Update on Tricare, Obamacare for veterans
by Thomas Crisp Contributing Columnist
Oct. 1 changes in TRICARE include the following:
— Defense Health Agency Stands Up: As of October 1, the newly established Defense Health Agency (DHA) assumes responsibility for health services that support operational forces, such as the management of TRICARE programs, pharmacy benefits, information technology, facilities planning, education and research. Operations previously run under the TRICARE Management Agency have been rolled into the newly established DHA.
— TRICARE Prime Service Areas: Despite pending legislation to the contrary, effective October 1, TRICARE Prime Service Areas are reduced for beneficiaries except active duty service members and their families. Those affected are beneficiaries who live outside 40 miles of a military treatment facility or base closure site.
Prime beneficiaries who see providers outside the 40-mile service area can remain in Prime if they live within 100 miles of an available primary care manager and sign an access waiver. Affected beneficiaries will need to re-enroll in Prime after Oct. 1, 2013, and check section 5 (waive drive time) on the TRICARE Prime enrollment form.
These changes have been planned since 2007, when proposals were requested for the next generation of TRICARE (known as T3) managed care support contracts. A provision in the House passed Defense Authorization bill (HR 1960) would allow beneficiaries to remain in a PSA if previously subscribed.
The provision sponsor is Chairman of the House Armed Services Committee, Howard “Buck” McKeon (R-CA). The Senate has yet to take up its bill. NAUS anticipates a similar amendment on the PSA situation is likely to be offered.
— Prime Fee Increase: Effective Oct. 1, TRICARE Prime fees increase: Single goes to $273.84 from $269 and family goes to $547.68 from $538.
[Source: NAUS Weekly Update 4 Oct 2013 ++]
TRICARE, ObamaCare Update 01
The Affordable Care Act was created to expand access to affordable health care coverage, lower costs, and improve quality and care coordination for all Americans. Under the health care law, people will have health coverage that meets a minimum standard (called “minimum essential coverage”) by Jan. 1, 2014, qualify for an exemption, or may be required to pay a fee if they have affordable options, but remain uninsured.
Because of this, many TRICARE beneficiaries may be wondering how this new law will affect them and their families. Simply speaking, the ACA will have very little impact on TRICARE beneficiaries. The biggest change they will notice may be an extra letter in their mailbox every January, and an extra box to check on their tax forms every April.
Beneficiaries who receive TRICARE benefits, whether at no cost, by electing to pay an enrollment fee, or by paying monthly premiums, have minimum essential coverage under the Affordable Care Act. This includes: TRICARE Prime, Prime Remote and Standard; TRICARE Reserve Select (TRS); TRICARE Young Adult (TYA); TRICARE Retired Reserve (TRR); and the Continued Health Care Benefit Program (CHCBP).
Eligibility alone for premium-based TRICARE benefit plans – TRS, TYA, TRR and CHCBP — does not constitute minimum essential coverage. Eligible beneficiaries must purchase and be in good standing, by paying their premiums to have coverage in force, in order for these TRICARE programs to qualify as minimum essential coverage. There are two groups of TRICARE beneficiaries who do not meet the minimum essential coverage requirement: those getting care for line of duty only related conditions, and those only eligible to receive care in military hospitals or clinics.
Beginning with the 2014 tax season, and every tax year after that, the Department of Defense will send every TRICARE beneficiary the same information it sends the Internal Revenue Service. This notification will detail whether sponsors and their dependents had minimum essential coverage during the previous year.
Sponsors can then use this information when they file their tax forms. Because the information sent to the IRS is generated using beneficiaries’ Social Security numbers, it’s essential for sponsors to make sure their family’s Defense Enrollment Eligibility Reporting System (DEERS) information is correct and up to date. [Source: AFPS DHA article 10 Oct 2013 ++]
VA pain management update
On Oct. 10, the House Veterans Affairs Subcommittee on Health held a hearing to examine the rising use of opiate painkillers to treat veterans. The committee expressed concern over the skyrocketing rate of prescriptions for these highly addictive medications, and the sense that there is a need for greater care coordination in pain management across VA.
VA representatives acknowledged the potential harm caused by opiate painkillers and stated that they are developing new alternative pain management programs which will soon be instituted across the department.
The new approach, known as the Chronic Pain Rehabilitation Program (CPRP) and based out of the Tampa VA Hospital, focuses on exercise, occupational therapy, pool therapy, relaxation training, acupuncture and massage, with the goal of eliminating dependency on opiate painkillers.
Although the CPRP currently accepts referrals from all 50 states, it is the goal of the VA to establish a similar program in every VISN. [VFW Washington Weekly 11 Oct 2013]
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