Congress Poised to Eliminate Urgent Care Pre-Authorization Requirements Under TRICARE
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On Sept. 15, 2016, the Urgent Care Association of America (UCAOA) sent a letter  to the Senate and House Armed Services Committees expressing support for legislative language in the Fiscal Year 2017 National Defense Authorization Act (NDAA) that would eliminate the TRICARE pre-authorization requirements for beneficiaries seeking urgent care services.

This legislative development follows recent implementation of a TRICARE pre-authorization pilot that was mandated by Congress.  Under the three-year pilot, TRICARE beneficiaries will be allowed two unauthorized urgent care visits per fiscal year. Beyond the two urgent care visits without authorization, a TRICARE patient will be required to get a referral (or authorization) for an urgent care visit to be covered.

If elimination of pre-authorization requirements for urgent care services is passed by Congress, the presumption is that the pre-authorization pilot would continue until Jan. 1, 2018, when the pre-authorization section of the law takes effect.

In its letter to lawmakers, UCAOA expressed concern with the language in the House NDAA language that suggests that TRICARE would be limited to contracting with urgent care centers that are open until 11pm daily. UCAOA stated its preference of the Senate-passed language that does not include the same hours of operation limitation and instead offered that urgent care centers must be able to offer extended hours.

It is expected the NDAA bill will be passed in the “lame duck” session of Congress following the elections. If retained and signed into law by President Obama, this language would remove a large hurdle for military families attempting to access the convenient and cost-effective quality care provided by urgent care centers across the nation.  

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