Congress plays an important oversight role on TRICARE contracts, and for good reason: when they were awarded in 2016, the current T-2017 Managed Care Support Contracts with Humana Military in the East Region and HealthNet Federal Services in the West Region were valued at $58 billion over six years. The increase in costs has been used in the past to justify increases in TRICARE fees, so we are naturally concerned that beneficiaries could be exploited to offset the increase in costs in the future. The letter reminds Congress that the MOAA and TMC have committed to block proposals to shift healthcare costs to beneficiaries, especially if the increase in costs is due to changes to the TRICARE contract. DOD awards contracts with private sector companies – called managed care support contractors – to provide health services to TRICARE beneficiaries through networks of civilian providers. In July 2016, dod awarded its fourth generation of TRICARE contracts, known as T-2017, for the management of civilian suppliers in its two regions (East and West). For new TRICARE contracts, the DOD provides for a transitional period – usually 9 to 12 months – for incoming and outgoing contractors. Meanwhile, incoming entrepreneurs need to take certain steps to prepare for health care. The letter also reminds Congress that the T-5 changes are taking place in the context of MHS reforms – changes that radically change the organization and governance of the direct care system of military hospitals and clinics. The new contracts include the requirement to improve integration between military hospitals and tricare`s civilian components. They are also calling for an improved electronic transfer process to reduce wait times for recipients who require special care. The John S.
The McCain National Defense Authorization Act for fiscal year 2019 included a provision for the GAO to review the T-2017 transition. This report examines (1) how the requirement to implement TRICARE Select affected the transition, (2) what challenges the DOD faced in implementing the T-2017 transition process, and (3) how the DOD addressed post-healthcare issues. The GAO reviewed and analyzed DOD guidelines, contractual requirements, and other relevant documents, and interviewed DOD officials, TRICARE contractors, and other stakeholders. The DOD provided a transitional period for its incoming and outgoing contractors, after which the incoming contractors assumed responsibility for the provision of health care. New contractors struggled to meet the deadlines for processing recommendations and claims because the DOD`s transitional guidelines were not specific enough to prepare them. As part of the Military Health System (MHS) reforms of the National Defense Authorization Act (NDAA) for fiscal year 2017, Congress ordered significant changes to the TRICARE program, including the construction of the Managed Care Support Contractor. The Department of Defense is required to look for alternative payment models for healthcare providers, including value-based incentive programs that transfer greater risk to providers and contractors. The Ministry of Defence must also ensure that local, regional and national health schemes have the opportunity to participate in order to increase competition among entrepreneurs and provide greater choice for beneficiaries. DOD provides health care through subcontractors with TRICARE, its regional health program. In July 2016, the DOD awarded its fourth generation of TRICARE contracts, consolidating two regions. The Department of Defense has addressed most of the problems that arose after health care began by requiring contractors to develop and implement corrective action plans. The Department of Defence and contractors are addressing some ongoing issues, including issues related to the accuracy of contractors` supplier inventory in both regions and the processing of claims in one region.
The DOD has the ability to avoid similar problems in the future by improving the specificity of its transitional guidelines and the effectiveness of its prudential requirements. The implementation of a new option required for health services has delayed some aspects of the transition to the Ministry of Defence`s (DOD) fourth-generation TRICARE managed care support contracts (T-2017). The National Defence Authorization Act for fiscal year 2017 required the doD to implement TRICARE Select, a new preferred supplier advantage option. As a result, the Department of Defense has postponed the start of healthcare – the date on which the new T-2017 contractors would assume responsibility for healthcare management – from October 1, 2017 to January 1, 2018 in order to align with the prescribed implementation date for TRICARE Select. The Department of Defence has also delayed and extended a period for the Department to make changes to recipient information in the TriCARE eligibility system. According to the DOD and its contractors, this delay contributed to problems related to registration processing backlogs that were not resolved until several months after health care began. «TRICARE is entering a new era, leveraging the knowledge gained during the first three phases of the contract,» said Vice Admiral Raquel C. Bono, Director of the Defense Health Agency. «Ministry of Defense leaders and established managed care support contractors are committed to managing a smooth transition to new managed care support entrepreneurs with minimal disruption to our beneficiaries.
«I am pleased that our new TRICARE contracts are focused on improving the care experience for our military, retirees and their families,» said Karen S. Guice, M.D., Acting Under Secretary of Defense for Health Affairs. The Ministry of Defense experienced difficulties during the transition from Q-2017 due to weaknesses in the direction and oversight of the transition. In particular, dod guidelines do not always specify the amount and type of data that outgoing contractors must share with incoming contractors. This led to disagreements between contractors over data transfers, which the DOD did not always resolve in time. The contractors reported that these issues contributed to post-health care issues for T-2017 contracts, by .B. in processing recommendations. The DHA also noted that some of the DHA`s monitoring requirements, . B, such as referrals to specialized treatments, were neither feasible nor effective, limiting some tests of contractors` willingness to provide health care. This happened in part because the relevant subject matter experts at the Ministry of Defense did not review the requirements. A notice posted Friday on beta SAM`s website says the second draft tender for T-5 contracts will include updates to tricare manuals and several contract areas, interim award criteria, a revised clinical feedback process, reformulated network requirements for industry feedback, a list of high-quality military knowledge, capabilities and capability codes, revised APM criteria and a project Recipient Selection Locations and Competitive Demonstrations.
The Department of Defense (DoD) announced the next generation of TRICARE managed care support contracts on July 21. The new contracts, which take effect nine months after the award, establish two TRICARE regions in the U.S. – East and West – instead of the current three. .
