With a shove from Congress, the Department of Defense will take several actions next year to make two million TRICARE Standard users feel less like the neglected stepchildren of military health care. Ed Wyatt, principal deputy assistant secretary of defense for health affairs, said the effort will include developing a list of physicians who accept Standard patients and reimbursements, and doing more to educate both beneficiaries and physicians on the TRICARE Standard program. Users of TRICARE Standard, formerly called CHAMPUS, "have legitimate concerns about access" to care in some areas of the country, Wyatt said. "We're going to address their concerns."
The department agrees that not enough has been done in recent years to keep the "third tier" of military medicine "a first rate benefit," Wyatt said. Defense health officials have been focused on improving TRICARE Prime, the military's managed care program, and implementing TRICARE-for-Life, the insurance supplement to Medicare for service elderly. Another health care option, TRICARE Extra, is a preferred provider plan that offers discounts to non-Prime patients who use network doctors.
Last March, beneficiary groups complained to a House panel that the Standard program has been neglected and a rising number of doctors won't accept Standard users as patients. They urged lawmakers to force Defense officials to help Standard patients more, by creating and making available lists of physicians who accept Standard patients. They also said patients and providers lacked current information on Standard benefits.
In response, the House version of the 2004 defense bill urges DoD to develop an "outreach" plan for Standard users to help them understand their coverage, obtain health care provider information, and ease other program difficulties. The Senate bill directs the defense secretary to ensure "continued viability and adequacy" of TRICARE Standard benefits.
Wyatt said whatever final guidance Congress provides, Defense officials are committed to educating beneficiaries and providers on the Standard benefit, and to making available to beneficiaries lists of providers in their area who recently have accepted Standard patients. But the lists, Wyatt cautioned, will provide assistance, not guarantees. "Providers choose to participate in TRICARE, as in Medicare, on a case by case basis," he said. Some physicians manage their practices to accept only a limited number of TRICARE Standard patients. So the kind of list we might produce would not guarantee that if you went to a doctor, [he or she] will accept assignment."
Beneficiary groups also complained last March about a requirement that TRICARE Standard patients living within 40 miles of a military hospital or clinic get a statement from the facility that it can't provide the necessary care. Without a "non-availability statement," or NAS, TRICARE Standard will not cover the treatment.
Wyatt said the onerous NAS requirement will all but disappear when new TRICARE support contracts take effect next year. Under a delayed provision of law enacted a few years ago, the secretary of defense will have to notify Congress 60 days in advance that a certain hospital needs to impose an NAS requirement on a certain procedure. He can do so for one of three reasons: to maintain medical readiness, to sustain a patient base for graduate medical education, or to save the government a lot of money.
Clearing any of those hurdles will not be "a trivial process," Wyatt said, so most Standard users will never face an NAS requirement again. DoD will begin developing more specific initiatives to improve TRICARE Standard after meeting with beneficiary groups. "Whatever we implement we want to make sure it answers questions they have," he said. But for sure, Wyatt said, "there will be some kind of education effort. There will be some kind of effort to help beneficiaries find providers."
Publication of a TRICARE Standard handbook also is likely, he suggested. Health officials would draw upon lessons learned in educating mobilized Reservists on new health benefits during the war on terrorism.
Military Tax Breaks
House Republican leaders felt heat from military taxpayers when they removed a package of service tax breaks from the $350 billion tax bill before President Bush signed it earlier this month. But a new solution is in the works. Rep. Bill Thomas (R-Calif.), chairman of the House Ways and Means Committee, has combined the military tax package with legislation to protect child care tax credits, another sore point for many in the original tax bill.
HR 1308, the All-American Tax Relief Act of 2003, was expected to win quick House approval. It would extend to members of the Armed Forces and the Foreign Service the same capital gains tax exclusions on proceeds from home sales that have been available to less transient taxpayers for six years. The provision would be retroactive to home sales since May 1997.
The bill also would allow drilling Reservists and National Guardsmen new tax deductions of up to $1500 a year for lodging and travel expenses when serving and staying overnight more than 100 miles from home. The military death gratuity of $6000 would be made fully tax exempt; survivors now pay taxes on half of it.
The Senate in March passed a more generous military tax relief package. Differences in the two bills could be worked out during a conference committee or the two chambers could continue to "ping pong" the long-awaited military tax breaks between them, until they get a bill they can agree on or time expires for another session of Congress.
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Syndicated columnist TOM PHILPOTThas covered military affairs for more than 25 years, including six as senior editor of Navy Times. He writes free-lance magazine articles, primarily on defense issues. His work has appeared in Washingtonian, Reader's Digest, and Kiplinger's Personal Finance magazines. His book, Glory Denied, is now available in paperback. To send feedback on MILITARY UPDATE columns, e-mail Tom at
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