Question. How could the program benefit overall with such a system? Answer. Functional development, acquisition and implementation of the National Claims System program will assure that CHAMPUS FIs are responsive to emerging coordinated care program requirements and advances in claims processing technology where return on investment warrants adoption of the advanced capabilities. Improved service to CHAMPUS providers and beneficiaries and control of benefit costs are major considerations in evaluating proposals for investment in new system capabilities. Question. Would not such a program be cost effective? Answer. The functional development, acquisition and implementation of a National Claims System program permits critical costbenefit analysis of the application of new claims technology in which the merits of adoption can be evaluated in terms of its impact on both benefit and administrative costs. This evaluation will consider as well the cost effectiveness of various options for delivery of claims processing functions equipped with the new technology. CRI/OVER 65 Question. A key feature of the USTF program for the Government has been caring for the over 65 population. The goal of the CRI is to provide the maximum amount of care for CHAMPUS-eligible beneficiaries, what will be the Department's goal with respect to the responsibility for care of over age 65 beneficiaries? Answer. In the Department's Coordinated Care Program, Medicare eligible beneficiaries will have the opportunity to enroll in the direct care portion of the program. Those who enroll will be referred to providers in the civilian sector who accept Medicare assignment when care is not available in the military treatment facility (MTF). MTF commanders will be responsible for maintaining a list of providers who accept Medicare assignment and will ensure availability of the provider list to beneficiaries via the Health Care Finders. Many MTF commanders will want to ensure that Medicare eligible beneficiaries use the MTF so the skills of specialists can be maintained by treating this group of older patients. In the Coordinated Care Support Program, which is the successor to the CHAMPUS Reform Initiative, the contractor will be required to incorporate these same features for Medicare eligible beneficiaries. CURRENT SATISFACTION OF CRI Question. Currently, there is a high beneficiary satisfaction rate (97 percent) as well as a high acceptance by military treatment facilities commanders (96 percent). Why would you rationally change something that affects so many people with such an incredible success rate? Answer. The Deputy Secretary of Defense has approved the Department's Coordinated Care Program (CCP) for implementation as the permanent program which will reform the MHSS and thereby address its access, quality and cost concerns. All new CCP initiatives, or projects which are successors to managed care program now operating, will comply with all CCP provisions. Requiring all projects, whether they are regional programs or localized projects, to conform to CCP will achieve greater equity across the MHSS with regard to access and uniform benefits within beneficiary categories. Moreover, by its very design, CRI addressed CHAMPUS costs primarily not MTF cost. CHAMPUS accounts for only 26 per cent of DoD's health care expenditures. In contrast, the CCP addresses our total MHSS and is designed to achieve greater efficiencies in the whole system. The design of the CRI successor program, the Coordinated Care Support Program (CCS) reflects the changes that were necessary to bring the CRI in compliance with the provisions of CCP. While there have been changes in the new program, it is important to note that many of the features of the current CRI program were retained, including those that proved to be the most successful in achieving CRI's objectives. The RFP for the CCS contract builds upon the "lessons learned" and the strengths of all our current managed health care demonstrations and initiatives. Current CRI components, including Service Centers, Health Care Finders and Resource Sharing are retained since these features contributed significantly to increased access, higher beneficiary satisfaction, and more efficient use of both MTF and civilian provider network resources MTF commander/contractor interface activities and quality/utilization review functions have also been enhanced. CCS will also provide new features such as a mechanism to refer Medicare eligible beneficiaries who require care which is not available in the MTF to civilian providers who accept Medicare assignment. In addition, all beneficiaries will be directed to DoD designated specialized treatment facilities (STFs) when appropriate. The new contract will also require a single claims processing system for both network and non-network claims which will simplify management of this critical program component. The new features of CCS, as well as the CRI features which have been retained or enhanced, will result in a program which is more effective than its predecessor. Therefore, the availability of care which is on high quality and accessibility and is cost effective will be greater than that which is presently available in the CRI. CHAMPUS REFORM INITIATIVE (CRI) Question. We met with several representatives this morning who applauded the benefits and the success of the CRI programs in their areas, but expressed grave concerns of the amount of increased expense and limited availability the health care plans proposed under the new RFP. They also discussed the fact that the actuarial costs will be more expensive. How much more expensive will the actuarial costs be for the enrollees? Answer. In pursuit of the principle of benefit equity under Coordinated Care Support, this Department sought to eliminate the disparity of health care benefits to beneficiaries based on non-medical peculiarities. The goal has been to improve the medical care of all beneficiaries and eliminate the disparity of benefits which are based on military assignment and geographic location, not necessarily medical necessity. The enrolled beneficiaries of CRI, who amount to more than 20% of CHAMPUS eligibles within California and Hawaii, will be required to contribute a more equitable portion for their health benefit. The remaining enrolled beneficiaries throughout the world should experience no change in CHAMPUS financial requirements. MILITARY HEALTH BENEFITS Question. From this morning's session we learned of a 22 year Navy veteran who became disabled, and through a loophole, 1 year after the accident, was completely cut off by the CHAMPUS/DOD benefits. This loophole discriminated against military retirees who become 100 percent disabled. Then we learned further that the DOD is now trying to recoup the $200,000 of benefits it granted before the veteran was cut off, and now, the DOD is suing this disabled 22 year military veteran. Our Committee, through Mr. Young, introduced legislation that was signed into law by the President on November 26, to amend this type of inequity against the disabled retirees. Yet, to date, there is little if any verification that any notification has been sent out to those disabled retirees, nor has any verification sent to any of the key agencies that were represented this morning. Why hasn't any notification taken place? What other Congressional mandates need to be given to direct you to change this problem? How is it that a postal worker or any other type of Federal employee can be cared for, but the Department of Defense cannot take care of its own? Answer. Because of the need to clarify, through a DOD General Counsel review, differences in the language contained in the Authorization and Appropriation Acts, there was a delay before we could begin implementation of the provision. A news release concerning the restored CHAMPUS eligibility for Medicare disability beneficiaries is in preparation and will be distributed to more than 4,000 beneficiary and provider media outlets. Additionally, a notice will be mailed to the approximately 14,000 individuals identified by the Defense Enrollment and Eligibility System (DEERS) as potentially affected by the new legislation. I have directed that this legislation be implemented immediately. CHAMPUS has provided guidance to the claims processing contractors. I have been assured that the contractors will be prepared to receive and process claims effective March 18, 1992. Under the provisions of law that existed prior to the new legislation, all CHAMPUS beneficiaries, other than the dependents of Active Duty Service Members, lost eligibility for CHAMPUS benefits upon becoming entitled to coverage under Part A of Medicare. I am not aware that the Congress applied the same provision to Federal programs covering postal workers or other Federal employees, but such programs are underwritten in the private sector and vary in many respects, including employee premiums. Question. This morning, we were informed that under the new RFP, the proposal is higher cost shares for enrollees, and even higher deductions for those opting not to enroll, those opting not to enroll will be locked out of military facilities and clinics except for emergency care, and pharmaceutical services. Is this true? Answer. In the interest of consistency and equity these provisions, which will apply across the entire MHSS, are included in the RFP. [CLERK'S NOTE.-End of questions submitted by Mr. Dicks.] INFECTIOUS DISEASE RESEARCH Mr. YOUNG. Dr. Mendez, you might have detected that the members of the subcommittee have an interest in this and are convinced it has a potential for providing a good service at a lesser price, and we are sure you got that message. Dr. MENDEZ. Yes, sir. Mr. YOUNG. I wanted to change the subject for just a second. On the subject of infectious disease research, the Services have done a good job. The Army has done a really great job. The Navy has done a great job. The Air Force has done a great job, but we have a little bit of conflict between the Army and Navy when it comes to doling out the money for research. And for a specific reason, duplication of effort, et cetera, it was determined that the Army would become a lead agency, and the Army would get the funding and then it would dole out the money to the various agencies. The Navy has felt that it hasn't gotten sufficient funding to adequately fund their research programs, and they do a great job in their research programs as well. Congress, and this Committee specifically, directed that the issue of a lead agency versus separate agency funding be reviewed, and I wonder if you could tell us where we stand on that. Has the ASBREM group met to discuss this? Have they made any decisions? Are you getting any direction for us yet? Dr. MENDEZ. I believe that R&D is working that at your direction. The ASBREM, I think, has been a good body, Mr. Young, in my judgment. I think it has been a good body to try to resolve that. It is interesting. When you ask me the question, I have the Army on my left, the Navy on my right. They may have very definite feelings about it, but I think that the ASBREM mechanism is a mechanism that can reach this type of resolution, and in my judgment, it is doing so. Mr. YOUNG. Are we close to reaching any kind of recommendation or position relative to having a lead agency or having separate funding for the separate services? Dr. MENDEZ. It is my understanding that it is being worked with the services now. Admiral HAGEN. Mr. Young, the confusion here, we believe that this problem was identified by us in the services and we worked with the ASBREM, as you know, and all of us met together, the surgeons general several months ago, believing that the ASBREM was the right forum to address this issue, and I think you won't find any conflict amongst the services at this point that that is the correct way to address it. So I think I can certainly speak for the Navy saying that we support that method and we are happy that with this methodology things are better. General LEDFORD. That is correct, sir, absolutely. The surgeons general met on this and we have distributed some $15 million to the Navy to this program for this year, and we certainly intend to hold up our end of the bargain in the future. The Navy is doing good research, but we feel that it is intelligent to have an oversight agency, and we have got a really good one. Mr. YOUNG. General, nodding your head indicates you agree? ANDREW COX CASE Mr. YOUNG. Thank you very much. Mr. Chairman, I want to thank you and all the members of the Committee for the interest that you have shown today on the matter of Terry Cox and Andy Cox, my constituents. If I might just say a final word, Dr. Mendez, you have agreed to look into this and see what can be done to resolve the problem, and I have to urge you to expedite your consideration, because Mrs. Cox has been directed to appear before an administrative law judge for a hearing on the subject of the repayment in less than six weeks. As Chairman Murtha points out, you can sue her all day long, but she doesn't have a nickel to give to you. We would hope that you would review it quickly and expedite it and get that emotional burden off of her one way or another. Dr. MENDEZ. We will. Admiral HAGEN. We will, indeed. Mr. YOUNG. So she can get about taking care of her husband. Thank you very much, Mr. Chairman. [CLERK'S NOTE.-Questions submitted by Mr. Young and the answers thereto follow:] CHAMPUS DISABILITY BENEFIT Question. Last year, Congress closed a loophole under which 100 percent disabled military retirees lost their CHAMPUS benefits after 29 months of becoming disabled and replaced with less comprehensive Medicare. Provisions were included in both the Defense Appropriations and Authorizations legislation to address this loophole. However, the Authorization legislation (Public Law 102-190) required that CHAMPUS provide these retirees with supplementary coverage through a unique "benefits-less-benefits" formula (paragraph 3, sec. 1086(d), of Title X) rather than the coordination of benefits (COB) approach which is the standard formula for coordinating coverage with other health insurance providers. Is the Department considering converting from the COB method to the benefits-less-benefits approach in the future as far as coordinating CHAMPUS as a supplement to other providers? Answer. The Department has no plans at this time to modify the method of coordinating benefits between CHAMPUS and other health insurance coverages in cases other than Medicare disability beneficiaries, where the "benefits-less-benefits" methodology is prescribed by law. [CLERK'S NOTE.-End of questions submitted by Mr. Young:] Mr. MURTHA. Mr. Miller, any questions? |