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01-24-04, 10:15 PM
DoD Eliminates TRICARE Standard Nonavailability Statements
Jan. 23, 2004
No. 04-02

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Under the 2002 National Defense Authorization Act, the Department of Defense military health system eliminated the requirement for TRICARE Standard beneficiaries to obtain a nonavailability statement (NAS) on Dec. 28, 2003. This change in policy allows these Standard beneficiaries to receive inpatient care at civilian hospitals without obtaining prior approval from their military treatment facility (MTF). An exception in the law continues the requirement for an NAS for non-emergency inpatient mental healthcare services.

In discussing the NAS elimination, Dr. William Winkenwerder, Jr., assistant secretary of defense for health affairs, said, "With this change in policy, beneficiaries now have the freedom to choose a military treatment facility or a civilian facility, without any extra paperwork. However, I urge TRICARE beneficiaries to still look to the Military Health System as their first choice for healthcare because I believe the services we offer are second to none."

Before the change in NAS policy, it was necessary for TRICARE Standard beneficiaries to first obtain an NAS from their MTF. An NAS indicates that care is not available from the military facility and authorizes care at a civilian facility. Under the 2002 law, an MTF may request a Departmental waiver of the elimination policy requirement in certain specific, but limited, circumstances. However, such limited MTF waiver requests do not apply to maternity services, unless the affected beneficiary began her first prenatal visit before the Dec. 28 NAS elimination date.

Maternity patients should check with their local MTF to compare maternity services there with those available in civilian facilities. The Military Health System recently implemented a Family-Centered Care program that offers enhanced services and recognizes the unique needs of military families in today's climate of increasing deployments and high operations tempo. Beneficiaries are encouraged to review the enhanced MTF maternity services at www.tricare.osd.mil/familycare/default.cfm and with their military medical provider.

The need for an NAS for non-emergency inpatient mental healthcare applies only to beneficiaries who use TRICARE Standard or Extra, who are not Medicare eligible and who have no other health insurance that is primary to TRICARE. DoD does not require preauthorization for TRICARE beneficiary inpatient mental healthcare when Medicare is the primary payer.

Should an MTF be granted a NAS waiver under the new law, a notice must be published in the Federal Register to inform beneficiaries that a NAS is required for a certain procedure. The MTF, Services and TRICARE Management Activity will notify the affected beneficiaries if this occurs. Beneficiaries should check the TRICARE Web site at www.tricare.osd.mil if they are seeking an inpatient service and want to know if their nearby MTF applied for a NAS waiver. They also may contact the beneficiary counseling and assistance coordinator/health benefits advisor at their nearby MTF for more information.

Before seeking care at a civilian facility, the Military Health System urges beneficiaries to check with their nearby MTF to compare services and answer any questions. Even if the MTF could not provide needed services in the past, the facility's staffing levels or capabilities may have changed, and they might now be available at the MTF.