COVID 19 MSO/VSOs Questions and Answers (as of 1500, 25 MAR) COMMUNITY SPREAD Q: When a military family member is confirmed to have COVID-19, what steps will be taken to isolate them and identify anyone they may have come in contact with? Who leads these investigations and will they notify families who may be at risk? A: Any patient with a laboratory-confirmed diagnosis of COVID-19 is being provided with the CDC guidance on how to self-isolate. When an individual is diagnosed with laboratory-confirmed COVID-19 within a military medical treatment facility (MTF), the MTF notifies installation, local and/or state public health officials—these public health officials conduct a contact investigation in accordance with Service or locality protocols. For a laboratory-confirmed COVID-19 patient who is a member of the military, the military public health takes lead on investigating potential military contacts and the local or state public health takes lead on investigating potential non-military contacts. The lead investigator will contact all effected individuals, interview them, and provide education and guidance on how to keep themselves and their families as safe as possible. Q: Will there be extra precautions taken at the gate to prevent the spread of COVID-19, like wearing gloves to take ID's? Will MPs and contractors follow standardized, DOD-established policies, or will these be put in place base-by-base, command-by-command? What protections exist for gate guards and other service members who have more potential opportunities for contact? A: Service and component commanders in consultation with public health officials and in accordance with CDC guidance are implementing additional measures to reduce the spread of the virus that causes COVID-19. These include adding force health protection measures…the use of PPE, gate guards wearing gloves and not touching ID cards, but rather scanning them. DoD personnel are being provided with protective measures based on their level of risk of exposure to the virus that causes COVID-19. Q: For military families with a service member activated, mobilized, or deployed as part of a Coronavirus outbreak response: How frequently will these service members be tested for the virus? A: The Department of Defense is following CDC guidance for the screening, testing, and quarantine of individuals based on their travel history and potential exposure history. The Service Members will be screened, tested, and quarantined in accordance with CDC guidance. Q: What procedures can you expect will be in place to keep your family safe from potential exposure? A: The Department of Defense is using the CDC guidance to educate all DoD personnel of the measures each individual and community can implement to reduce the spread of the virus that cause COVID-19 to protect the health and safety of military service members, civilian employees, contractors, and their families--in the workplace, the community, and at home. However, we acknowledge the infeasibility for Service Members to social distance in all cases, such as when on a submarine or a tank, etc. We ask that Service Members take prudent measures as best they can, given their situation and mission. SECDEF has called upon commanders and senior NCOs at all levels to assess their situation and avoid putting a large number of people in small rooms. Alternatives include holding meetings outside or meeting in smaller groups. He has also encouraged Service Members, no matter how junior, to inform their chain of command if they see something that does not make sense of that could be done more safely next time. PHARMACY: Q: What are my pharmacy options during the COVID pandemic? A: The TRICARE pharmacy benefit is built to take care of our service members, veterans, retirees and their families with flexible options to meet beneficiary needs. We deliver the pharmacy benefit through multiple points of service, to include offering the opportunity to limit exposure to the public by employing our safe and convenient home delivery option for maintenance medications (drugs taken for long term conditions). The Centers for Disease Control and Prevention (CDC) COVID-19 guidance includes the recommendation to have a supply of necessary medications on hand. TRICARE offers beneficiaries the option to get a 90- day supply of their prescriptions at military pharmacies, via TRICARE Pharmacy Home Delivery, or at retail network pharmacies. As a first step, beneficiaries should ensure they have refills remaining on their prescription. Each prescription bottle indicates the number of refills remaining. If there are no refills left, they will need to call their healthcare provider. If enough refills remain, beneficiaries can get a 90-day supply at military pharmacies, via TRICARE Pharmacy Home Delivery, or at retail network pharmacies. Military pharmacies offer up to a 90-day supply of most medications at no cost to beneficiaries (quantity limits still apply). After military pharmacies, home delivery is the most affordable option. Beneficiaries can switch to home delivery to get up to a 90-day supply delivered right to their door (copays apply). At a retail network pharmacy , beneficiaries can get up to three, 30-day supplies (copays apply). You can ask your doctor to write your prescription for a 90-day supply. You can access up to three, 30-day supplies at a time at retail (three copays apply) or fill it at TRICARE Home Delivery through Express Scripts (one copay applies). For example, the copayment for a 90-day supply of generic medication is $10 with home delivery compared to $39 for three 30-day supplies from a retail pharmacy. We strongly encourage beneficiaries consider home delivery whenever possible because it provides a convenient and affordable way to get medications without leaving the house. There are many convenient ways to switch a prescription to home delivery to include by phone, online, and via the Express Scripts mobile app. Q: Also, questions are being asked about pharmaceutical supply chains and reimbursement for payments of additional prescriptions. A: Currently there are no pharmacy supply chain issues/outages as a result of COVID-19 and the Defense Logistics Agency is engaged with Prime Vendors to ensure Military pharmacies get their fair share if shortages do occur. Q: At 17 MAR 2020 Facebook live event, a subject matter expect indicated that beneficiaries can get early prescriptions through Express Scripts. Can you please provide clarification? A: At this time, there is no plan to waive refill restrictions to get prescriptions refilled early. TRICARE offers beneficiaries the option to get a 90-day supply of their prescriptions at military pharmacies, via TRICARE Pharmacy Home Delivery, or at retail network pharmacies. We understand the desire to be prepared. Present conditions do not call for us to enact early refills at Home Delivery or retail, but we are monitoring the situation closely and are updating our information and policy if or when the situation changes. We are encouraging beneficiaries to refill their medications at the appropriate time. Standard refill policies, which allow you to refill or renew a prescription medication when 25% of your current prescription is remaining, should help you stay on track with your medication during this time. Should you have any questions or concerns about your individual situation, pharmacists are available 24/7 to answer questions, offer counseling and support, and assist with prescription orders. To learn more, visit militaryrx.express-scripts.com or call 877.363.1303. NURSE ADVICE LINE Q: We have heard the Nurse Advice Line is experiencing a larger than usual call volume, and wait times are long. We have heard from beneficiaries that the often get a busy signal and when they get through the line the call is getting dropped. It would be helpful to understand: What is the current wait time (so that we can help manage expectations)? What is being done to reduce the wait time, and when can a reduction in wait time be expected? What is being done to improve the infrastructure so that fewer calls are dropped? Is there any consideration to having two separate lines – (1) a COVID-19 line and (2) an all other line so that those who have non-COVID-19 related questions – that may be just as acute, get timely support? A: NAL call volume continues to be up approximately 300 percent compared to historical volume and reached a record high of almost 10,500 calls March 19, 2020. While wait times continue to be high, the Healthcare Optimization Division is in constant contact with the vendor to identify ways to reduce hold times by streamlining operations to eliminate back-ups in the process. These efforts have reduced hold times and abandoned calls over the last two days and further improvements are expected when up to 60 new registered nurses and a similar number of care coordinators are brought on board. More than 80 percent of all calls are related to either COVID-19 and related symptoms such as cough and nasal congestion and of those calls, 80 percent require a virtual telephone visit with a primary care provider. To support care coordination efforts, MTFs were asked to increase the number of virtual telephone visits available for NAL booking in DHA guidance distributed to service and markets March 16, 2020. Q: Families are telling us they’re having difficulty finding the phone numbers for the nurse advice line. I realize the numbers are in the “Find a Phone Number” section, but it seems that people are having difficulty finding it. If you can imbed them in the Conrona text that would be helpful. A: Based on this feedback, we have made information for the Nurse Advice Line more accessible, to include creating easy access to the Nurse Line on the right column of TRICARE.mil/coronavirus and moving it up in our content feed. We are also adding it to the right navigation in the ‘Contact Us’ section and the ‘Call Us’ section. TESTING Q: If military family members demonstrate a need for COVID-19 testing, where should they go? Should they go to the Military Treatment Facilities (MTFs) or to a testing facility in the community? Will MTFs have enough tests to be able to conduct that testing when appropriate? A: Military family members should call the Nurse Advice Line or their Primary provider in order to be screened by a medical professional to determine if a test is needed. If it is determined they need to be tested, they will be directed to their nearest testing location. MTFs will collect the sample and either do the test on site or send it to a lab where it can be done. MEDICAL EXPENSES Q: Will the President’s announcement to waive co-pays for COVID-19 apply to military families? Are there any exceptions? Will the co-pay relief apply to the appointment as a whole, or just to testing and direct COVID-19 treatment? Will any hospital stays, urgent care visits, or medical treatments related to secondary effects of COVID-19 (additional respiratory treatments like corticosteroids, etc) also be co-pay free? A: While the testing is free, beneficiaries are responsible to pay applicable copayments for doctor’s visits with network and non-network providers. At this time, we cannot waive copayments for the office visit due to statutory regulation. Q: Will TRICARE For Life cover a COVID-19 vaccine in the future? A: TRICARE covers CDC recommended vaccines in full through the TRICARE Pharmacy program, for beneficiaries enrolled in any of the TRICARE programs including TRICARE For Life. Preventive vaccines obtained at network pharmacies or military treatment facilities are provided at no cost to the beneficiary. Medicare Part D is not required in order to receive CDC recommended vaccines at no cost from network pharmacies or military treatment facilities. Q: If a service member is trying to get approved to go to urgent care and is not able to get through to the nurse advice line, will the urgent care fee waived/reimbursed? A: During duty hours, an Active Duty Service Members should reach out to their primary care managers using secure messaging or should call the clinic or appointment line to have their urgent medical issues addressed virtually. All MTFs are able to use telephone visits and are expanding capacity to address urgent issues virtually via telephone. After duty hours, Service members will call the Nurse Advice Line. Hold times have dropped dramatically and are expected to drop even more with additional hiring actions. Hold times also are shorter after duty hours. If the RN determines the Service Member needs to be seen, the RN will arrange a virtual visit with a MTF provider or will refer the patient to urgent care. Active Duty Service Members who receive urgent care from a civilian provider without a referral should keep their bill and contact their primary care manager for assistance with reimbursement. Please refer to TRICARE.mil/coveredservices/itiscovered/urgentcare for additional information. Q: The Marine Corps has cancelled drilling for the Reserves until the end of April (at the earliest). The Navy and Air Force have made similar moves. What does this mean for TRICARE benefits for Reservists? A: Cancellation of drills does not impact a Reserve Component member’s eligibility for TRICARE. Members of the Selected Reserve (and their families) maintain access to TRICARE Reserve Select, which is a premium-based plan, and have access to TRICARE Prime and Select when on certain types of active duty orders. Please refer to TRICARE.mil/Plans for more information. MENTAL HEALTH: Q: Mental Health Resources: how will the Military Health System ensure access to mental health resources, particularly during this time when stress levels are high and access to facilities may be limited? A: Mental health services will be provided within the capacity of current available services. Some if not all, mental health interactions could be temporarily restructured to a telehealth interaction. Providers will inform current patients on necessary changes to appointing and providing care. The MHS recognizes that COVID-19 may increase anxiety within the beneficiary population and will strive to provide the mental health care TRICARE beneficiaries need. APPLIED BEHAVIOR ANALYSIS Q: Is TRICARE considering covering telehealth services for Applied Behavior Analysis? A: We are closely tracking the quickly changing situation regarding COVID as it relates to TRICARE beneficiaries, including those beneficiaries in the ACD. There has been no change in policy regarding TH for the ACD at this time, but we are actively evaluating the policy and should a change be made, we will make an announcement which will be posted on the www.health.mil/autism website and to ABA providers who have signed up for ACD messages. ELECTIVE SURGERY 24 MAR, the Department issued guidance directing that all Military Medical Treatment Facilities (MTFs) and Dental Treatment Facilities (DTFs) postpone all elective surgeries, invasive procedures, and dental procedures as of March 31, 2020 for 60 days. Q: What is “elective”? A: Elective surgeries and procedures are those that are not urgent and can be rescheduled for a later date. Examples include but are not limited to: laser surgery, hernia repair, non-emergent back surgery, colonoscopies, and joint replacements. MTFs and DTFs will continue to conduct surgeries and procedures to save lives and avoid further harm from underlying conditions or diseases, or where the risk of delaying the procedure outweighs all other considerations. Q: What do I do if I really need my procedure? A: We encourage those who are impacted by this policy to talk to their local MTF or DTF. Q: Who is impacted by this policy? A: This policy applies to all eligible beneficiaries who use our MTFs or DTFs including: Active Duty Service Members, their family members, retirees and their family members, Reserve Component and National Guard service members on active duty or issued a delayed-effective date active duty order, and any other eligible beneficiary. Q: Who do I call if I have questions? A: Work through your MTF or DTF; each facility can address your concerns, and can provide guidance on rescheduling and how to proceed. Q: How will this impact the coronavirus outbreak? A: In the executive order, the President stated: “To ensure that our healthcare system is able to surge capacity and capability to respond to the spread of COVID-19, it is critical that all health and medical resources needed to respond to the spread of COVID-19 are properly distributed to the Nation’s healthcare system and others that need them most at this time.” Q: Are you closing the Military Medical Treatment Facilities? A: No. Military clinics and hospitals will remain open. This is specifically for elective surgeries and procedures. For those who have may have COVID-19 symptoms, we encourage you to call your local treatment facility’s COVID hotline and follow the instructions on how to seek care. Q: What will Military Medical and Dental Treatment Facilities continue in terms of offering services that are non-COVID related? A: Non-elective procedures, particularly acute and urgent care, will continue, as well as procedures that will keep a Service member medically ready and deployable. We will continue to provide routine appointments and exams, such as check-ups, specialty consultations, and prenatal visits at this point in time. However, individual MTFs and DTFs may further limit availability based on response demands.