Senators Express Concerns Over Recent Changes to TRICARE

WASHINGTON, D.C. -- Last evening, U.S. Senators Richard Burr (R-NC), Kay Hagan (D-NC), James Inhofe (R-OK), Barbara Mikulski (D-MD), Saxby Chambliss (R-GA) and Kirsten Gillibrand (D-NY) sent the following letter to Secretary Hagel, regarding a change to TRICARE's reimbursement policy, excluding more than 100 different Molecular Pathology Laboratory (MoPath) tests and other Laboratory Developed Tests (LDTs) with no notice to beneficiaries or to health care providers.

Despite such a large change in policy, which took place January 1, 2013, no notices were given to either beneficiaries or providers, and doctors continued to order the tests, while major laboratories shouldered the costs in hopes that the Defense Department would reverse the policy.

In their letter, the Senators highlight their concerns about how TRICARE's refusal of coverage will affect military families and patients.

"We are concerned that TRICARE's refusal of coverage and reimbursement for certain LDTs outside of a Military Treatment Facility (MTF) denies military families and patients access to care simply because they either choose to receive care at a civilian medical provider or are unable to access a MTF. Additionally, it is concerning that TRICARE changed a reimbursement policy which may negatively impact a significant population of patients and military families. It is our understanding that MoPath tests and other LDTs are standard practice of care for many providers."

They also ask Secretary Hagel to address several questions by March 14, 2014.

"1. What are TRICARE's policies for providing a notification and public comment period for reimbursement policy changes impacting beneficiaries and the policies allowing for public and stakeholder comment to any such policy change? Please explain in detail which if any of these policies and procedures were applied with respect to the change in TRICARE's reimbursement policy for certain MoPath tests and other LDTs.

2. What stakeholder input and feedback did TRICARE take into consideration, including from TRICARE patients and providers, to fully inform the reimbursement and coverage policy change made by your Department, including how this decision will affect patient access to care?

3. What is TRICARE's justification for denying coverage for LDTs for patients who receive care outside of a MTF, but continuing coverage and reimbursement for LDTs provided for patients who receive care within a MTF?

4. Does TRICARE have an appeals process for services that a physician determines are medically necessary for a specific patient, but are not covered under current TRICARE policy? If so, please provide detailed information."

"Our military's health insurance should adhere to the widely held standards of care accepted by the medical community at large," said Senator Burr. "Our members of the military and their families should have the same access as other government employees and civilians in the private sector and not be penalized for receiving care at a private facility."

"These tests provide useful information to help physicians determine the best course of treatment for their patients and are widely considered by the medical community to be the normal standard of care," said Senator Hagan. "Our military families have sacrificed so much for our country and shouldn't be forced to pay out of pocket for routine lab tests that are available to most patients."

"The recent changes in TRICARE's reimbursement of laboratory developed tests are arbitrary and unjustified," said Senator Inhofe. "It sets up an inequitable benefit among TRICARE beneficiaries and is inconsistent with the accepted standard of care. Congress and military families deserve an explanation."

"We have a sacred trust with those who have risked their lives so that we may live in freedom. Part of that sacred trust is making sure we provide our veterans with the care and benefits they have earned and deserve," Senator Mikulski said. "I'm so pleased to stand alongside my Senate colleagues, holding TRICARE accountable and fighting to ensure that our servicemen, service women, and their families are not denied coverage and reimbursements for Laboratory Developed tests. Our military families must receive the best care and treatments possible."

"Many of our nation's active duty and veterans rely on private facilities for their medical care when a Military Treatment Facility is not accessible to them, and they should not be denied the same standard of care available to their counterparts who have the benefit of such access," said Senator Chambliss. "We owe these men and women and their families the basic health care they've been promised. It is time for TRICARE to resolve this matter."

"Members of the military and their families deserve the best health care available, and that includes any necessary diagnostic tests or lab work," said Senator Gillibrand, the chairwomen of the Senate Armed Services Subcommittee on Personnel. "We need an explanation of why reimbursement rates were changed unannounced, and what is going to be done to fix it."

To view the text of the letter, click here.