Outpatient mental health care
(to include Partial Hospitalization Programs (PHPs), Intensive Outpatient Programs
(IOPs), Opioid Treatment Programs (OTPs), Office-Based Opioid Treatment
(OBOT), and office -based outpatient treatment) does not require
preauthorization. TRICARE no longer requires continued authorization
after the eighth outpatient mental health visit each fiscal year.
PCM referral is not required for outpatient, office-based mental
health and SUD visits to an authorized TRICARE network provider;
however, all other outpatient mental health and SUD services require
a referral from the PCM or other network TRICARE authorized institutional
or individual professional mental health or SUD provider as authorized
in the TPM,
Chapter 7, Section 3.5, paragraph 4.0 and
TPM,
Chapter 7, Section 3.8, paragraph 6.0. The
contractor shall steer all beneficiaries who contact them to the
Military Treatment Facility/Enhanced Multi-Service Market (MTF/eMSM)
or appropriate network provider. Additionally, the contractor shall
expound upon the benefits of using the MTF/eMSM and network providers
during all appropriate beneficiary and provider briefings. See
Chapter 16, Sections 2 and
6 for referral
requirements under the TRICARE Prime Remote (TPR) program.