December 5, 2003

According to Tricare officials, many prescription pads used by providers contain embedded watermarks to prevent fraud and forgery. When prescriptions written on watermarked pads are faxed to the Tricare Mail Order Pharmacy (TMOP), the watermarked area of the copy received at TMOP is either black and unreadable or totally blank. Accordingly, Tricare is encouraging providers to fax a cover sheet containing the provider's name and telephone number with each prescription. Then TMOP can contact a provider when an unreadable watermarked prescription is received. Officials noted that TMOP will make every attempt to track down providers so long as they have contact information. 

December 12, 2003

The Medicare Prescription Drug Bill should have no impact upon Tricare for Life or the Tricare Senior Pharmacy program, according to defense and congressional officials, because those programs are set in law. To reinforce this, however, Rep. Ed Schrock, R-Va., has introduced HR-3390, which would keep Tricare Senior Pharmacy participants from having to pay more than other Tricare beneficiaries. 

December 12, 2003

Except for certain provisions affecting military retirees (previous item) the Medicare prescription drug act probably will not offer a reason for most retirees to stop using Tricare for Life or the Tricare Senior Pharmacy service. Under the act, drug discount cards will be available in April 2004, and low-income seniors will be subsidized for $600. In 2006, beneficiaries can sign up for a standalone drug plan or join a private health plan. They would be charged a premium of $35 per month, or $420 per year. After a $250 deductible is met, insurance would pay 75 percent of drug costs up to $2,250. Coverage would stop between $2,250 and $5,100, above which the act would cover 95 percent or require a modest copayment. Also available will be health insurance policies with high deductibles combined with tax deductible savings accounts. 

December 12, 2003

On Dec. 8, President Bush signed the Medicare Prescription Drug, Improvement and Modernization Act of 2003 into law. In addition to civilian pharmacy benefits (next item), five provisions may impact on Medicare-eligible military retirees and their families. First, the bill will eliminate late enrollment penalties for Medicare-eligibles who enrolled in Medicare Part B in 2001, 2002, or 2003 in order to be covered by Tricare for Life. Second, it will eliminate late penalties for those who enroll in Part B during a special enrollment in 2004 that will run through Dec. 31. Next, it will replace a planned 4.5 percent cut in Medicare payments to doctors with a 1.5 percent increase in 2004 and 2005. Fourth, it will eliminate the annual $1,500 cap on Medicare physical therapy payments. Finally, it will establish a means test for Medicare Part B participation, creating higher premiums beginning at the $80,000 annual income level.

Report on VA hospitals delayed 
By Brian Faler 
Associated Press 

Web Posted : 12/22/2003 1:49 PM 

A federal commission considering a plan to remake the Veterans Affairs health care system -- a proposal that could shut down seven hospitals but also provide some new facilities -- will delay announcing its recommendations until next year. 
The group had originally planned to release its report Dec. 11. But Richard Larson, executive director of the commission, said it is still reviewing the public comments and other information it has collected over the past several months on the plan -- and won't release its findings until sometime in the next six weeks. He declined to set a firm deadline. 

Veterans Affairs Secretary Anthony Principi "wants a report, and the commission wants to make sure we give him the best possible report," Larson said. "We had a target schedule, a target date and, golly, it's going to take us a couple weeks longer than we had anticipated." 

The plan, originally announced in August, would be the largest overhaul of the agency's sprawling health care system since the end of World War II. It is designed to tailor that system more closely to the nation's population of veterans, a group that, in recent decades, has increasingly moved to the South and West. The proposal is also intended to better reflect the health care industry's increased emphasis on outpatient care, while cutting costs at some aging facilities. 

The seven hospitals that could be closed are in California, New York, Pennsylvania, Ohio, Kentucky, Mississippi and Texas. Any closing is always a sensitive topic because it would likely inconvenience some veterans -- a group with significant political clout -- and cause economic dislocations in some communities. 

The proposed plan also includes new medical centers in Orlando and Las Vegas, as well as new facilities for the blind and for treating spinal cord injuries. In Washington, Maryland and Virginia, the plan would expand existing outpatient clinics and build new ones. 

"This is not about saving money," Larson said. "It is about enhancing services. It could well end up costing more money." 

The commission will forward its recommendations to Principi, who will accept, reject or, possibly, send the package back to the group for further elaboration. 

The delay is "a big deal ... in communities where people are anxiously awaiting some resolution," said department spokesman Phil Budahn. "For us, we had never done anything like this before. The original timeline was just a little too optimistic." 

The commission has held 38 hearings nationwide, meeting with state and local elected officials, veterans groups, and representatives of unions and medical facilities. It has also made 68 visits to VA facilities and collected more than 200,000 comments from the public. Larson declined to generalize about the reactions the panel has received. 

"In each community, we hear something different," he said. "It depends on what the proposal is in that community. And some communities were well-organized and, basically, had a lot of public support for what the community's position was. And other communities, it was less so. It really varies from place to place." 

John McNeill, an official in the Washington office of the Veterans of Foreign Wars, said: "Let's wait to see what the report is. It's not necessarily good to shoot the horse before it gets out of the starting gate." 


December 26, 2003

On Dec. 28, Tricare Standard beneficiaries who live within a 40-mile radius of a Military Treatment Facility will no longer need a non-availability statement from the MTF before receiving inpatient care (except for inpatient mental health care). The Secretary of Defense, however, can always waive this cancellation in any of three circumstances: (1) if he can demonstrate that significant costs would be avoided by performing specific procedures at the affected MTF or facilities; (2) if he determines that a specific procedure must be provided at the affected MTF or MTFs to ensure satisfactory proficiency levels of the providers at the facility or facilities; or (3) if he determines that the lack of non-availability statement data would significantly affect the interface with Tricare contract administration. Sources within DoD assert that there is little possibility of such waivers

December 26, 2003

Under the original Combat-Related Special Compensation law, effective June 1, 2003, retirees with 10% or more VA disability compensation resulting in a Purple Heart, and those with at least 60% disability because of combat or combat-related causes, were eligible for CRSC. (Almost all Guard and Reserves were excluded.) Under those provisions, up to 40,000 disabled retirees have applied and only about 10,000 have been processed. On Jan. 1, 2004, military retirees, including Guard and Reserves, with combat and certain combat-related disabilities rated 10 percent or higher are eligible to apply for CRSC. By some estimates, as many as 100,000 may apply under the new provisions. Regardless of backlogs, pay for retirees approved will be retroactive to June 1, 2003 for the original CRSC and Jan. 1, 2004 for the expanded program.