VA/DOD Health Care:

More Guidance Needed to Implement CHAMPUS-Funded Sharing Agreements

HEHS-95-15: Published: Oct 28, 1994. Publicly Released: Nov 7, 1994.

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Pursuant to a congressional request, GAO reviewed the extent to which Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) funds are being used for health care resource-sharing agreements between the Departments of Veterans Affairs (VA) and Defense (DOD).

GAO found that: (1) in February 1994, after nearly 3 years of negotiation, VA and DOD agreed on a framework for VA to treat CHAMPUS-eligible beneficiaries and receive reimbursement from CHAMPUS funds; (2) implementation of CHAMPUS/VA sharing agreements has been delayed because of disagreements between DOD and VA over VA hospital requirements; (3) neither DOD nor VA has conducted a systemwide search to identify additional opportunities for sharing agreements; (4) potential sharing opportunities have been missed because DOD hospital commanders have not used CHAMPUS funds for sharing agreements between their hospitals and VA hospitals and are unclear about their authority to do so; and (5) DOD needs to clarify the authority of DOD hospital commanders to propose sharing agreements using CHAMPUS funds, and it needs to provide instructions on developing and implementing such agreements.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: A Memorandum of Understanding (MOU) between DOD and VA was established on June 29, 1995, that authorizes VA medical centers to be CHAMPUS providers in DOD's TRICARE managed care networks and to be reimbursed for care to DOD CHAMPUS eligible beneficiaries. Guidance to military treatment facility commanders is being communicated through DOD's semi-annual TRICARE conferences and through presentations, seminars, and written materials.

    Recommendation: The Secretary of Defense should direct the Assistant Secretary of Defense for Health Affairs and the military services to fully inform and explain to military hospital commanders the authority to propose using CHAMPUS funds for sharing agreements with VA and their roles and authorities under this program.

    Agency Affected: Department of Defense

  2. Status: Closed - Implemented

    Comments: These instructions are being communicated to TRICARE components through the Internet on the Worldwide Web. The Web has been established as an official means of communicating policy to the TRICARE components. Existing managed care contracts are being modified to provide authority for these contractors to include VA medical centers in the networks.

    Recommendation: The Secretary of Defense should direct the Assistant Secretary of Defense for Health Affairs and the military services to provide specific instructions on developing and implementing such agreements.

    Agency Affected: Department of Defense

  3. Status: Closed - Implemented

    Comments: The MOU established on June 29, 1995, provides authority for sharing opportunities in TRICARE contract regions. In addition, two new sites for sharing projects similar to the pilot in Asheville, N.C. have been identified for startup by October 1, 1995. These are VA medical centers in Indianapolis, IN, and Syracuse, NY.

    Recommendation: The Secretary of Defense should direct the Assistant Secretary of Defense for Health Affairs and the military services to identify sharing opportunities in which CHAMPUS funds can be used to buy available VA services.

    Agency Affected: Department of Defense

  4. Status: Closed - Implemented

    Comments: VA disagreed with the specific wording of the recommendation, stating that it was DOD's responsibility to prioritize CHAMPUS needs. However, VA did reemphasize to facility management the importance of close communication between VA and DOD and encouraged medical center directors to take the lead in strengthening communications.

    Recommendation: The Secretary of Veterans Affairs should direct VA medical center directors to actively identify available VA services that may be candidates for sharing agreements with DOD and to communicate such information to the relevant DOD hospital commander.

    Agency Affected: Department of Veterans Affairs

 

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