Defense Health Care: Status of Fiscal Year 2004 Requirements for Reservists' Benefits and Monitoring Beneficiaries' Access to Care Page: 3 of 7
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DOD decided that the TAMP benefit and the provision of benefits upon activation
would be retroactive to November 6, 2003. The provision allowing qualified
reservists and their families to enroll in TRICARE requires DOD to issue regulations
to administer the program. Congress limited expenditures for these three provisions
to a combined total of $400 million for fiscal year 2004. All of the provisions are
temporary, expiring December 31, 2004.
In addition, the NDAA 2004 required DOD to enhance its monitoring of beneficiaries'
access to care for TRICARE Standard including
1) designating an official to ensure the adequacy of provider participation in the
Standard option in each of TRICARE's market areas;5 and
2) conducting surveys in 20 market areas every fiscal year until all markets have
been surveyed to determine how many providers are accepting new patients
under TRICARE Standard.
Status of Implementation of NDAA 2004 Requirements
DOD is in varying stages of implementing the provisions for reservists' health care
under NDAA 2004. First, in order to extend the TAMP benefit period to 180 days as
required by law, DOD modified its Defense Enrollment Eligibility Reporting System
(DEERS), the database that maintains information about TRICARE eligibility. This
modification, which also included changes that allowed DOD to track expenditures
for the benefit, was completed in January 2004. According to DOD, reservists who
separated prior to that period will be retroactively reimbursed for their own or family
members' medical expenses that were incurred on or after November 6, 2003.
Second, DOD has not completed all of the changes that will allow it to make
reservists and their families eligible for TRICARE benefits as soon as they receive
delayed-effective-date orders for activation or 90 days before activation-whichever
is later. This benefit could not be immediately implemented because it also required
DEERS modifications to record eligibility and track benefit expenditures. In
addition, according to DOD officials, it required other complicated changes, including
changes to TRICARE's contracts that are used to deliver health care through civilian
providers. Further, each of the seven components that constitute the reserves had to
change the process for ordering reservists to active duty, ensuring that DEERS
receives mobilized reservists' eligibility information.6 According to a DOD official,
the department expects to implement this benefit this month, and reservists with
qualifying orders issued on or after November 6, 2003 will receive retroactive
payments for these benefits.
' DOD has identified 182 TRICARE market areas across the United States where there are large
numbers of beneficiaries. The market areas were identified as part of DOD's awarding of new
TRICARE support contracts that are scheduled to be implemented in June 2004.
6The armed forces reserve components consist of the Air Force Reserve, the Air National Guard, the
Army Reserve, the Army National Guard, the Navy Reserve, the Marine Corps Reserve, and the Coast
Guard Reserve.GAO-04-563R Status of Defense Health Requirements for Fiscal Year 2004
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United States. General Accounting Office. Defense Health Care: Status of Fiscal Year 2004 Requirements for Reservists' Benefits and Monitoring Beneficiaries' Access to Care, text, March 17, 2004; Washington D.C.. (https://digital.library.unt.edu/ark:/67531/metadc300230/m1/3/: accessed April 25, 2024), University of North Texas Libraries, UNT Digital Library, https://digital.library.unt.edu; crediting UNT Libraries Government Documents Department.