Congress Passes Urgent Care Pilot Program for TRICARE
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On November 17, 2015, Congress sent to President Obama legislation establishing a three-year pilot program that would waive pre-authorization for TRICARE beneficiaries seeking urgent care.

The pilot program was included as part of the Fiscal Year 2016 National Defense Authorization Act (Section 725) and will take effect six months after the President signs the bill (S. 1356) into law.  Although the bill sets the parameters of the program, the Department of Defense is responsible for setting forth the details of the pilot.

The bill establishes that the pilot program will examine the use of urgent care by TRICARE beneficiaries in military medical treatment facilities and TRICARE purchased care provider networks. At the end of the first year of the pilot, the Department of Defense must submit a report to Congress that includes the following elements:

   a comparison of urgent care use to the use of emergency departments in military medical treatment facilities and the TRICARE purchased care provider network;

   whether the pilot program decreases the inappropriate use of medical care in emergency departments;

   the affect of the nurse advice line on urgent care and emergency department use;

   an analysis of any cost savings;

   a determination of the optimum number of urgent care visits available to covered beneficiaries without preauthorization; and

   an analysis of the satisfaction of covered beneficiaries with the pilot program.

A year after the first report, another report will be required, in which the Department of Defense is asked to make recommendations with respect to extending or making permanent the pilot program. A final report will also be required.

UCAOA advocated in support of waiving pre-authorization for urgent care visits for TRICARE beneficiaries and hopes to work with the Department of Defense to implement the pilot program.


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