(The Center Square) – Twenty American lawmakers sent a letter to Biden-Harris administration Secretary of Defense Lloyd Austin urging the Defense Health Agency to fix a financial burden caused by a change to its TRICARE reimbursement policy for children’s hospitals.
Four Colorado lawmakers, Democratic U.S. Senators John Hickenlooper and Michael Bennet, and U.S. Representatives Doug Lamborn and Jason Crow, a Republican and Democrat, were among those 20 lawmakers.
“We write to express our deep concerns about a 2023 Defense Health Agency (DHA) rule that catalyzed a major shift in the TRICARE reimbursement methodology for children’s hospitals,” the lawmakers wrote in their letter. “Children’s hospitals situated in defense communities in our home states are now grappling with the impacts of this change.”
Previously, DHA exempted children’s hospitals from the adult Medicare reimbursement process since its policies do not apply to the care typically needed by children.
Over 2.4 million children receive medical care from children’s hospitals via TRICARE annually. However, the change negatively impacts children’s hospitals in military communities, like Colorado Springs, the release said.
One in five patients at Children’s Hospital Colorado pays with TRICARE, and the rule change will cost them over $25 million annually, the release said.
The Children’s Hospital Association (CHA) voiced its concerns about the proposed rule in letters to the Department of Defense in 2020 and 2023.
However, Biden-Harris administration implemented the rule change in October 2023 without offering a response to CHA.
The lawmakers specifically asked these questions, according to the release:
What dialogue has DHA had with the affected children’s hospitals to understand how this new reimbursement methodology impacts operations and access to care?What data and sources informed the agency’s analysis of the impact on children’s hospitals that care for TRICARE patients?How did the agency account for the financial impacts of military families traveling for care in circumstances where local services are no longer available?How did the agency develop the contingency payment, and why did the DHA set a lower contingency payment for pediatrics?Can the agency verify the number of children’s hospitals that are expected to qualify for the contingency payment that is outlined in the rule?
Hickenlooper has publicly backed reversing the rule change; he offered an amendment to the annual National Defense Authorization Act that would have defrayed at least some of these costs, according to the release.
Read the full letter here.
