A Colorado health care provider serving more than 15,000 military-connected children will remain in the TRICARE network, reaching a deal with new regional managed care support contractor TriWest days after announcing plans to leave the network.
Children’s Hospital Colorado “worked closely with TriWest and achieved important improvements in the new contract that will help us maintain access to care,” according to a Dec. 24 press release. The day before, MOAA and the National Military Family Association (NMFA) wrote to DoD health affairs leadership urging the department to work with TriWest and the hospital to reach an agreement.
“Many Colorado military families sought assignment there because they were assured that their medically fragile children would receive treatment at a nationally recognized children’s hospital,” the letter states. “We ask you to act to ensure that those families continue to receive the care they need and deserve, and that the TRICARE network remains robust and able to serve the needs of America’s military families.”
Members of the Colorado congressional delegation put out a joint statement Dec. 17 asking the hospital and TRICARE officials to return to the bargaining table.
Children’s Hospital Colorado filed a legal challenge in 2023 claiming TRICARE reimbursement rate cuts, including a nearly 40% cut to outpatient care rates, would not cover the cost of some patients’ care. A judge ruled in favor of DoD in April.
Despite agreeing to remain in the network, “TRICARE reimbursement rates remain well below the cost of providing care,” said Jena Hausmann, president and CEO of Children's Colorado, in the press release. “We will continue engaging with the Department of Defense and elected officials to ensure that Children’s Colorado can maintain high-quality, specialty pediatric care for all kids in Colorado.”
Taking Care of Military Families
A new DoD policy enacted in October 2023 eliminated an exemption for children’s and cancer hospitals which had allowed them to receive higher reimbursement rates for outpatient treatment. The old policy aligned with similar hold-harmless language used to set Medicare reimbursement rates; if the new policy results in children’s hospitals leaving the TRICARE network, it would amount to a benefit cut, despite ongoing promises to offer “world-class healthcare” for servicemembers and families.
Many military families with children who need specialty health care build their careers around providers like Children’s Colorado – family-centered facilities that can offer pediatric expertise and life-changing treatment through the TRICARE network. If these facilities leave the network, families already facing long wait times and difficulty securing appointments would see even greater access issues … and what begins as one family’s medical concern would become a readiness issue for the all-volunteer force.
Fair reimbursement for all children’s specialty care providers is a critical part of the overall TRICARE benefit, and will remain a key advocacy priority for MOAA as the 119th Congress begins. Keep up with the latest on this issue and others by registering at our Legislative Action Center.
MOAA Knows Why You Serve
We understand the needs and concerns of military families – and we’re here to help you meet life’s challenges along the way. Join MOAA now and get the support you need.
