[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).

[[Page 52449]]


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: <a href="/cdn-cgi/l/email-protection#385d5459561648165f4a5d5d56165b514e785559515416555154"><span class="__cf_email__" data-cfemail="d1b4bdb0bfffa1ffb6a3b4b4bfffb2b8a791bcb0b8bdffbcb8bd">[email protected]</span></a>, 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

[[Page 52450]]

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


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