Defense Health Care:

Disability Programs Need Improvement and Face Challenges

GAO-02-73: Published: Oct 12, 2001. Publicly Released: Oct 12, 2001.

Contact:

Marjorie E. Kanof
(202) 512-5055
contact@gao.gov

 

Office of Public Affairs
(202) 512-4800
youngc1@gao.gov

The military's health program--TRICARE--provides medical care to about 8.3 million active duty service members and retired beneficiaries and their dependents and survivors. The Department of Defense (DOD) also provides benefits for persons severely disabled by physical or mental problems through its Individual Case Management Program for Persons with Extraordinary Conditions (ICMP-PEC) and for less severely disabled active duty dependents through its Program for Persons with Disabilities (PFPWD). Recently, military families and advocacy groups have raised concerns about accessing ICMP-PEC benefits. Also, the DOD Authorization Act for 2001 entitled military retirees age 65 and older and their dependents and survivors to TRICARE benefits for life which may have caseload and cost effects on ICMP-PEC. As of June 2001, 38 ICMP-PEC participants were projected to receive $6 million in services in fiscal year 2001, Their annual per-case costs were projected to range from $13,000 to $382,000. ICMP-PEC now lacks a clear purpose, well-defined eligibility criteria and benefits, and an efficient application process. In contrast, PFPWD is an established program with well defined criteria and benefits that assist thousands of ADFMs with their special health care service and equipment needs. Also, before April 2001, PFPWD provided many services and equipment at modest cost to ADFMs with severe disabilities that were also available at higher copayments to less seriously disabled ADFMS under TRICARE Basics. Data are unavailable on how many PFPWD participants are affected by the program's $1,000 monthly benefit limit. A comparison of ICMP-PEC's home care benefit of up to 24 hours of skilled nursing care per day, seven days per week-and unlimited skilled nursing facility coverage with Medicare and selected Medicaid programs showed that ICMP-PEC's benefits are more generous.

Status Legend:

More Info
  • Review Pending-GAO has not yet assessed implementation status.
  • Open-Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.
  • Closed-implemented-Actions that satisfy the intent of the recommendation have been taken.
  • Closed-not implemented-While the intent of the recommendation has not been satisfied, time or circumstances have rendered the recommendation invalid.
    • Review Pending
    • Open
    • Closed - implemented
    • Closed - not implemented

    Recommendations for Executive Action

    Recommendation: The Assistant Secretary of Defense for Health Affairs should be directed to develop procedures for PFPWD program managers to communicate with one another across regions about active patients leaving and entering their respective jurisdictions to facilitate and expedite their reapplication for PFPWD.

    Agency Affected: Department of Defense

    Status: Closed - Implemented

    Comments: The policy changes regarding the probability of a PFPWD authorization for the purchase of durable equipment or durable medical equipment have been developed, approved and policy changes were issued April 17, 2003, with implementation on August 1, 2003.

    Recommendation: To ensure that DOD's active duty and retired beneficiaries and dependents with seriously disabling conditions can readily access needed services and equipment, the Secretary of Defense should direct the Assistant Secretary of Defense for Health Affairs to make needed improvements to TRICARE Management Activities (TMA) ICMP-PEC records to ensure that they capture the actual case-by-case cost data needed to properly plan and manage the current program.

    Agency Affected: Department of Defense

    Status: Closed - Not Implemented

    Comments: During GAO's review of the ICMP-PEC program in 2001, DOD began to make improvements to the record keeping, data gathering, and reporting processes for this program. However, Congress repealed the authority for the ICMP-PEC program in the National Defense Authorization Act of 2002. Because of the programs termination, DOD has suspended efforts to produce special reports to provide patient-level cost data.

    Recommendation: To ensure that DOD's active duty and retired beneficiaries and dependents with seriously disabling conditions can readily access needed services and equipment, the Secretary of Defense should direct the Assistant Secretary of Defense for Health Affairs to provide guidance on how the legislative changes made to ICMP-PEC since its inception are to be implemented.

    Agency Affected: Department of Defense

    Status: Closed - Not Implemented

    Comments: Congress repealed the authority for the Individual Case Management Program for Persons with Extraordinary Conditions (ICMP-PEC) in the National Defense Authorization Act of 2002. Therefore the DOD pulled its proposed rule for the program published in 2001 and will not be issuing a final rule. Additionally, the only modifications to the TRICARE Policy and Operations Manuals will be to eliminate references to the program.

    Recommendation: To ensure that the Department of Defense's (DOD) active duty and retired beneficiaries and dependents with seriously disabling conditions can readily access needed services and equipment, the Secretary of Defense should direct the Assistant Secretary of Defense for Health Affairs to clarify ICMP-PEC's purpose, eligibility criteria, and service coverage and provide guidance to better equip regional program managers in administering the program and target groups in understanding it.

    Agency Affected: Department of Defense

    Status: Closed - Not Implemented

    Comments: Per section 710 of the National Defense Authorization Act for 2002, Congress repealed the authority for the Individual Case Management Program for Persons with Disabilities (ICMP-PEC). Consequently, DOD is pulling its proposed rule published in August 2001 and will take no further action.

    Recommendation: The Assistant Secretary of Defense for Health Affairs should be directed to reassess PFPWD's purpose and structure, including its cost-share and monthly benefit limit once the effects of eliminating TRICARE Prime copayments on PFPWD's cost and caseload are better known.

    Agency Affected: Department of Defense

    Status: Closed - Implemented

    Comments: DOD drafted changes to the TRICARE policy that incorporated the expanded benefits allowed by the National Defense Authorization Act of 2002. Implementation of the changes under the Extended Care Health Option (ECHO), as the PFPWD was renamed, are subject to the final rule and TRICARE contract adjustments for the ECHO program. The proposed rule for ECHO was published in the Federal Register on August 6, 2003. The final rule was published August 20, 2004. Publication of changes to the TRICARE manuals were completed on February 14, 2005, and change orders to the TRICARE contracts are expected to be issued on September 1, 2005.

    Apr 18, 2014

    Apr 8, 2014

    Apr 2, 2014

    Mar 26, 2014

    Mar 24, 2014

    Mar 10, 2014

    Mar 7, 2014

    Mar 6, 2014

    Looking for more? Browse all our products here