[Federal Register Volume 88, Number 197 (Friday, October 13, 2023)]
[Notices]
[Pages 70959-70961]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-22790]


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DEPARTMENT OF DEFENSE

Office of the Secretary


TRICARE; Notice of TRICARE Plan Program Changes for Calendar Year 
(CY) 2024

AGENCY: Office of the Secretary of Defense, Department of Defense 
(DoD).

ACTION: Notice; TRICARE plan program changes for CY 2024.

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SUMMARY: This notice provides information regarding TRICARE Plan 
Program Changes for CY 2024.

DATES: TRICARE health plan information in this notice is valid for 
services during CY 2024 (January 1, 2024-December 31, 2024).

ADDRESSES: Defense Health Agency, TRICARE Health Plan Division, 7700 
Arlington Boulevard, Suite 5101, Falls Church, Virginia 22042-5101.

FOR FURTHER INFORMATION CONTACT: Ms. Debra Fisher, phone: (703) 275-
6224.

SUPPLEMENTARY INFORMATION: A final rule published in the Federal 
Register (FR) on February 15, 2019, (84 FR 4326-4333) that established 
the requirement for the Director, Defense Health Agency (DHA), to 
provide public notice to Military Health System (MHS) beneficiaries 
each calendar year in connection with the annual open season enrollment 
period with a summary of changes to the TRICARE program. The following 
changes or improvements to the TRICARE program benefits apply for CY 
2024.

Announcement of Open Season

    Open Season is an annual period when beneficiaries can enroll in or 
make changes to their healthcare, dental, and vision coverage for the 
next calendar year.
    During the TRICARE Open Season that runs from November 13, 2023, 
through December 12, 2023, qualified MHS beneficiaries may enroll in or 
change their TRICARE Prime or TRICARE Select plan.
    During the Federal Employee Dental and Vision Insurance Program 
(FEDVIP) Open Season that runs from November 13, 2023, through December 
11, 2023, qualified MHS beneficiaries, including TRICARE for Life 
beneficiaries, may enroll in or make changes to their dental and vision 
plans. FEDVIP is operated by the U.S. Office of Personnel Management.
    Any changes MHS beneficiaries make during Open Season will take 
effect on January 1, 2024. If a beneficiary remains eligible and does 
not make any changes during Open Season, then their coverage will stay 
the same for 2024. TRICARE enrollees can ensure they receive important 
health plan information by promptly listing any change in address and 
other information in the Defense Enrollment Eligibility Reporting 
System (DEERS).

Annual Announcements

    The following TRICARE program features are subject to a year-to-
year determination and are announced each year prior to the annual 
TRICARE Open Season.
    Urgent Care Visits: There continues to be no limit to the number of 
urgent care visits a covered beneficiary enrolled in TRICARE Prime may 
receive without a referral for Plan Year 2024. They may receive urgent 
care from any TRICARE-authorized urgent care center (UCC), either 
network or non-network, without a referral. They may also receive 
urgent care from any TRICARE network provider. If the TRICARE Prime 
enrollee seeks care from a non-network TRICARE authorized provider 
(outside of a TRICARE-authorized UCC), the usual TRICARE Prime Point of 
Service (POS) deductible and cost-shares shall apply. Private Sector 
care for Active Duty Service Members is subject to different rules. 
Covered beneficiaries who want assistance on decisions to seek urgent 
care in the United States (U.S.), except those enrolled in the 
Uniformed Services Family Health Plan (USFHP), may call the MHS Nurse 
Advice Line (NAL) for health care guidance from a specially trained 
registered nurse. The NAL is available 24/7 to all non-USFHP TRICARE 
beneficiaries. Beneficiaries who live overseas can call the NAL for 
health care advice when traveling in the U.S. but must coordinate care 
with their Overseas Regional Call Center. For additional information, 
call the servicing TRICARE contractor or visit https://www.tricare.mil/ContactUs and click on ``MHS Nurse Advice Line.''
    Prime Service Area Changes: Prime Service Areas (PSAs) are 
geographic areas around military medical treatment facilities and Base 
Realignment and Closure sites. PSAs support the medical readiness of 
active duty members of the Uniformed Services by adding to the 
capability and capacity of military hospitals and clinics. There are no 
changes to the existing PSAs for CY 2024.

[[Page 70960]]

What's New

    The following changes or improvements to the TRICARE program 
benefits apply to CY 2024 (although some changes were implemented in 
2023):
    Elimination of Cost-Sharing for Female Tubal Sterilization as 
Preventive Care: Effective January 1, 2023, TRICARE eliminated cost-
sharing for female tubal sterilization as a preventive service when it 
is performed by in-network TRICARE-authorized providers.
    Preconception and Prenatal Carrier Screening: TRICARE covers 
preconception and prenatal carrier screening tests for cystic fibrosis, 
spinal muscular atrophy, fragile X syndrome, Tay-Sachs Disease, 
hemoglobinopathies, and conditions linked with Ashkenazi Jewish descent 
for beneficiaries with a limit of one test per condition per lifetime.
    Breastfeeding Supplies: Effective January 25, 2023, in keeping with 
industry norms of shipping packages of 100 versus the earlier-covered 
90 breast milk bags, TRICARE began cost-sharing for 100 breast milk 
bags every thirty days following the birth event for breastfeeding 
TRICARE Prime and TRICARE Select enrollees.
    USFHP: USFHP is an additional TRICARE Prime option available 
through networks of community-based, not-for-profit health care systems 
(designated providers) in six geographic areas of the U.S. 
Beneficiaries are encouraged to review the information at https://www.tricare.mil/Plans/Enroll/USFHP and other available resources to 
determine whether they are in a USFHP eligible ZIP Code.
    TRICARE Prime enrollees who reside in a ZIP Code where a USFHP 
service area and a PSA served by a TRICARE regional contractor overlap 
may change between the two at any time. This will be considered a 
Primary Care Manager (PCM) change and can be changed by phone, online, 
or by mail. Beneficiaries who are not enrolled in TRICARE Prime but 
wish to enroll in USFHP can contact the USFHP in their area to make 
enrollment changes during Open Season or as a result of a Qualifying 
Life Event (QLE). A QLE is a certain change in the beneficiary's life, 
such as marriage, birth of a child, or retirement from active duty, 
which may mean different TRICARE health plan options are available. A 
QLE opens a 90-day period for beneficiaries to make eligible enrollment 
changes.
    TRICARE Managed Care Support Contracts for East and West Regions 
Change: A set of new TRICARE Managed Care Support contracts that 
facilitate health care in the private sector will serve beneficiaries 
in the East and West regions. Under the new contracts, beneficiaries 
residing in Arkansas, Illinois, Louisiana, Oklahoma, Texas, and 
Wisconsin will shift from the East to the West region. Beneficiaries 
with questions about this transition can seek more information at 
https://newsroom.tricare.mil/News/TRICARE-News/Article/3254092/changes-to-tricare-expected-in-2024.
    Reimbursement and Coverage of Services Provided by Freestanding 
End-Stage Renal Disease (ESRD) Facilities: Effective January 12, 2023, 
TRICARE now recognizes freestanding end-stage renal disease facilities 
as authorized institutional providers, with an accompanying 
reimbursement methodology.

Planned Changes

    Low Back Pain Physical Therapy Demonstration Ends: This three-year 
demonstration operating in ten states ends on December 31, 2023. The 
demonstration addresses the ongoing issue of low back pain among 
TRICARE enrollees and was designed to test the impact of waiving cost-
shares associated with the first three physical therapy visits for low 
back pain. Information can be found at https://www.tricare.mil/Plans/SpecialPrograms/LowBackPain.
    Laboratory Developed Test Demonstration Extended: The Laboratory 
Developed Test (LDT) Demonstration to assess whether submitted LDTs 
without United States Food and Drug Administration approval or 
clearance otherwise meet TRICARE coverage criteria, i.e., proven safety 
and effectiveness for its intended use, was slated to terminate on July 
18, 2023. However, DHA has opted to extend the LDT Demonstration 
through July 18, 2028, to allow the Agency additional time to determine 
how to address LDT coverage long-term and allow continued coverage of 
these tests for TRICARE beneficiaries in the interim.
    Coronavirus Disease (COVID-19) Response Changes: The U.S. National 
Emergency responding to the COVID-19 pandemic, originally declared in 
March 2020, ended on April 10, 2023. The Secretary of Health and Human 
Services (HHS) then ended the corresponding Public Health Emergency 
(PHE) on May 11, 2023. DoD had implemented certain flexibility for the 
MHS for the pendency of the National Emergency and HHS PHE that were to 
sunset with the termination of such emergency statuses.
    On termination of the National Emergency, DoD resumed requiring a 
three-day acute care hospital stay prior to admission to a skilled 
nursing facility and requiring TRICARE Prime enrollees seek referrals 
to acquire COVID-19 vaccines from non-network, authorized providers 
without incurring point-of-services charges; and discontinued coverage 
of National Institute of Allergy and Infectious Disease (NIAID)-
sponsored clinical trials (note: eligible beneficiaries who enrolled in 
a covered trial on or before April 10, 2023 will continue to have their 
care covered through the end of the trial). DoD also discontinued 
coverage of the treatment use of investigational drugs under expanded 
access for all new episodes of treatment and eliminated the temporary 
waiver of certain interstate and international licensing requirements 
for providers practicing both in person and via telehealth.
    On termination of the HHS PHE, DoD discontinued its temporary 
coverage of facilities registered with Medicare Hospitals Without Walls 
initiative. DoD also discontinued its waiver of cost-sharing for COVID-
19 testing. Normal TRICARE copayments and cost-sharing apply to testing 
and related services after May 11, 2023.
    Additionally, for DoD beneficiaries receiving telehealth from the 
Direct Care component via Facetime, Google Duo/Meet, Microsoft Skype or 
other similar platforms, their telehealth services have moved to an 
approved DHA Platform. For DoD beneficiaries receiving Private Sector 
telehealth, any platform used by their provider must be HIPAA-
compliant.

Appendix A

    Certain TRICARE enrollee out-of-pocket costs (enrollment fees, 
premiums, catastrophic caps, deductibles, and copayments) are adjusted 
annually by Federal law and regulations based on the annual Cost of 
Living Adjustment (COLA) applied to Uniformed Service member retired 
pay. A difference in copayments remains between those who joined a 
Uniformed Service before January 1, 2018, (Group A), and those who 
joined on or after that date (Group B).
    The retiree COLA is typically announced after the Federal fiscal 
year begins in October. Beneficiary out-of-pocket expenses impacted by 
the 2024 COLA will be posted to the tricare.mil/changes web page before 
the start of TRICARE Open Season, November 13, 2023.

Pharmacy Out-of-Pocket Expenses for CY 2024

    TRICARE Pharmacy copayments will increase on January 1, 2024:

[[Page 70961]]



                                                      Pharmacy Copayments for Calendar Year 2024 *
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                                                        Retail network
                                    Retail network        brand-name      Retail network non- Mail order generic   Mail order brand-    Mail order non-
              Year                 generic formulary   formulary 30-day    formulary 30-day    formulary 90-day   name formulary 90-   formulary 90-day
                                     30-day supply          supply              supply              supply            day supply            supply
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2024............................                $16                 $43              ** $76                 $13                 $38                 $76
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* Active Duty Service Members enjoy a $0 copay for covered drugs at any pharmacy.
** For all beneficiaries except Active Duty Service Members, select brand-name maintenance medications (taken for long-term conditions) may only be
  filled twice at retail and then must be filled through home delivery or military pharmacy.

Premium Based Plans

    The CY 2024 monthly premiums for TRICARE Reserve Select, TRICARE 
Retired Reserve, and TRICARE Young Adult and the quarterly premiums for 
Continued Health Care Benefit Program will be posted to the 
tricare.mil/changes web page once announced.

    Dated: October 11, 2023.
Natalie M. Ragland,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2023-22790 Filed 10-11-23; 4:15 pm]
BILLING CODE 6001-FR-P