DOD and VA Health Care:
Access for Dual Eligible Beneficiaries
GAO-03-904R: Published: Jun 13, 2003. Publicly Released: Jun 13, 2003.
Additional Materials:
- Full Report:
- Accessible Text:
Contact:
(202) 512-7207
contact@gao.gov
Office of Public Affairs
(202) 512-4800
youngc1@gao.gov
The Department of Defense (DOD) reported that under its current policy, beneficiaries eligible for both TRICARE and the Department of Veterans Affairs' (VA) health care (dual eligible beneficiaries) are not allowed to utilize the services offered by both health care systems for treatment for the same episode of care. For example, if a beneficiary experiences back pain and seeks treatment from VA, the beneficiary must then receive all care related to that back pain from VA. Should the beneficiary then decide to seek treatment for the back pain from TRICARE, any claims related to that care would be denied. According to DOD, this policy was established to ensure continuity of care for beneficiaries and to ensure that there was no duplication of care or of payments from TRICARE or VA. Under the policy, if beneficiaries are dissatisfied with the care provided by VA, they are unable to switch to TRICARE to receive services for the same episode of care. On April 16, 2003, DOD reported to the Congress on a proposal to change its policy and promulgate regulations for coordinating care between DOD and VA. As agreed, we focused our review on the reasonableness of DOD's process. To do so, we reviewed the report submitted to the Congress and TRICARE policies, and interviewed agency officials from DOD and VA. Our work was conducted in June 2003 in accordance with generally accepted government auditing standards.
DOD proposes to change its basic policy to enable dual eligible beneficiaries to access both systems for the same episode of care, thus ensuring full freedom of choice. DOD also proposes to pay for medically necessary care to the extent that such care would be covered by TRICARE. DOD's proposal appears reasonable, and it is in the process of developing regulations to implement it.
Feb 11, 2021
-
Electronic Health Records:
VA Has Made Progress in Preparing for New System, but Subsequent Test Findings Will Need to Be AddressedGAO-21-224: Published: Feb 11, 2021. Publicly Released: Feb 11, 2021.
Feb 1, 2021
-
Veterans Community Care Program:
Immediate Actions Needed to Ensure Health Providers Associated with Poor Quality Care Are ExcludedGAO-21-71: Published: Feb 1, 2021. Publicly Released: Feb 1, 2021.
Jan 14, 2021
-
Prescription Drugs:
Department of Veterans Affairs Paid About Half as Much as Medicare Part D for Selected Drugs in 2017GAO-21-111: Published: Dec 15, 2020. Publicly Released: Jan 14, 2021.
Dec 10, 2020
-
VA Construction:
VA Should Enhance the Lessons-Learned Process for Its Real-Property Donation Pilot ProgramGAO-21-133: Published: Dec 10, 2020. Publicly Released: Dec 10, 2020.
Dec 9, 2020
-
VA Disability Benefits:
Process for Identifying Conditions Presumed to be Service Connected and Challenges in Processing Complex Gulf War Illness ClaimsGAO-21-253T: Published: Dec 9, 2020. Publicly Released: Dec 9, 2020.
Nov 12, 2020
-
Veterans Health Care:
Agency Efforts to Provide and Study Prosthetics for Small but Growing Female Veteran PopulationGAO-21-60: Published: Nov 12, 2020. Publicly Released: Nov 12, 2020.
Sep 30, 2020
-
VA Health Care:
Additional Steps Could Help Improve Community Care Budget EstimatesGAO-20-669: Published: Sep 30, 2020. Publicly Released: Sep 30, 2020. -
Veterans Community Care Program:
Improvements Needed to Help Ensure Timely Access to CareGAO-20-721T: Published: Sep 30, 2020. Publicly Released: Sep 30, 2020.
Sep 28, 2020
-
Veterans Community Care Program:
Improvements Needed to Help Ensure Timely Access to CareGAO-20-643: Published: Sep 28, 2020. Publicly Released: Sep 28, 2020.
Sep 21, 2020
-
VA Disability Benefits:
VA Should Continue to Improve Access to Quality Disability Medical Exams for Veterans Living AbroadGAO-20-620: Published: Sep 21, 2020. Publicly Released: Sep 21, 2020.
Looking for more? Browse all our products here