The Families First Coronavirus Response Act
8 April 2020
BACKGROUND: The TRICARE implementation of the Families First Coronavirus Response Act directs copays be waived for doctor-ordered, approved COVID 19 testing. This change will be retroactively effective to tests and related provider services furnished on or after March 18, 2020, the date that the Families First Act was enacted.
Tests approved under the Act were limited to Food and Drug Administration (FDA) approved, cleared or authorized diagnostic products for the detection or diagnosis of COVID-19. The Act was subsequently modified by the Coronavirus Aid, Relief, and Economic Security (CARES) Act, expanding diagnostic tests meeting the criteria for cost-share and copayment limitation. The additional approved tests include those pending emergency use authorization by the FDA, tests developed in and authorized by a State with notification given to the Secretary of Health and Human Services, and any other tests approved by the Secretary.
Contractors will be directed to reprocess claims that had a copayment or cost-share, retroactively for tests or related provider services and supplies furnished on or after the date of enactment (March 18).
Due to the complex nature of claims billing, it may not be possible to waive all copayments and cost-shares related to the COVID-19 testing in real time. It may be the case that beneficiaries are required to pay a copayment or cost-share up front, and receive reimbursement later
TRICARE implementation of the Families First Coronavirus Response Act directs copays be waived for doctor ordered approved COVID 19 testing.
Contractors will be directed to reprocess claims that had a copayment or cost-share, retroactively for tests or related provider services and supplies furnished on or after the date of enactment.
Beneficiaries required to pay a copay for prescribed COVID 19 testing will be able to file a reimbursement claim, retroactive to the date of the law’s signature.
Assistant Secretary of Defense for Health Affairs, Honorable Mr. Thomas McCaffery, signed an exception order to waive TRICARE copays for FDA approved COVID-19 testing to comply with the Families First Coronavirus Response Act.
The copayment or other cost sharing are excluded for any approved test for the detection or diagnosis of COVID-19, services and supplies related to the furnishing or administration of a diagnostic test, and evaluation of an individual to determine the need for a test received during:
- Doctor office visits (in-person and telehealth)
- Urgent Care visits
- Emergency Room visits that result in an order for or administration of diagnostic test
Tests administered for visits not related to the treatment or evaluation of conditions related to COVID-19 would be excluded. For example; Doctor Office visit that results in an influenza test and not for COVID-19, the copayment or cost-share would apply.
This law does not waive TRICARE copayments and cost-shares for the treatment for COVID-19 infection.
TRICARE retains the copayments and cost-shares that exist for the TRICARE program and TRICARE health plans including pharmacy copays.
Active duty service members and ADFMs under Prime do not have cost-shares and so are not impacted by this law.
Beneficiaries overseas with a cost-share (retirees and their family members, active duty family
Members (ADFMs) under TRICARE Select, and TRICARE for Life may be eligible for cost share.
Waivers for approved tests under established guidelines/standards of care for COVID-19 testing for the country, host-nation, and/or regional health authority (e.g., World Health Organization), where the patient is treated.