their concerns about how TRICARE's refusal of coverage will affect military families and patients.

"We are concerned that TRICARE's refusal of coverage and reimbursement for certain LDTs outside of a Military Treatment Facility (MTF) denies military families and patients access to care simply because they either choose to receive care at a civilian medical provider or are unable to access a MTF.  Additionally, it is concerning that TRICARE changed a reimbursement policy which may negatively impact a significant population of patients and military families.  It is our understanding that MoPath tests and other LDTs are standard practice of care for many providers."

They also ask Secretary Hagel to address several questions by March 14, 2014.

1. What are TRICARE's policies for providing a notification and public comment period for reimbursement policy changes impacting beneficiaries and the policies allowing for public and stakeholder comment to any such policy change?  Please explain in detail which if any of these policies and procedures were applied with respect to the change in TRICARE's reimbursement policy for certain MoPath tests and other LDTs.

2. What stakeholder input and feedback did TRICARE take into consideration, including from TRICARE patients and providers, to fully inform the reimbursement and coverage policy change made by your Department, including how this decision will affect patient access to care?

3. What is TRICARE's justification for denying coverage for LDTs for patients who receive care outside of a MTF, but continuing coverage and reimbursement for LDTs provided for patients who receive care within a MTF?

4. Does TRICARE have an appeals process for services that a physician determines are medically necessary for a specific patient, but are not covered under current TRICARE policy?  If so, please provide detailed information."

View the full letter below.

TRICARE letter

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