Clarification on Hawaii General Excise Tax Reimbursement
Thursday, April 21, 2022
Based on feedback received, Health Net Federal Services, LLC (HNFS) is rescinding its March 2022 education piece titled, “General Excise Tax Reimbursable under TRICARE.” Please refer to this updated April 2022 version for clarification regarding TRICARE reimbursement of Hawaii’s general excise tax (GET). Please note that providers who include GET as a component of their billed charges will receive reimbursement of the GET only to the extent total billed charges do not exceed the CHAMPUS maximum allowable charge, or CMAC, minus any applicable network discount. Hawaii’s GET is not separately reimbursable, and providers may not be reimbursed for more than the CMAC for any service billed.
Additionally, we previously advised that the practice of billing TRICARE patients for the GET was allowed under TRICARE; that statement was made in error. TRICARE policy and HNFS’ network provider agreements prohibit providers from passing along the GET to TRICARE beneficiaries. We apologize for any confusion caused by our previous communication.
We offer the following answers to frequently asked questions to clarify GET reimbursement guidelines.
Q. Is Hawaii’s GET reimbursable by TRICARE?
A. Hawaii’s GET is not separately reimbursable by TRICARE. Providers who include the GET in billed charges may only be reimbursed up to the CMAC for covered services, minus any applicable network discount. GET billed as a separate line item on a claim will not be considered for reimbursement. Please refer to TRICARE Reimbursement Manual, (TRM), Chapter 5, Section 1, paragraph 3.2; and 32 C.F.R. 199.14(j)(1). This applies to all TRICARE-authorized providers, including applied behavior analysis providers.
Q. What if there is not an established CMAC for a service billed?
A. If there is not an established CMAC for a covered service, HNFS will reimburse up to the provider’s billed charge or a state prevailing rate, whichever is less. While TRICARE policy does allow HNFS to consider state taxes when calculating state prevailing rates, at no point will HNFS reimburse more than the state prevailing rate for a covered service. Please refer to TRM, Chapter 5, Section 1, paragraphs 3.2 and 3.2.4.5.
Q. Can providers pass the GET along to TRICARE beneficiaries?
A. No. Providers may not pass along GET to TRICARE beneficiaries. Although Hawaii law does not prohibit providers from charging patients the GET, per TRICARE regulations and HNFS’ network and non-network provider participation agreements, providers must accept payment from HNFS as payment in full for covered services and may not collect anything from beneficiaries other than statutorily authorized copayments, cost-shares or deductibles.
Find more information about sales tax in the TRM, Chapter 5, Section 1 and TRICARE Policy Manual, Chapter 1, Section 12.1. We appreciate your cooperation with these guidelines.
