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TRICARE Expands Treatment Options for Mental Health and Substance Use Disorders

7/19/2017

TRICARE expanded mental health and substance use disorder (SUD) services, adding intensive outpatient programs and expanding options for opioid treatment. In addition to other improvements, this expansion improves access to care and increases opportunities for mental health and SUD treatment. It also makes it easier for beneficiaries to access the right level of care for their health and wellness needs. 

These new services round out existing TRICARE covered treatments, including:

  • Emergency and non-emergency inpatient hospitalization
  • Psychiatric residential treatment center care for children
  • Inpatient/residential SUD care
  • Partial hospitalization
  • Outpatient and office-based mental health and SUD treatment 

“If someone does well in inpatient psychiatric care and no longer requires 24-hour care, they could step down a level. Their options may be a partial hospital program, an intensive outpatient program at six hours a day, or outpatient treatment with a TRICARE-authorized providerAn authorized provider is any individual, institution/organization, or supplier that is licensed by a state, accredited by national organization, or meets other standards of the medical community, and is certified to provide benefits under TRICARE. There are two types of TRICARE-authorized providers: Network and Non-Network.,” said Dr. Patricia Moseley, a senior policy analyst for military child and family behavioral health at the Defense Health Agency. “Now we have a continuum of care to meet our beneficiaries’ needs.”

Other changes are:

Increased Substance Use Disorder Treatment Options

Improvements to SUD options include opioid treatment programs and office-based opioid treatment. Office visits with qualified TRICARE-authorized providers may include coverage of medications for opioid addiction.

Reduced Limitations on Number of Treatments

TRICARE reduced limitations for receiving mental health and SUD services. There are no limits for the number of times beneficiaries can get SUD treatment, smoking cessation counseling and outpatient treatment per week. In addition, TRICARE removed the requirement for authorization after the eighth outpatient mental health or SUD visit.

Lower Copayments and Cost-Shares

Lower copayments and cost-shares continue from last year. Since October 2016, non-active duty dependent beneficiaries, retirees, family members and survivors began paying generally lower copayments and cost-shares for mental health and SUD care. One example is the cost per each mental health and SUD outpatient office-based visit, now reduced from $25 to $12. See the full list of updated mental health copayments and cost-shares on the TRICARE website.

“Mental health and substance use disorder treatment is now cost equivalent to medical and surgical care, as it should be,” said Dr. Moseley.

New TRICARE-Authorized Provider Options

For mental health and SUD treatment providers, becoming TRICARE-authorized is now a more streamlined process for providers and facilities. This means more options for TRICARE beneficiaries.

The changes remove unique certification requirements to become consistent with industry standards. In the coming months, new mental health and SUD institutional provider options (such as intensive outpatient programs) will be available. Your TRICARE regional contractors are developing networks now. Contact your regional support contractor for services in your area.

For more information on the updated services and expanding treatment options for mental health and SUD, visit Mental Health Care on the TRICARE website.

Also, register to join the next TRICARE webinar, “Expanding Treatment Options for Mental Health and Substance Use Disorders,” July 31, from 1 to 2 p.m. EDT.

When you have a mental health emergency, call 911 or go to the nearest emergency roomThe hospital department that provides emergency services to patients who need immediate medical attention.. For emergencies overseas, call your TRICARE Overseas Program regional call center and choose option 1 for medical assistance.

Last Updated 7/19/2017