MOAA Legislative Update: You could be Bounced from TRICARE Prime

June 04, 2009

You could be Bounced from TRICARE Prime.

A new DoD policy aimed at “cleaning up” TRICARE Prime enrollment at military treatment facilities (MTF) could mean some significant changes for many Prime enrollees.

TRICARE has long had established travel access standards to help beneficiaries receive timely health care. The standards require that enrollees shouldn’t be assigned a primary care manager (PCM) at a military hospital or clinic that’s more than a 30-minute drive from the beneficiary’s home address.

As a practical matter, DoD never really enforced that policy. But it will be enforced now.

If they want to continue to be seen in the MTF, current Prime enrollees in the U.S. who live farther away than a 30-minute drive from the MTF will have to request a waiver of the drive-time standard from the MTF commander or the TRICARE Regional Office. Drive times will be determined by a computer program similar to MapQuest. Approved waivers will have to be renewed annually from now on.

Unless they apply for and are granted a waiver before October 1, enrollees who live more than 30 minutes (but less than 40 miles) from the MTF will be assigned a civilian primary care manager closer to their residence. Absent a waiver, those who live more than 40 miles from the MTF will be disenrolled from Prime and revert to TRICARE Standard as of October 1.

TRICARE contractors are mailing letters to all affected beneficiaries, providing detailed instructions on the waiver process.

MOAA Cites Family Caregiver Needs

On June 4, MOAA Government Relations Deputy Director CDR René Campos (USN-Ret) joined a panel of witnesses before the House Veterans Affairs Subcommittee on Health to discuss ways the VA and DoD can improve care and support to families and caregivers of wounded, ill, and injured servicemembers.

A panel of VA and DoD officials talked about programs and initiatives under way to address unmet needs.

Campos stressed the need for major system fixes—not just patching the system with additional layers of programs and policies that further entrench the bureaucracies and build up more barriers.

She said Congress needs to pass legislation that would establish a joint, permanent, one-stop VA-DoD seamless system of care and support that includes: 

•  A permanent joint oversight office that reports to senior VA, DoD, and congressional leaders on all aspects of seamless transition 
•  A Center of Excellence for Caregivers and Families to coordinate support programs and services 
•  A single advocate to assist with coordination of care and services and 
•  Training, certification, and compensation programs that pay caregivers directly

“Seamless transition is a project that requires consistent long-term oversight if we are ever to change cultures,” Campos said. “If VA-DoD remains focused on meeting the needs of troops, veterans and their families, rather than the needs of the bureaucracy, then we’ll build the right system—for today and the future.”

Military Spouses Speak Out on Healthcare, Ops Temps, and Impacts on Children

A group of military spouses testifying before the Senate Armed Services Personnel Subcommittee on June 3 pulled no punches in highlighting the stresses military families incur associated with ops tempo and deployment separations, health care access, and children’s education, as well as a pressing need for better access to mental health counseling.

Chairman Ben Nelson (D-NE) and ranking Republican Sen. Lindsey Graham (R-SC) agreed on the need for more mental health providers. Graham said they are trying to address this problem by creating additional “home-grown” military providers.

“Army families are stressed and they are stretched,” said Sheila Casey, wife of Army Chief of Staff Gen. George Casey. “Young married couples don’t have enough time to build strong bonds with each other,” added Casey. “What really keeps me up at night is the effect on our children.”

After asking a panel of DoD and service policy experts what studies are being done on the impact of deployments on children, Chairman Nelson was told that a couple of Army-related studies would be released within a few months. Nelson said a DoD-wide study could be helpful and might examine some differences among the services.

To combat inconsistent educational quality as military parents move, retired Air Force service member and military spouse Patricia Davis recommended school vouchers for military children – a concept that captured the attention of the Senators. Sen. Saxby Chambliss (R-GA) suggested the Subcommittee may consider a pilot voucher program for military families. “There’s no reason why you ought to be required to fund private school education [at personal expense],” he said.

When one service panelist speculated that a voucher plan might pose adverse tax implications for the recipients, Sen. Graham responded, “What if it were made tax free?”

Sen. Roland Burris (D-IL) wondered how a voucher program would impact federal impact aid to local public schools, and headquarters family policy officials agreed that it would need to be examined.

Given the interest expressed by the subcommittee, we expect to hear more about the idea of school vouchers for military children.

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