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Requirement Expires for Tricare Standard Nonavailability Statements

American Forces Press Service

WASHINGTON, Jan. 23, 2004 – People covered by the Tricare Standard military health care plan no longer need approval from their military treatment facility to seek inpatient care at civilian hospitals.

The need to get a nonavailability statement before seeking civilian inpatient care expired Dec. 28 under a provision of the 2002 National Defense Authorization Act. A nonavailability statement indicates that care is not available from the military facility and authorizes care at a civilian facility.

An exception in the law continues the requirement for Tricare Standard beneficiaries to get a nonavailability statement before seeking nonemergency inpatient mental health care services. However, officials said, this applies only to beneficiaries who use Tricare Standard or Extra, who are not Medicare eligible, and who have no other health insurance that is primary to Tricare. DoD does not require preauthorization for Tricare beneficiary inpatient mental health care when Medicare is the primary payer.

"With this change in policy, beneficiaries now have the freedom to choose a military treatment facility or a civilian facility, without any extra paperwork," said Dr. William Winkenwerder Jr., assistant secretary of defense for health affairs. "However, I urge Tricare beneficiaries to still look to the military health system as their first choice for health care. because I believe the services we offer are second to none."

A military treatment facility may request a departmental waiver of the new policy in certain specific, but limited, circumstances. But those requests don't apply to maternity services, unless the affected beneficiary began her first prenatal visit before Dec. 28, officials said.

Any military treatment facility granted a waiver must publish a notice in the Federal Register that a nonavailability statement is required for a certain procedure; the treatment facility, the services and the Tricare Management Activity will notify the affected beneficiaries if this occurs, officials said. Maternity patients should check with their local military treatment facility to compare maternity services there with those available in civilian facilities, Military Health System officials said.

A recently implemented "Family-Centered Care" program offers enhanced services and recognizes the unique needs of military families in today's climate of increasing deployments and high operations tempo, officials said. Beneficiaries can review the enhanced military treatment facility maternity services online and with their military medical care provider.

Beneficiaries can check the Tricare Web site if they are seeking an inpatient service and want to know if their nearby military treatment facility applied for a nonavailability statement waiver. They also may contact the beneficiary counseling and assistance coordinator or health benefits adviser at their nearest treatment facility, officials said.

Before seeking care at a civilian facility, military health system officials urge beneficiaries to check with their nearby military treatment facility to compare services and ask questions. Even if the facility could not provide the needed services in the past, the facility's staffing levels or capabilities may have changed, and they might now be available, officials said.

(Compiled from a Tricare news release.)

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Biographies:
Dr. William Winkenwerder Jr.

Related Sites:
Tricare
Military Health System
Military Treatment Facility Family Care Program



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