Topics In This Week's News Include:
Here's the News!!!
1. Military Health Care Task Force Holds First Meeting:The Task Force on the Future of Military Health Care held its firstopen meeting January 16, in Alexandria, Virginia. The commissionersreceived an overview of the Military Health System (MHS), the DefenseHealth Program (DHP), and the DoD "sustaining the military healthbenefit" efforts. Dr. William Winkerwerder, Assistant Secretary ofDefense for Health Affairs, and Dr. David Chu, Under Secretary ofDefense for Personnel and Readiness, added their commentary on theirhealth care programs and initiatives.
The MHS and DHP briefing included information about the MHS mission,beneficiaries and benefits, financial resources, operation andmaintenance structure, medical military construction, the Medicareeligible retiree health care fund and current issues. The MHS missionis:
- Provide health care to the military in order to deploy healthy service members;
- Provide patient care to beneficiaries;
- Maintain professional proficiencies: and
- Deploy medical staff in support of deployed service members.
Currently, the approximately 9.1 million beneficiaries include 2.3million active duty family members and 2.2 million eligible retireefamily members. Funding for the DHP covers operation and maintenance(O&M), research, development, test and evaluation (RDT & E) andprocurement (purchases for equipment and systems). Total DHP fundingincluded in the President's FY 2007 budget is approximately $21million. Additional FY 2007 budgeted items are medical militarypersonnel, medical military construction and unified medical program,totaling approximately $28 million. The Medicare eligible retireehealth care fund covers beneficiaries eligible for TRICARE for Life(TFL). The total FY 2007 estimated TFL cost is $7.7 billion. and has atotal budget authority of approximately $36 million. The MHSinfrastructure consists of 259 veterinary, 417 dental, and 409 medicalclinics, as well as 70 inpatient facilities. Patient care makes up 81percent of the DHP O&M budget. Patient care received within themilitary medical facilities is valued at approximately $5.6 million,with $11 million paid for private sector care. Current financial issuesare the added cost of the Global War on Terrorism and the failure ofthe 110th Congress to pass the FY 2007 appropriations bill that fundsmilitary construction and Defense health care. Instead, it decided tofund all programs without a completed appropriations bill through at aContinuing Resolution at FY 2006 levels. This decision will create a $2billion budget shortfall for Defense health care this year.
The briefers presenting the "sustaining the military health benefit"discussed the rising cost of TRICARE, in terms familiar tobeneficiaries who have followed this issue since DoD's attempt lastyear to increase certain TRICARE fees. Currently, health care makes up8 percent of DoD's total budget, but is projected to rise to $62billion and 12 percent in 2015. Officials noted that the under age 65retiree eligible population is approximately 3 million. They indicatedthat the changes proposed last year, and still supported by theDepartment, are estimated to create $11.2 billion savings over fiveyears.
Dr. Winkerwerder and Dr. Chu highlighted the reason behind theirinsistence on the proposed beneficiary fee increases and emphasized theneed to educate Service leadership, Congress, and TRICARE beneficiarieson rising health care costs and its impact on the DoD budget.
NMFA has been proactive regarding DoD's proposed benefit changes.Last year, we educated Congressional members on the potential impactthese changes would have had on the targeted population and pointed outpotential unintended consequences should the DoD proposals beimplemented. NMFA acknowledged and continues to assert that the risingcosts of health care must be addressed; however, the Association statedthe increases as proposed by DoD were too high and would be applied tooquickly. We, along with other military associations soughtCongressional oversight of TRICARE fee increases. The 2007 NationalDefense Authorization Act (NDAA) required DoD not to raise prices untilOctober 1, 2007, to cooperate with a Government Accountability Officestudy on the fee increase issue and to set up the task force. In 2007,NMFA will continue to oppose disproportionate increases in TRICAREPrime fees and TRICARE standard enrollment fees. We will continue tomonitor this issue and address it in Congressional testimony.
The initial report of the task force is due to Congress in May,2007. NMFA will be monitoring the task force's meetings and decisions.The next meeting is scheduled for February 6, 2007, in the Washington,DC, area. The task force website is: http://www.ha.osd.mil/dhb/fmhc/. (Source: http://www.ha.osd.mil/dhb/fmhc/meeting/2007Jan.cfm 2. 2005 Health Related Behaviors Survey Released:The Department of Defense recently announced results of its 2005 Surveyof Health Related Behaviors among Active Duty Military Personnel. Thefindings show notable decreases in the use of cigarettes and illegaldrugs since initiation of the surveys in 1980 and progress towardsmeeting selected Healthy People 2010 objectives. The 2005 survey,however, revealed rates of heavy drinking remain elevated especiallyamong young people, use of smokeless tobacco has increased, and, eventhough most military personnel engage in moderate or vigorous exercise,more service members meet criteria for being overweight.
The 2005 survey indicates the majority of the U.S. Armed Forces,although under heavy work stress during the current wartimeenvironment, use positive coping mechanisms to deal with stress. Thisis the ninth survey in the series of anonymous surveys asking activeduty service members about various lifestyle and health-relatedbehaviors. In addition to substance use, the survey also assessesnational health status goals from the Department of Health and HumanServices' Healthy People 2010 objectives, nutrition and weightmanagement measures, mental well-being of the force, and deploymentissues. More than 16,000 service members, randomly selected torepresent men and women in all pay grades of the active forcethroughout the world, completed the survey.
When comparing the 2005 findings to earlier survey results, therewere both tremendous improvements in the past 25 years and some issuesof concern. Between 1980 and 1998, the surveys show a continuingdecline in the use of illegal drugs and cigarettes and an increase inalcohol abstainers or light drinkers among military personnel. Whenfirst surveyed in 1980, 27.6 percent of the active force acknowledgeduse of illegal drugs during the month prior to taking the survey. In2002, only 3.4 percent reported using illegal drugs. Heavy drinking(five or more drinks per occasion at least once a week) declined from20.8 percent in 1980 to 15.4 percent in 1998, but rose to 18.1 percentin 2002, before declining slightly in 2005 (18.5 percent). Cigarettesmoking declined from 51.0 percent in 1980 to 29.9 percent in 1998,increased significantly to 33.8 percent in 2002 and remained at thatlevel in 2005 (32.2 percent). Heavy cigarette smoking (1 or morepacks/day), showed a steady decline from 1980 (34.2 percent) to 2002(13.1 percent), with a further significant decrease from 2002 to 2005(11.1 percent). In contrast, past month smokeless tobacco use showed asmall increase from 2002 (12.2 percent) to 2005 (14.1 percent).
According to Dr. William Winkenwerder, Assistant Secretary ofDefense for Health Affairs, the 2005 survey is the first time thisseries has evaluated behaviors related to mental well being, workstress, and family stress associated with deployment to Iraq,Afghanistan and other theaters. Overall, most military personnel areusing positive coping mechanisms in dealing with the stresses of theircurrent wartime environment. Results come from self-reported data andmay differ from information in official records or other data sources.The screening questions do not represent a formal clinical diagnosticevaluation, but suggest that some personnel should be encouraged toobtain more evaluation.
Rates of current (one month) Post Traumatic Stress Disorder (PTSD)symptoms in the DoD population as measured by a self-report screenerwere 6.7 percent for total DoD and ranged from 3.7 percent to 9.3percent for each service. An estimated 8.1 percent met screeningcriteria for further evaluation for serious psychological distress.
Personnel deployed in the past three years (i.e., from 2002 to2005), compared to those who did not deploy, had higher rates of workand family stress and higher rates of heavy alcohol use, cigarette use,and illicit drug use. A greater number met criteria for depression,anxiety and PTSD symptoms on the screening questions. Statisticallysignificant relations were observed among heavy alcohol use, stress,and mental health issues. Compared with abstainers, heavy users ofalcohol reported more problems with stress at work (41.1 percent vs.28.4 percent) or in their family (24.7 percent vs. 15.3 percent); weremore likely to meet screening criteria for anxiety (17.5 percent vs.10.1 percent) and depression (31.2 percent vs. 19.1 percent); andreported more limitations in activities as a result of poor mentalhealth (4.8 percent vs. 2.0 percent). Heavy drinkers were also morelikely than those who drank less to meet the criteria for furtherevaluation for serious mental disorders and reported to have a historyof suicidal ideation or physical or sexual abuse. It can not beascertained from the survey which behavior (the heavy alcohol use orthe mental health problems) came first; however, NMFA hopes DoD wouldexamine potential intervention strategies in which reducing one wouldhelp reduce the other (i.e., encouraging more positive copingstrategies could both lessen use of alcohol and improve mental health).
DoD continually monitors the general health of service members,their modifiable lifestyle behaviors and the effects of combat andoperational-related stressors through the DoD level programs such as:Defense Lifestyle Assessment Program (DLAP), Deployment HealthPrograms, and Healthy Choices for Life Initiatives. In 2005, DoDexpanded the scope of the active duty surveys to include the NationalGuard and Reserve, and is sponsoring other special studies, the firstof which is examining unit-level influences on alcohol and tobacco use.TRICARE has also launched the Healthy Choices for Life initiative,focusing on the key health issues of weight management, tobaccocessation and reducing alcohol abuse, along with measuring their costs.In addition, the Secretary of Defense has made safety, including safepractices and behaviors to reduce injuries and accidents, a toppriority with the establishment of the Defense Safety Oversight Council.
The final 2005 survey report is available on at: http://www.ha.osd.mil/special_reports/2005_Health_Behaviors_Survey_1-07.pdf . (Source: http://www.defenselink.mil/Releases/Release.aspx?ReleaseID=10395).
3. More Changes Made in TRICARE Formulary:TRICARE officials recently announced that Dr. William Winkenwerder Jr.,Director of the TRICARE Management Activity (TMA), is continuingselected medications on the TRICARE Uniform Formulary and designatingothers as nonformulary (or third tier) effective January 17, 2007. Achart available at http://www.tricare.mil/news/news.aspx?fid=260shows the medications, their status as formulary (tier-one generics ortier-two brand name) or third tier (nonformulary), and theimplementation date. The categories of drugs affected by the latestchanges are: Attention Deficit Hyperactivity Drugs, Narcolepsy Drugs,Older Sedative Hypnotic Agents, Monophasic Oral Contraceptive Drugs,Antiemetic Drugs, and Topical Anti-fungal Drugs.
Medications on the first tier (formulary generics) are availablethrough the TRICARE Retail Pharmacy (TRRx) for $3 for up to a 30-daysupply and through the TRICARE Mail Order Pharmacy (TMOP) for $3 for upto a 90-day supply. Beneficiaries may purchase medications on thesecond tier (formulary brand-name) for the same number of days for $9.Medications on the third tier (nonformulary) require a $22 co-paymentin both venues. By using the mail-order pharmacy, beneficiaries save upto 66 percent on prescriptions. Beneficiary co-payments are higher atnon-network retail pharmacies.
Beneficiaries currently on third-tier medications may want toconsult their health care providers about changing to a first- orsecond-tier alternative. When a provider prescribes a medication, DoDofficials encourage beneficiaries to talk to that provider and see if ageneric alternative is available that would provide the same clinicalresults in that drug class. This would save beneficiaries money at bothretail and mail-order pharmacies, and help the Defense Departmentcontain health care costs. Beneficiaries may also ask their provider ifestablishing medical necessity for the tier-three medication isappropriate. If a provider determines medical necessity for atier-three drug, the co-payment is reduced to $9.
Tier-three medications will not be available at military treatmentfacility (MTF) pharmacies unless an MTF provider determines medicalnecessity and writes the prescription. Not all tier-one and tier-twodrugs are available at all MTF pharmacies. For a list of medications,their formulary status and where they are available, go to: www.tricareformularysearch.org/dod/medicationcenter/default.aspx. Medical necessity forms and criteria are available at www.tricare.osd.mil/pharmacy/medical-nonformulary.cfm.
Visit www.express-scripts.com/TRICAREfor more information on the TRICARE Retail Pharmacy and locations andthe TRICARE Mail Order Pharmacy, or call 866-363-8667 for the mailorder pharmacy or 866-363-8779 for the retail pharmacy.
4. You Can Provide Input on the TRICARE Pharmacy Formulary: Whenit directed DoD to institute the 3-tier formulary, Congress establishedthe Uniform Formulary Beneficiary Advisory Panel (BAP) to review andcomment on the recommendations of the DoD Pharmacy and Therapeutic(P&T) Committee. Members of the BAP include active duty familymembers, retirees and retiree family members, two clinical expertsoutside of DoD, a pharmacist from the Uniformed Services Family HealthPlan and physicians or pharmacists from the TRICARE regionalcontractors and the pharmacy contractor. NMFA Government RelationsVolunteer Deb Fryar serves as an active duty family memberrepresentative on the panel. The P&T Committee forwardsrecommendations, along with the comments from the BAP, to the director,TRICARE Management Activity for consideration prior to a final decision.
The military health system encourages TRICARE beneficiaries to bepart of the process by communicating their concerns to the BAP. TheFederal Register announcement of the public BAP meeting and its agendais posted on the BAP website at www.tricare.osd.mil/pharmacy/BAP/two to six weeks in advance of the meeting. The site providesinformation on how beneficiaries should submit comments or concerns.NMFA will also announce the date of the next meeting when it ispublished.
5. Retirees Can Pay TRICARE Fees Through Allotments:Military retirees in TRICARE Prime are reminded they may pay theirPrime enrollment fees by establishing a monthly allotment from theirService retirement pay. The Defense Financial Accounting System (DFAS),the U.S. Coast Guard or the U.S. Public Health Service deducts theretirement pay allotment. Retirees enrolled in TRICARE Prime currentlyreceive a quarterly or annual bill, which they can pay by check orcredit card. Choosing to pay by allotment saves on paperwork and time.
Retirees may begin to take advantage of this convenient process bydownloading and completing an enrollment fee allotment authorizationform, based on the region in which they live: TRICARE North, TRICARESouth, TRICARE West. This form is used to stop, start, or changemonthly allotment payments from retiree pay accounts. Allotment formscan be found at these links:
- West Region: https://www.triwest.com/triwest/default.html?/triwest/unauth/content/enrollment/
- North Region: https://www.hnfs.net/bene/enrollment/enrollment_activities_current_beneficiaries.htm
- South Region: http://www.humanamilitary.com/south/bene/TRICAREResources/forms/BeneForms.htm#2.
Retirees should send the completed form with an initial quarterlypayment to their regional contractor. The regional contractor willforward a payment request to the designated pay agency and the agencywill set up a monthly payment to the regional contractor on theretiree's behalf. Retirees should contact their regional contractor orgo online to a contractor's secure website to make sure it received theenrollment fee allotment authorization form and initial quarterlypayment.
DFAS will put allotment orders in the pay system for processing onceTRICARE sends the request. Retirees may view their allotment detailsthrough myPay at: https://mypay.dfas.mil/mypay.aspx,or on their pay statements (leave and earnings statement or retired orannuitant account statement), when DFAS activates the allotment.
Beneficiaries who receive survivor benefits from either retired oractive duty sponsors are paid through a separate pay account and arenot eligible for an enrollment fee allotment.
For more information on enrollment fee allotments, retirees may contact their regional contractor:
- West Region: TriWest, 1-888-874-9378, www.tricare.osd.mil/west
- North Region: HealthNet, 1-877-TRICARE, www.tricare.osd.mil/north
- South Region: Humana Military, 1-800-444-5445, www.tricare.osd.mil/south
For more information on monthly allotments, visit the DFAS website at: http://www.dfas.mil/.
6. "Military Retirees Health Care Protection Act" Introduced:Representatives Chet Edwards (D-17,TX) and Walter Jones (R-3, NC)reintroduced last year's "Military Retirees Health Care Protection Act"(H.R. 579) in the new Congress. The bill would remove the authority ofDoD to change TRICARE fees without Congressional approval. Its languageacknowledges the extraordinary sacrifices endured by career militaryservice members, who deserve retirement and health care benefits betterthan provided for civilian retirees, and notes that military membershave already paid large premiums because of their devotion to duty anddecades of sacrifice to their country. The bill also would mandate thatthe percentage increase in TRICARE fees should not exceed the yearlypercentage in beneficiary military compensation increase.
Representatives Edwards and Jones introduced similar legislation inthe 109th Congress (H.R. 4949), which had gathered support from 164co-sponsors. The legislation stated a sense of Congress that the nationand DoD have an obligation to provide health care benefits to militaryretirees and there are other options available to stem the growth andrising cost of health care than raise fees to beneficiaries. It led tothe inclusion of language in the FY 2007 National Defense AuthorizationAct (NDAA) barring any fee increases during the current fiscal year.
NMFA appreciates the continued support by Representatives Edwardsand Jones of the health care benefits for active duty militaryfamilies, retirees, their families, and survivors. In supporting theirbill last year, we acknowledged some changes were needed to offsetrising health care costs, but stated our concern over the DoDproposal's timeframe for implementation of beneficiary changes and thelarge percentage fee increases. Our 2007 goal is to opposedisproportionate increases in TRICARE Prime fees and TRICARE standardenrollment fees. H.R. 579 would address that goal. To view NMFA's 2007issues statement, go to: http://www.nmfa.org/site/DocServer/2007_Issues_and_Actions.pdf?docID=7241.
NMFA has teamed with the Military Coalition (TMC) to address thisissue during the 110th Congress. The TMC Health Care Committee'slegislative guiding principles are:
- Military service members have paid health care premiums through their sacrifices endured during their decades of service;
- DoD has a commitment to provide health care benefits that out weigh civilian retiree's plans; and
- DoD must exhaust all other options to lower health care costs before exhorting to increase fees to eligible beneficiaries.
TMC Health Care Committee's goals seeking Congressional authorityfor fee increases and assurances that increases not exceed in any yearthe percentage increase received by military members or retirees arereflected in H.R. 579. Other TMC Health Care Committee's goalsaddressing DoD's proposed beneficiary changes are:
- If a TRICARE Standard enrollment fee is required then access to TRICARE participating providers must be guaranteed;
- No fee for AD service members and their families;
- No fee structures according to military retiree's rank; and
- Advocate for full Defense Health Program funding from Congress.
For all of TMC Health Care Committee's 2007 goals, go to: http://www.themilitarycoalition.org/Testimony/committeegoals/healthcare.htm. To view the text of H.R. 579, go to http://thomas.loc.gov/ and type in "H.R. 579" in the bill search box.
7. Free Tax Help Available to Military Families:Once again Military OneSource is offering free tax assistance to allactive duty, National Guard, and Reserve members, as well as theirDEERS-enrolled spouses and children. Family members who are filingreturns for a deployed or severely injured service member can also usethis free service for the service member's tax return. Authorized usersmay prepare and electronically file one federal and one state return atno charge. The most notable change to the program for this year is thatthe software is H&R Block TaxCut Online rather than TurboTaxOnline.
The TaxCut software is very user friendly and leads you through aseries of interview questions to ensure that you receive all of thedeductions and credits for which you qualify. Prior to logging intoTaxCut, be sure to visit MyPay (https://mypay.dfas.mil/)to print your W-2. In addition, you will need W-2s for any non-militaryemployment. Don't forget to gather interest income statements(1099-Int) from your bank or credit union as well as the details of anyexpenses that may qualify for a deduction or credit such as mortgageinterest, tuition, childcare or charitable contributions. Once you havecollected your supporting documents you are ready to file.
To access the free filing offer you must enter TaxCut through the link on the Military OneSource website; http://www.militaryonesource.com/.You will be required to register with Military OneSource if you are notalready a registered user. After login the site will redirect you tothe H&R Block TaxCut website where you can begin enteringinformation for your return. Accessing the H&R Block websitedirectly, rather than through the OneSource link, will result inregular charges for preparation and filing.
Military members and families that used last year's TurboTax Onlinethrough Military OneSource will have to enter manually personalinformation in TaxCut. Prior year information entered into TurboTaxOnline cannot be uploaded into TaxCut Online. Users may want to printcopies of their 2005 returns for reference. To access 2005 returns fromthe TurboTax Online website, http://turbotax.intuit.com/,click on "Access Your Prior Year Returns". Once logged in, you will beable to print PDF files of your 2005 returns. Taxpayers who used TaxCutOnline or purchased TaxCut or TurboTax software that was loaded totheir hard drive can upload personal and prior year informationdirectly to TaxCut online.
As always, Military OneSource has qualified tax consultantsavailable to assist service members and their families with taxquestions. While they cannot prepare your return for you, they are ableto assist you with questions that you may have as you work through theTaxCut filing process. To contact a OneSource Tax Consultant, use thetoll free OneSource tax resource number: 1-800-730-3802.
8. Military Children Receive Additional Support in North Carolina: NorthCarolina is no stranger to military related challenges. With sevenmilitary installations located within the state, North Carolina is hometo the fourth largest number of military personnel in the nation, about123,000 including members of the National Guard and Reserve.Communicating and connecting to so many families can be difficult,especially during a deployment, but on December 12, 2006, Governor MikeEasley announced the launch of a new initiative that hopes to help thechildren of military parents who are deployed on active duty. Theinitiative includes training institutes to help educators betterunderstand the challenges faced by children of deployed parents as wellas a new website to help educators identify and assist these students.
Both the Department of Public Instruction and the N.C. Board ofEducation collaborated with the Military Child Education Coalition toprovide institutes and encourage representatives from each of theState's school districts to participate in one of three regional"Supporting Children and Families of the National Guard and ReserveInstitutes". The two-day training sessions are designed to helpeducators understand the challenges faced by children with deployedfamily members in the National Guard and Reserve and strategies tosupport the needs of children and their families.
The new web site, www.ncpublicschools.org/militarysupport, provides information about the stages of military deployment, commonand serious stress reactions among students with deployed parents, tipson identifying and working with students with deployed parents,suggested lesson plans and activities, and additional resources forsupporting children struggling with the separation from a family memberduring deployment. Information about the site will be communicated toteachers and administrators across the state.
NMFA congratulates Governor Easley for his leadership. By providingthe opportunity for educators in his state to stay informed andeducated on the stressors and challenges faced by our military childrenhe also provides the example for other states to follow suit.
9. Opportunity for Military Spouses: TheMedical Transcription Industry Association (MTIA), sponsor of theapprenticeship program for the development of the medical transcriptionworkforce, announces that it is now accepting applications forapprentices. This national apprenticeship program, registered by theU.S. Department of Labor, forges a stronger alliance betweeneducational institutions and transcription employers to increase thenumber of qualified medical transcriptionists employed in the UnitedStates. The Department of Defense is supporting this program as acareer opportunity for military spouses.
The MTIA Apprenticeship Program is a 2-year program in the area ofacute care. An eligible candidate for the program must be a graduatefrom a Medical Transcriptionist Training Program that has been approvedby MTIA, and the candidate must have obtained the AAMT RegisteredMedical Transcriptionist (RMT) credential. The number of apprenticeopenings will be dependent upon the needs of participating employers, alist of which can also be found at http://www.mtia.com/.
10. Navy Hotline To Assist Individual Augmentee Families During Deployments: TheExpeditionary Combat Readiness Command (ECRC), headquartered atAmphibious Base Little Creek, Norfolk, Virginia, has established ahotline for active duty and reserve Sailor's families on IndividualAugmentee (IA) orders. The toll free phone number is 877-364-4302.
This phone number helps IA family members find the information orresources they may need while their Sailors are deployed. The ECRC'shotline aims to alleviate the stress IA family members may experience.The ECRC wants to be a conduit for family members so they can get intouch with the group or organization that can provide the support theyneed.
With the unique deployments Navy IA Sailors and their families mayface, it is important for family members to know where they can go forhelp. Unlike a ship or squadron deployment, an IA may come from an areawithout fleet concentration. This could make it difficult for theirfamilies to find the resources and information they need. Even thoughthe Navy is doing new missions in different ways, Navy officials wantto assure Sailors and their families that the Navy is still going tocare for its family members the way it always has.
The ECRC also plans to establish a website designed specifically forIAs and their families. Navy Lifelines has a developed a sectionfocused on Individual Augmentees that can be found at: http://www.lifelines.navy.mil/portal/page/itc/LSNAPP/LSN5DETAILLFT?current_id=25.60.500.405.0.0.0.0.0§ion_id=188.8.131.52.0.0.0.0.0.
11. What's Important to You?Should DoD do more to support families of deployed service members? Ishelping military spouses in their careers a priority? How about makingit easier for you to get an appointment at your local military medicalfacility? Should Congress provide bigger military pay raises or housingallowances? NMFA is preparing its list of legislative and policy goalsfor 2007. We know we will be asked by Members of Congress and othersabout the critical challenges facing military families, about what'sworking for them, and about what is important to them. This is yourlast chance to help us tell them what really is important to militaryfamilies. Complete our "What's Important?" survey today! Go to: www.nmfa.org/whatsimportant.