Committee Goals

Health Care Committee Legislative Goals for 2012

Guiding Principles for Military Health Care Benefits:
A primary benefit of enduring a career of unique and extraordinary sacrifices that few Americans are willing to accept is a range of exceptional retirement benefits that a grateful Nation provides for those who choose to dedicate much of their life to the national interest for decades of service. Due to mission requirements the Department of Defense (DoD) Military Health System (MHS) is inherently inefficient and beneficiaries (active, National Guard and Reserve, U.S. Public Health Service Commissioned Corps [PHS], and the National Oceanic and Atmospheric Administration [NOAA] members, retirees, survivors and their families) should not be held accountable for the inefficiencies of the organizational structure, management, administration, and policies and procedures or cost the of medical readiness and operational requirements for DoD.

DoD must work in partnership with The Military Coalition (TMC), the Department of Veterans Affairs (VA) and other governmental agencies to ensure that our past, present and future military members and families receive timely access, a cost effective and high quality health care benefit. Before seeking increases in enrollment fees, deductibles, co-payments, or changes to benefit eligibility, the DoD should pursue any and all options to constrain the growth of health care costs in ways that do not degrade the benefit to beneficiaries and provide incentives to promote healthy lifestyles.

TRICARE Management Activity (TMA) will educate TRICARE beneficiaries about their health care, pharmacy, and dental benefits. TMC will encourage TMA to include TMC and other stakeholders in developing and implementing their communication efforts to beneficiaries. TMA and TRICARE Managed Care Support Service contractors will support and educate providers within their area of responsibility.

Ensure all TRICARE beneficiaries have access to:

• A robust health and behavioral/mental health care system
• Consistent benefits and continuity of care over their lifetime;
• Electronic Health Record (EHR) or other medical record data within DoD's direct and purchased care systems, and associated government agencies;
• An integrated plan to meet the special needs of family members;
• Advance notification of benefit or policy changes within a reasonable timeframe;
• A transparent health care system that provides information on quality outcome measures and cost savings; and,
• Seamless health care and support services for those wounded, ill or injured and their caregiver / family members within and across government agencies.

TMC Believes:
All current and future retired service members earn equal health care coverage by virtue of their service.
Means-testing has no place in setting military health fees.
Congress should direct DoD to pursue any and all options to constrain the growth of health care costs in ways that do not disadvantage beneficiaries.
Support further collaboration of DoD – VA to achieve real "seamless transition" for injured, ill and wounded warriors as well as other service members and veterans transiting the two systems; preserve integrity and access to both systems for dually eligible members

Legislative Goals:

TRICARE Fees and Payments
Oppose DoD plans to establish TRICARE Standard enrollment fees and to significantly increase Standard deductibles.

Oppose any plan to increase annual TRICARE Prime enrollment fees for military retirees more than the annual COLA.*

Oppose initiatives that would reduce TFL coverage (e.g., the deficit commission proposal to establish a $500 deductible and limit coverage to 50% of the next $5,000).

Oppose initiatives to base beneficiary fees on a percentage of DoD cost, since much of DoD cost growth is driven by military requirements, since DoD and service programs are inherently inefficient and duplicative, and since DoD expends insufficient efforts to address those shortcomings.

Oppose DoD plans to charge currently serving members and their families any health care fees other than pharmacy co-payments unless they make the choice to participate in TRICARE Standard or use out-of-network providers under TRICARE Prime.

Oppose DoD plans to charge an annual TFL fee and significantly raise deductibles.

Eliminate network copays for Prime enrollees who are referred outside the Military Treatment Facility (MTF).

Require DoD to educate beneficiaries on the referral process and their options.

Amend the statutory formula for Medicare and TRICARE provider payments to more closely link adjustments to changes in actual practice costs and resist payment reductions.

Work with DoD and Congress to ensure payments to TRICARE providers will enhance beneficiary access to care.

Seek incentives for providers initiatives to target high risk patients for preventative services.

*VFW and JWV oppose any increase in TRICARE fees and deductibles for all active-duty and retired military personnel.

Oppose any increases to the 'catastrophic cap'.

Seek legislation to waive TFL Part B premium requirement for those Medicare eligible who continue to maintain creditable health care coverage through an employer, to also include those who no longer meet eligibility for Social Security Disability and are TRICARE eligible but are required to continue paying Medicare Part B.

Eliminate Medicare Physical, Occupational, Speech Therapy and Residential Inpatient Behavioral annual caps.

Seek TRICARE coverage of out-patient Residential Treatment Centers.

Seek legislation to eliminate the limit when TRICARE Standard is second payer to other health insurance (OHI): e.g., return to the policy where TRICARE pays up to the amount it would have paid, had there been no OHI.

Seek to cap further increases in the TRICARE Standard inpatient copay.

Expand beneficiary copay waivers and other incentive programs for various preventive services and medical treatments.

TRICARE Benefit Issues

Seek legislation to delay the onset of removal of Medicare eligibles from the USFHP, until a seamless transition plan can be established.

Seek to extend coverage for children of military and veteran families until age 26 under CHAMPVA as is already implemented for millions of families under civilian insurance plans, and soon to be implemented coverage for families of federal workers.

Seek legislation to allow eligible families to enroll in TRICARE or TRICARE Reserve Select (TRS) without the sponsor being enrolled as long as the sponsor is enrolled in the VA or OHI.

Seek legislation to reinstate TRICARE benefits for remarried widows when the second marriage ends.

Support all U.S. Territories, Alaska, and Hawaii being designated as CONUS for TRICARE Travel Benefit purposes.

Advocate for increased DoD efforts to ensure consistency between the MTFs and purchased care sectors in meeting Prime access standards and focusing on beneficiary and provider needs in administering authorizations and referrals for specialty care.

Work with DoD to streamline the portability among the TRICARE programs for those temporarily displaced from their Primary Care Manager: e.g., college students, wounded service members, and family members of the deployed.

Encourage the inclusion of TFL beneficiaries in DoD preventive programs.

Advocate for the standardization of case management practices for the seamless transition of care between and within all Services, MTF's, and the four TRICARE Regions.

TRICARE Pharmacy Program
Advance the use of the home delivery option through enhanced communication with beneficiaries.

Engage DoD to preserve access to a broad range of medications in each class for tiers 1 and 2. DoD needs to minimize the changes to the formulary for beneficiaries and ensure the changes have limited impact on the beneficiary.

Require DoD to include alternate packaging methods for pharmaceuticals to enable nursing home, assisted living, and hospice care beneficiaries to utilize the pharmacy program. Packaging options should additionally include beneficiaries living at home who would benefit from this program because of their medical condition (for example beginning stages of Alzheimer's).

Seek legislation to provide medications for chronic conditions, such as asthma, diabetes, and hypertension cost-free or at the lowest level of co-payment regardless of drug status, brand or generic.

Ensure DoD is getting the best cost for its medications while ensuring beneficiaries have options to a robust pharmacy network and a cost effective pharmacy benefit.

Work to ensure the TRICARE Pharmacy benefit remains strong, affordable, and continues to meet the pharmaceutical needs of millions of eligible beneficiaries through proper education and trust.

TMC will oppose any degradation of current pharmacy benefits, including any effort to charge fees or copayments for use of MTFs.

Oppose basing pharmacy copayments on the percentage of drug cost to the government.

Dental Program
Pursue legislation to increase the government subsidy on the TRICARE Active Duty Dental Plan from 60% to 72% in order to allow for increases in orthodontia coverage and certain other improvements.

Support retiree dental care by subsidizing oral preventive care costs.

Promote improvements in the active duty and retiree TRICARE dental benefits and coordination of benefits when they relocate (i.e., include teeth colored fillings, implants, and orthodontia—beneficiaries are often forced to pay two dentists if they relocate while in treatment).

Seek legislation to enable TRICARE eligible Former Spouses to participate in the TRICARE Retiree Dental Plan.

Seek legislation that would allow Survivors qualified for CHAMPVA medical to be allowed to enroll in CHAMPVA Dental. The plan, modeled like the TRICARE Retiree Dental Plan is completely funded by the enrollees' payments.

National Guard and Reserve Health Care

Allow beneficiaries of the Federal Employee Health Benefit Plan (FEHBP) who are Selected Reservists the option of participating in TRICARE Reserve Select (TRS).

Appropriate funds for the government treatment of Selective Reserve members to correct any medical or dental readiness deficiencies discovered during periodic health assessment screenings.

Expand dental care to cover 180 days post mobilization to ensure service members meet readiness standards when DoD dental treatment facilities are not available within a 50 mile radius of the member's home.

Increase access to health and dental care for those residing in rural areas through the use of innovative technologies.

Request GAO review DoD's process for calculating TRICARE Retired Reserve premiums and recommend an equitable premium.

Seek legislation to allow eligibility in Continued Healthcare Benefits Program (CHCBP) for Selected Reservists who are subject to disenrollment from TRS.

Work with Congress and DoD to ensure consistency of benefits and continuity of care for National Guard and Reserve members and their families regardless of duty status.

Seek legislation creating an optional program of subsidized premiums for private employer to allow for the continuation of coverage during periods of mobilization.

Seek improvements to the pre- and post deployment health assessment program, to address a range of mental/behavioral health issues such as, substance abuse and suicide.

Provide funding and access to a full range of evidenced-based care and services for Reserve Component members and their families, particularly during periods of reintegration back into the community.

Increase access and funding to VA mental health care in rural areas through implementation of improvements to the Education Debt Reduction Program, including an emphasis on the need to recruit and retain qualified healthcare professionals to expand the program—all of which are included in Sec. 303 of P.L. 111-163.

Defense Health Program (DHP) Management, Finances, and Accountability

Work with Congress and DoD to seek full funding of the DHP for the direct care and purchased care systems, providing access to the military health care system for ALL uniformed services beneficiaries.

Require a GAO report of the TMA contracting and acquisition processes, including lessons learned from the T3 experience.

Collaborate with DoD and Congress on efforts to manage overall health care costs, ensure operational efficiencies are realized and encourage DoD to focus efforts on lowering actual health care costs by:

• Support the establishment of a Unified Medical Command or some other consolidated MHS Governance structure that promotes: intra-operability; the delivery of patient centered quality care; efficiency; uniform policies, programs, and services; decreased bureaucracy; effective resource sharing; accountability and compliance; innovation; and timely access to care.*
• Seek positive ways to encourage and educate beneficiaries to seek care in the most appropriate and cost effective venue;
• Take advantage of the unused capacity of MTF and increasing beneficiary use of MTFs by expanding the current primary care base eligibility;
• Encourage improved collaboration between the direct and purchased care systems and implementing best business practices;
• Focus the MHS, health care providers, and beneficiaries on quality measured outcomes, ensuring TRICARE Network provider eligibility is linked at a minimum to the Centers for Medicare and Medicaid Services' quality outcome measures.
• Monitor the MHS financial controls to eliminate fraud, waste and abuse;
• Establish TRICARE networks in areas of high TRICARE Standard utilization to take full advantage of network discounts; and,
• Encourage DoD to enhance cooperation, collaboration, and communication between the service medical departments (direct care system), the office of the Assistant Secretary of Defense for Health Affairs (ASD HA) (purchased care system), and health care systems outside of defense.

* AFA and AFSA do not support a "Unified Medical Command" specific structure but do support the stated improved organizational outcomes.

Shared TMC Health Care Committee Goals:

Health Care Issues to Monitor: