New TRICARE Contract Shakes Up Doctors

HUmanamil

By Debbie Gregory.

TRICARE’s 10-state South Region behavioral healthcare therapists have been notified that while they may continue to see their patients under the new behavioral healthcare network, they will do so under a revised fee deal. The deal is not in the practitioners’ best interest, and has some mental healthcare professionals deeply concerned.

The new contract, which will take effect on January 1, 2018, cuts therapy fees to 30 percent less than the Medicare approved rates. Medicare’s rates are already considered to be on the low end.

Humana Military will administer the contract for the new TRICARE East Region, which was formed by merging the current North and South Regions. The contract will cover approximately 6 million beneficiaries in a 32-state region, including Washington D.C., and is also scheduled to begin January 1, 2018.

The West Region contract will be administered by HealthNet.

While TRICARE officials monitor the progress of the two companies as they build their networks, there is concern that many of the current providers will be unwilling to accept the new fee structure.

“We hope, to the greatest extent possible, that providers currently providing care to our patients are able to reach agreement with Humana and that they can continue to provide that care so there’s no disruption,” said Navy Capt. Edward Simmer, deputy director of the TRICARE Health Plan.

“The goal is to negotiate a mutually agreeable reimbursement rate with providers,” said Matt Paynter, chief of staff for Humana Military. “Certainly, this is never a take-it or leave-it-you’re-going-to-get-kicked-out thing. We work with providers.”

Supply and demand certainly play a role in the therapists’ ability to negotiate their fees.  Depending on their location, the number of TRICARE beneficiaries in their area and the demand for their services, therapists may be able to negotiate a higher rate of reimbursement.

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