The "TOTAL Care Act" initiates a five-year pilot program within TRICARE Prime, enabling female beneficiaries to access obstetrical and gynecological care without referrals and potentially select a TRICARE OBGYN provider as an additional primary care manager.
Steven Horsford
Representative
NV-4
The TOTAL Care Act initiates a five-year pilot program within the TRICARE Prime program, allowing female beneficiaries to access obstetrical and gynecological care without needing a referral, including the option to select a TRICARE OBGYN provider as an additional primary care manager. Within four years, the Secretary of Defense must report to Congress on the program's impact on TRICARE Prime enrollment and costs.
TRICARE Prime Gets an Upgrade: Direct Access to OB/GYN Care in New Pilot Program
The "TRICARE OBGYN Treatment and Access without Lags in Care Act," or TOTAL Care Act, is shaking up how military families get women's healthcare. Here's the deal: it's launching a pilot program that lets folks on TRICARE Prime see an OB/GYN without jumping through the referral hoop.
Straight to the Source
Right now, under TRICARE Prime, you usually need a referral from your primary care manager (PCM) to see a specialist. This bill [SEC. 2] cuts through that red tape for obstetrical and gynecological care. Within 180 days of this Act becoming law, the five-year pilot program kicks off. That means no more waiting for permission to get the care you need, whether it's a routine check-up, prenatal care, or something more specific.
Real-World Rollout
Imagine you're a military spouse, and you need to see an OB/GYN. Before, you'd have to book an appointment with your PCM, get a referral, then book the OB/GYN appointment. This pilot program streamlines that. You can go straight to the specialist. The bill even lets you pick an OB/GYN as a second primary care manager, giving you more control over your health.
This isn't just about convenience. It's about quicker access to specialized care, which can be crucial for catching potential problems early. Think annual exams, family planning, or addressing specific health concerns without delay.
Checking the Boxes
This program isn't a free-for-all. It's specifically for "covered participants" – female beneficiaries enrolled in TRICARE Prime who choose to participate [SEC. 2]. The Department of Defense is also keeping an eye on things. Within four years, they have to report back to Congress [SEC. 2] on how the program is affecting TRICARE Prime enrollment and if there are any changes in costs for obstetrical and gynecological care. Basically, they're making sure it works as intended and doesn't create unexpected problems.
The Bottom Line
The TOTAL Care Act aims to make women's healthcare more accessible and efficient for military families. By removing the referral requirement, it puts the power back in the hands of those who need the care, potentially leading to better health outcomes and a smoother healthcare experience.