Defense Health Care: Continued Management Focus Key to Settling TRICARE Change Orders Quickly Page: 8 of 32
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officers are assigned to each MCS contract and are supported by other
TMA staff as well as by the Lead Agents.3
Change orders may result from new laws or regulations, or from DOD
initiatives. The most recent data available, which were in our 1997 report,
showed that one-third of all TRICARE change orders resulted from new
laws or regulations, while the remaining two-thirds were self-initiated.
TMA officials told us that they were unable to provide updated statistics
for our current review because the data are maintained by several
different departments and would require significant effort to compile.
Most changes are incorporated into the MCS contracts by issuing the
change order as an amendment to the applicable TRICARE program
manual: the Policy Manual, the Automated Data Processing (ADP) Manual,
or the Operations Manual. Policy changes include the authorization of new
benefits or changes in the administration or payment of current benefits.
ADP changes involve modifications to how data are created, maintained,
or reported, as well as changes to systems requirements. Operations
changes include those involving the administration of the TRICARE
program, such as revisions to home health care billing procedures.
Changes can also be classified as "multiple," meaning they involve
modifying two or more of the manuals. Changes classified as "other" fall
outside these categories. Examples of such changes are the authorization
of travel costs incurred by the MCS contractors for government training
and orders directing MCS contractors to report information about ongoing
provider fraud investigations. Similar to our 1997 report, we found that as
of June 30, 2000, the Operations Manual was modified most frequently,
followed by the Policy Manual, as shown in figure 1.
GAO-01-513 TRICARE Change Order Management
3An administrative organization called a Lead Agent is designated for each of the TRICARE
regions to coordinate health care provided by all military treatment facilities in the region.
Lead Agents can issue change orders that are small in scope. However, we included in our
review only those change orders issued by TMA.
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United States. General Accounting Office. Defense Health Care: Continued Management Focus Key to Settling TRICARE Change Orders Quickly, report, April 10, 2001; Washington D.C.. (digital.library.unt.edu/ark:/67531/metadc293076/m1/8/: accessed November 17, 2018), University of North Texas Libraries, Digital Library, digital.library.unt.edu; crediting UNT Libraries Government Documents Department.