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For the past year, APA staff in the Practice Organization have led a multi-pronged, intense advocacy effort to shift the Department of Defense’s (DoD’s) management and oversight of its TRICARE program. We learned in 2017 that DoD’s Defense Health Agency (DHA) transition to two new TRICARE regions and contractors was resulting in variable but significant slashes to psychologists’ reimbursement rates and increases to beneficiaries’ co-payments in 2018. Here is the latest information on our grassroots, executive and legislative efforts to address reimbursement cuts.

Discussions continue with DHA leaders

Last year we surveyed all practicing APA members to request information about their experiences with TRICARE. With the data psychologists supplied APA staff immediately contacted Vice Admiral Bono, who leads DHA, and she promised to have her TRICARE staff look into the following issues and concerns psychologists raised:

  • Lack of timely information from Humana and Health Net.
  • Confusing contract negotiations or lack of any negotiations.
  • Huge cuts to psychologists’ reimbursement rates.
  • Issues with resulting TRICARE network adequacy.
  • Access to care for military families.
  • The criteria by which contractors would be renewed or selected in the next round.

After many months went by, Practice Organization staff again contacted DHA in early 2018 and then met with the TRICARE staff, which includes psychologists, to highlight ongoing problems, including billing and directory problems. It was clear that DHA staff were providing close oversight, though we feel that huge issues still remain in terms of contractor performance.

Taking the issue to Congress

Because of our ongoing concerns, the Practice Organization’s government relations team, along with psychology practice advocates from across the country, met with members of Congress and their staff throughout the spring to highlight the problems with the TRICARE contractors and what this meant for psychologists and military beneficiaries in their states and districts. We also incorporated into our annual APA testimony on funding for DoD the need for changes to TRICARE and its contractors’ operations.

This summer, Sen. Jon Tester, D-Mont, and House Rep. Tulsi Gabbard, D-Hawaii, worked with APA staff to send strong, bipartisan, bicameral letters to Vice Admiral Bono, requesting a briefing on the problems with DHA and its contractors.

Perhaps most importantly from the standpoint of forcing DHA to provide timely information, APA worked with Gabbard’s staff to get an amendment included in the National Defense Authorization Act for Fiscal Year 2019 requiring a report on TRICARE from the General Accountability Office (GAO). Sen. Mazie Hirono, D-Hawaii, then included similar language in the Senate version of the bill. We will work with GAO to ensure that the report addresses the concerns and questions related to behavioral health and keep you all posted on its results.

Psychologists’ collaboration with APA staff has been absolutely invaluable. We are focused on policy-level changes; your anecdotal information is powerful and critical in outlining for DHA and Congress what real effects reimbursement cuts have on practicing psychologists and their military clients, and what changes need to be made immediately to salvage these networks of care. Thank you for your engagement and information from the field.

About the author 

Heather O’Beirne Kelly, PhD, is a clinical psychologist and APA’s first director of Military and Veterans Health Policy. Watch this space for regular updates on issues ranging from protecting the VA’s integrated care system, to advocating for more attention to military sexual assault prevention, to encouraging more systematic training on evidence-based treatments.

Date created: September 2018