[Federal Register Volume 86, Number 180 (Tuesday, September 21, 2021)]
[Notices]
[Pages 52448-52450]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-20309]
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DEPARTMENT OF DEFENSE
Office of the Secretary
TRICARE; Notice of TRICARE Plan Program Changes for Calendar Year
2022
AGENCY: Office of the Secretary of Defense, Department of Defense
(DoD).
ACTION: TRICARE Plan Program Changes for Calendar Year 2022.
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SUMMARY: This notice provides information regarding TRICARE Plan
program changes for calendar year 2022.
DATES: TRICARE health plan information in this notice is valid for
services during calendar year 2022 (January 1, 2022-December 31, 2022).
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ADDRESSES: Defense Health Agency, TRICARE Health Plan, 7700 Arlington
Boulevard, Suite 5101, Falls Church, Virginia 22042-5101.
FOR FURTHER INFORMATION CONTACT: Ms. Elan P. Green, Defense Health
Agency, TRICARE Health Plan, email: [email protected], phone:
(303) 676-3907.
SUPPLEMENTARY INFORMATION: An interim final rule published in the
Federal Register (FR) on September 29, 2017 (82 FR 45438-45461)
established the requirement for the Director, Defense Health Agency, to
provide a public notice to TRICARE program beneficiaries with a summary
of changes to the TRICARE program each calendar year in connection with
the open season enrollment period.
The following changes or improvements to the TRICARE program
benefits apply for calendar year 2022:
Announcement of Open Season
Open Season is an annual period when you can enroll in or make
changes to your coverage for the next year. TRICARE and Federal
Employee Dental and Vision Insurance Program (FEDVIP) Open Season for
Calendar Year (CY) 2021 occurs November 8-December 13, 2021.
TRICARE Open Season: During TRICARE Open Season you can enroll in
or change your TRICARE Prime or TRICARE Select plan.
FEDVIP Open Season: FEDVIP Open Season is to enroll in or make
changes to your dental and vision plans. Dental plans are offered by
ten different carriers to eligible retirees and their family members
and vision plans are offered by four different carriers to
beneficiaries who have TRICARE coverage, including TRICARE for Life.
Any changes you make will take effect on January 1, 2022. If you
remain eligible and do not make any changes during Open Season, then
you will stay in the same plan for 2022. Improving what's covered:
Coronavirus Disease 2022 (COVID-19) Response
In regards to COVID-19 vaccination, although there is no separate
copayment or cost-share for clinical preventive services, there may be
a copayment, cost-share, or point of service (POS) charge if the
vaccine is administered as part of a primary or specialty care visit
for a reason other than preventive care or for other services received
during the office visit.
Due to the widespread need for COVID-19 vaccines and the
possibility that one day these vaccines may not be free-of-charge, on
February 23, 2021, a notice was published in the Federal Register (86
FR 10942) advising TRICARE Prime enrollees, not including Active Duty
Service Members (ADSMs), of a temporary waiver to the referral
requirement 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.
The effective date of the waiver was December 13, 2020. This waiver
will expire when the President of the United States (US) declares the
national emergency is terminated.
The following three temporary changes for care and treatment
continue to be effective as of May 12, 2020, for care and treatment
within the US and effective March 10, 2020, for the TRICARE Overseas
Program: Temporary audio-only telephonic office visits; temporary
waiver of cost-shares, co-pays and deductibles for all covered in-
network telehealth services (for Prime and Select beneficiaries); and
temporary interstate and international licensing. These changes will
expire when the President of the US declares the national emergency is
terminated, unless terminated, extended, or otherwise modified in a
final rule published to the Federal Register. Overseas termination date
may vary from the US date and will be determined by the Assistant
Secretary of Defense for Health Affairs.
The following temporary changes were made and continue to be
effective as of September 3, 2020, for care and treatment in the US and
effective March 10, 2020, for the TRICARE Overseas Program: Temporary
coverage of the treatment use of investigational drugs under expanded
access for the treatment of COVID-19 and temporary coverage of
temporary hospitals. This change will expire when the President of the
US declares the national emergency is terminated, unless terminated,
extended, or otherwise modified in a final rule published to the
Federal Register.
Effective October 30, 2020, TRICARE temporarily covers National
Institute for Allergy and Infectious Disease (NIAID) sponsored clinical
trials when for the treatment or prevention of COVID-19. This change
will expire when the President of the US declares the national
emergency has terminated, unless terminated, extended, or otherwise
modified in a final rule published to the Federal Register. A TRICARE
beneficiary who is already enrolled in a NIAID-sponsored clinical trial
prior to the end of the President's national emergency for COVID-19
will continue to have their care cost-shared through the end of the
clinical trial.
Effective January 1, 2021, Transitional Assistant Management
Program benefits are extended to National Guard members who have served
more than thirty continuous days in support of the COVID-19 mission.
Screenings
Effective March 9, 2021, the United States Preventive Services Task
Force (USPSTF) updated its annual screening recommendation for lung
cancer performed through low-dose computer tomography so it is now
covered for adults beginning at age fifty to eighty who have a 20 pack-
per year smoking history and currently smoke or have quit within the
past fifteen years instead of beginning at age fifty-five and only for
those with a 30 pack per year smoking history.
Effective May 18, 2021, the USPSTF updated its annual screening
recommendation for colorectal cancer for adults at average risk so they
may now begin screening at age forty-five instead of beginning at age
fifty.
Demonstrations, Programs & Pilots
Buckley Prime Service Area (PSA) Pilot. Health Net Federal Services
launched a new value-based care pilot beginning January 1, 2021.
Beneficiaries who live in the Buckley PSA and are enrolled in TRICARE
Prime with a civilian primary care manager are automatically part of
the pilot. The Buckley PSA Pilot is expected to run through December
31, 2022.
Childbirth and Breastfeeding Support Demonstration. Congress
required the Department of Defense (DoD) to conduct a demonstration
project beginning no later than January 1, 2022, to cover the services
of doulas and lactation consultants/counselors not otherwise authorized
under TRICARE. This demonstration project will run for five years,
through December 31, 2026.
Planned Changes
Urgent Care Referrals: There is no limit to the number of urgent
care visits that a Prime beneficiary (except for most Active Duty
members) may receive without a referral. You can receive urgent care
from any TRICARE authorized urgent care center (UCC) or network
provider. If the enrollee seeks care from a non-network provider
(except a TRICARE-authorized UCC), the usual POS deductible and cost-
shares shall apply. The Department has no current plans to change this
policy but in order to evaluate its ongoing
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appropriateness, it remains a year-by-year determination.
Prime Service Area Changes: There is no change to locations where
TRICARE Prime will be offered. TRICARE Prime locations are a year-to-
year determination and will be announced prior to the annual Open
Season enrollment period.
Enrollment Fee Payment by Allotment: TRICARE retirees and their
family members must pay enrollment fees by allotment, where feasible.
Payment by allotment is not required if a beneficiary does not receive
retired pay (e.g., unremarried former spouses, survivors) or the
retired pay does not cover the monthly enrollment fee amount.
Effective December 17, 2020, Doctors of Podiatric Medicine or
Podiatrists may prescribe physical therapy (PT) and occupational
therapy (OT).
Effective February 24, 2021, ablative fractional laser treatment
for symptomatic scars resulting from burns and other trauma is covered
for up to five-years.
Added coverage of remote physiologic monitoring for chronic and
acute conditions, including but not limited to weight, blood pressure,
pulse oximetry, and respiratory flow monitoring.
For more information, visit tricare.mil/changes or call your
regional TRICARE contractor.
Appendix A
Certain beneficiary out-of-pocket costs (enrollment fees,
premiums, catastrophic caps, deductibles, and copayments) are
annually adjusted based on federal law and regulations, most notably
by the annual retiree cost of living adjustment, or Cost of Living
Adjustment (COLA). Currently, there is a difference in copayments
between those who joined the military before January 1, 2018, (Group
A), and those who joined after that date (Group B). The retiree COLA
will not be announced until mid-October 2021. As of June 2021, the
projected COLA increase is 5.1 percent. Beneficiary out-of-pocket
expenses impacted by the 2022 COLA will be posted to the
tricare.mil/changes web page before the start of TRICARE Open
Season, November 8, 2021 to December 13, 2021.
Pharmacy Out-of-Pocket Expenses for CY 2022
TRICARE Pharmacy out-of-pocket expenses are listed in the table
below that take effect on January 1, 2022.
Table 1--Pharmacy Copayments for Calendar Year 2022
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Copayment amount Copayment amount Copayment amount Copayment amount Copayment amount
for a 30-day supply for a 30-day supply for a 90-day supply for a 90-day supply for a 90-day supply
Year of a retail generic of a retail of a mail order of a mail order of a mail order non-
is: formulary is: generic is: formulary is: formulary is:
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2022........................................... $14 $38 $12 $34 $68
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Dated: September 13, 2021.
Aaron T. Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2021-20309 Filed 9-20-21; 8:45 am]
BILLING CODE 5001-06-P