Archive for April, 2012

Some beneficiaries in Tricare’s western region may need to start looking for a new doctor. The Department of Defense has changed the contractor that creates the network of civilian health care providers for Tricare beneficiaries in the West region. The contract was originally awarded to Truest Healthcare Alliance, but the DOD re-opened the bidding process after UnitedHealth Military & Veterans Services filed a protest. In September, TriWest was ordered to pay a $10 million fine to settle a whistleblower lawsuit. TRICARE Management Activity (TMA) announced on March 16, 2012 that the TRICARE Managed Care Support Contract (MCSC) for the West Region was awarded to UnitedHealth Military & Veterans Services. The contractor provides administrative support and helps Tricare operate the health system, said Austin Camacho, a Tricare spokesman. The change should not affect most beneficiaries, he said. “It shouldn’t have any impact on our beneficiaries directly,” Camacho said. “We expect it to be a pretty much invisible process.” Still, he said, some providers who work with TriWest don’t have arrangements with UnitedHealth. If those providers don’t make the switch, the beneficiaries will have 10 months to find a new provider.
Tricare’s West region includes Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa (except the Rock Island Arsenal area), Kansas, Minnesota, Missouri (except the St. Louis area), Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Dakota, areas of west Texas, Utah, Washington and Wyoming. There are about 2.9 million Tricare beneficiaries in the West region, according to a Tricare news release. The contract is for the third generation of MCSC, referred to as “T-3.” The instant obligation on the award is $10,000,000. The total potential contract value, including the approximate 10-month base period and five one-year option periods for health care delivery, plus a transition-out period, is estimated at $20,462,202,594.It is important for beneficiaries enrolled in the TRICARE West Region to know the new T-3 contract and MCSC will not officially take over the TRICARE West Region until 1 APR 2013. In the meantime, the current T-NEX TRICARE contract will remain in place with TriWest Healthcare Alliance through the transition process to make sure beneficiaries continue to receive quality health care and maintain customer service. There will be a yearlong seamless transition as TMA moves forward into the new TRICARE T-3 contract.
TriWest is protesting DoD’s decision to award the contract to another bidder, saying the process was not fair. They were told they had submitted the lowest bid, but the decision was based on best value for the work. But company representatives went to a debriefing with the government about the process and learned “disturbing information about how the process itself was conducted.” First, the government did not account for several hundred million dollars' worth of discounts that was included in TriWest's bid. Second, the government did not fully examine UnitedHealth's track record. As part of the bid process, companies are required to submit their five largest accounts which serve as references. TriWest also included other information about its record, including the whistleblower lawsuit, and “were told that they had rated the highest category of past performance. However, TriWest contends that the bid evaluators only checked UnitedHealth's five largest accounts and did not probe any deeper into their history. Had they done an appropriate and reasonable buyer's check, the outcome may have been very different. A simple Google search, revealed “massive fines” levied against United Health and doctors have contacted TriWest, “expressing significant concern about the behavior and track record of [UnitedHealth] in the marketplace.” TriWest filed its protest 26 MAR, and this type of dispute is generally adjudicated within 100 days. Inall transition activities will be put on hold while the protest the interim is examined. [Source: http://www.tricare.mil/t3contracts & Stars and Stripes Jennifer Hlad articles 17 & 27 Mar 2012 +]

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Obnoxious Proposals

Posted: April 29, 2012 in Uncategorized
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It’s common in these highly politicized times to paste warm, fuzzy names on even the most obnoxious proposals. An initiative to whack Social Security benefits might be called the “Saving Social Security Act,” for example. A few years ago, when the Pentagon proposed big health care fee hikes, it was labeled the “Sustaining the Benefit” plan. Such euphemistic spin campaigns bring to mind the old quote, “We had to burn the village to save it.” One common phrase that’s cropped up repeatedly in speeches, press releases, and testimony by defense and service leaders is the importance of “keeping faith” with currently serving personnel in planning deep defense budget cuts. If only it were so. The fact is there’s far more breaking faith in those plans than keeping faith. That rhetoric first appeared in the wake of a Defense Business Board plan that envisioned changing the military retirement system and included an option to change retirement rules in midstream for servicemembers currently on active duty.
Cringing from tremendous backlash from the troops, defense and service leaders scrambled over each other to pledge they’d “keep faith” with the currently serving by applying any new retirement rules only to future service entrants. But they made no such pledge on anything else that would have similar — or worse — effects on troops and families. A huge part of the cuts proposed in the FY 2013 defense budget involve dramatically raising TRICARE Standard fees, TRICARE Prime fees, TRICARE For Life fees, and TRICARE pharmacy copayments. “These wouldn’t apply to uniformed servicemembers,” the leaders say. But that’s flatly untrue. The plan to triple pharmacy copayments would apply to family members of active duty servicemembers who don’t have access to military pharmacies, and they’d also apply to drilling Guard and Reserve members and their family members who don’t have such access. For family members with chronic diseases or significant disabilities, that could have a big effect on their finances. So don’t try to tell me higher expenses for family members don’t affect today’s servicemembers.
The Standard, Prime, and TRICARE For Life fee hikes — up to $2,000 a year or more — also directly affect every servicemember with career aspirations. They may not incur the fees until they retire, but there are tens of thousands on active duty today who will be retired within a year. And every single servicemember who plans to serve a career would incur them after leaving active duty. If keeping faith on retirement means protecting all active duty members from any retirement changes, how can it be anything other than breaking faith to whack their health care benefits? Is charging them an extra $2,000 a year for health care in retirement any different than cutting their annual retired pay by $2,000? And how about the plan to cut active duty force levels by 120,000-plus over the next several years? Service leaders acknowledge they’ll have to force out many who had planned to make the military a career — including many with multiple combat deployments. How is it keeping faith to kick them out the door in one of the highest unemployment periods in recent memory?
To be fair, service leaders don’t have much choice about some of these things. When budget crunches come, force levels always get cut and benefits always come under attack. Nobody likes it, and nobody can claim it’s fair. We know — and defense and service leaders know — they’re breaking faith in multiple ways. Real leaders should start with an apology and spare us the disingenuous blather about “keeping faith” with troops and their families. There’s no sugar-coating the major pain they seek to impose on currently serving and retired families alike. [Source: Co-Chairman of The Military Coalition Col. Steve Strobridge, USAF-Ret. article 15 Mar 2012 ++]

Spring-like weather has sprung up across much of the country and coupled with a warm winter, pollen counts are now soaring to record levels. The Over-the-Counter (OTC) Medication Demonstration Project allows TRICARE beneficiaries to fill prescriptions for certain OTC medications at retail network pharmacies and via home delivery. Positive feedback and cost savings for beneficiaries and TRICARE has resulted in a continuation of the demonstration at $0 cost share. The following OTC allergy medications may be filled under this demonstration:
 Cetirizine
 Loratadine tablets
 Prilosec OTC
 Omeprazole (generic of Prilosec OTC)
To have prescriptions filled under this demonstration, you'll need a written prescription for any of the OTC medications listed above from your health care provider. Submit the written prescription to any TRICARE retail network pharmacy or the TRICARE Pharmacy Home Delivery and the prescription will be filled at no cost.
 To find a network pharmacy go to: https://member.express-scripts.com/web/member/pharmacyLocator.sf?_flowExecutionKey=_cACDF84F2-92C4-5A85-A6C6-73A34392D2E5_k3B69D58F-394A-962E-9D0D-46254CD8A332
 To Register for home delivery go to: https://member.express-scripts.com/web/member/webflow.sf?_flowExecutionKey=_c44375366-4691-63EB-5856-A7524C942940_k247072D3-35A0-E7B4-383F-6021731EE3E3
[Source: http://www.tricare.mil/mybenefit/ Pharmacy 15 May 2012 ++]

The Department of Veterans Affairs announced 22 MAR the release of 68 new forms that will help speed the processing of Veterans’ disability compensation and pension claims. “VA employees will be able to more quickly process disability claims, since disability benefits questionnaires capture important medical information needed to accurately evaluate Veterans’ claims,” said Secretary of Veterans Affairs Eric K. Shinseki. “Disability benefits questionnaires are just one of many changes VA is implementing to address the backlog of claims. The new forms bring to 71 the number of documents, called disability benefits questionnaires (DBQs), that guide physicians’ reports of medical findings, ensuring VA has exactly the medical information needed to make a prompt decision. The newly released DBQs follow the initial release of three DBQs for Agent Orange-related conditions. When needed to decide a disability claim for compensation or pension benefits, VA provides Veterans with free medical examinations for the purpose of gathering the necessary medical evidence. Veterans who choose to have their private physicians complete the medical examination can now give their physicians the same form a VA provider would use. It is very important that physicians provide complete responses to all questions on the DBQs. VA cannot pay for a private physician to complete DBQs or for any costs associated with examination or testing. Asking your primary care provider to complete a DBQ is no different than asking your provider to write a letter or note providing medical evidence of a medical condition in support of a claim. The same co-pay rules apply equally to both situations. “By ensuring relevant medical information can be found on one form, we will cut processing time while improving quality,” added Under Secretary for Benefits Allison A. Hicke. Information on DBQ’s can be found at http://benefits.va.gov/disabilityexams. At http://benefits.va.gov/TRANSFORMATION/dbqs/veteraninstruct.asp are step-by-step instructions on completing the forms. A list of the available DBQs for download can be found at http://benefits.va.gov/TRANSFORMATION/dbqs/ListByDBQFormName.asp.
Veterans may file a claim online through the eBenefits web portal at https://www.ebenefits.va.gov. The Department of Defense and VA jointly developed the eBenefits portal as a single secure point of access for online benefit information and tools to perform multiple self-service functions such as checking the status of their claim. Servicemembers may enroll in eBenefits using their Common Access Card at any time during their military service, or before they leave during their Transition Assistance Program briefings. Veterans may also enroll in eBenefits and obtain a Premium account in-person or online depending on their status. [Source: Maryland DVA Director Phillip A. Munley article 22 Mar 2012 ++]

Notes of Interest

Posted: April 26, 2012 in Uncategorized
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 Vietnam Vet Children. The Birth Defect Research for Children has put out a call for additional data on Vietnam veterans' children with birth defects to increase the research on the linkage between Agent Orange and birth defects in Vietnam veterans’ children. Those who have been affected are requested to participate by joining the National Birth Defect registry on the Birth Research website http://www.birthdefects.org/registry/.
 e-Afterburner. The February edition of the Air Force Retiree newsletter, the e-Afterburner, is now available via the Air Force retiree services website http://www.retirees.af.mil/afterburner/.
 Jury Duty Scam. The phone rings, you pick it up, and the caller identifies himself as an officer of the court. He says you failed to report for jury duty and that a warrant is out for your arrest. You say you never received a notice. To clear it up, the caller says he'll need some information for “verification purposes”-your birth date, social security number, maybe even a credit card number. This is when you should hang up the phone. It's a scam.
 USS Dan Diego. The CO of the USS San Diego, CDR Jon Haydel, became the fifth commanding officer fired this year; four of the firings involved allegations of improper conduct. Last year, 23 commanding officers were relieved, nearly reaching the recent high-water mark of 26 in 2003.
 Reserve benefits. If you’re in the Guard or Reserve, to find information on your eligibility for benefits like health care, the GI Bill, home loans, and more check out http://www.va.gov/opa/publications/benefits_book/benefits_chap08.asp.
 Health topics. VA’s “A to Z Index” http://www.va.gov/health/topics/ provides Veterans and their caregivers with need-to-know information on a variety of services and health topics. VA captured the most popular topics and compiled them in one place to help you quickly retrieve information.
 IU. If you are unable to work because of your service-connected disability you may be eligible for Individual Unemployability. This program allows the VA to pay certain Veterans compensation at the 100 percent rate, even if VA has rated their service-connected disabilities less than 100 percent. Veterans must provide medical evidence that shows their disability prevents them from working. Learn more about the program at
http://www.vba.va.gov/VBA/benefits/factsheets/serviceconnected/IU.asp.
 MOH. Korean War veteran William Charette, a 79 year old Medal of Honor recipient, has died. With Charette's death, there are now 81 living recipients of the Medal of Honor.
 Afghanistan. President Hamid Karzai said 22 MAR the West will subsidize Afghan security forces by more than $4 billion a year for 10 years after U.S.-led troops leave in 2014.
 GI Bill. Some veterans have experienced delays in receiving their Post 9/11 GI Bill educational benefits for the spring term. The Department of Veterans Affairs (VA) has added additional staff and resources to resolve this situation as quickly as possible. Veterans should also remember that students using their Post-9/11 GI Bill benefits must ask their school officials to complete an enrollment certification, which the school official will send to VA.
[Source: Various 15-31 Mar 2012 ++]

Maine lawmakers are celebrating approval of a law that creates a special treatment court for veterans suffering from drug addiction and mental illness. The bill sponsored by Rep. Maeghan Maloney was presented in memory of Justin Crowley-Smilek of Farmington, an ex-Army Ranger who returned from Afghanistan with post-traumatic stress disorder and was shot and killed after he threatened a Farmington police officer with a knife. Crowley-Smilek was in and out of court several times, including the day before his death, when he was ordered to seek psychological help. The new measure, signed into law by Gov. Paul LePage on 14 MAR, requires courts to screen veterans who enter the system and to coordinate with administrators at the Togus Veterans Affairs office to ensure veterans know about treatment programs. [Source: Associated Press article 16 Mar 2012 ++]

 Veterans whose lives have collided with the criminal justice system are increasingly turning up in veterans courts across the nation. There are now more than 90 courts across the U.S., including nine in California, tailored to veterans willing to work to repair their lives. One of the first such courts was in Orange County, where veterans who meet the judge's criteria, including maintaining steady employment and staying clean and sober, can have their charges dropped or reduced. The weekly sessions at Orange County's Combat Veterans Court provide a one-stop service, bringing together representatives from the district attorney's office and the U.S. Department of Veterans Affairs' Justice Outreach program, along with probation officers and volunteer mentors. Each veteran is carefully evaluated by a team before being accepted into the program. It took three arrests and the threat of prison to get Shaughn Whittington to the court. He slumped in a black suit, blue shirt and black tie, bracing for a claustrophobic courtroom, a stern judge. No need. Here, defendants are called participants. People applaud. Judge Wendy Lindley hands out gift cards. “It looks more like a support group instead of a courtroom,” said Whittington, 27, who was arrested twice on drug charges and once on suspicion of assault. “It's that Marine Corps mentality. You look at it like it's a joke.”
Lindley's court stands apart nationally. It is designed exclusively for combat veterans. As a longtime Superior Court judge, she has seen what the residue of combat stress can do. “We are dealing with people whose mental and physical health is very compromised,” she said. “We owe them, each one of them, the highest level of care.” She designed her court to be especially sensitive to war's psychic wounds, which are difficult to understand, let alone heal. Participation is voluntary; only murder cases are ineligible. The program is capped at 50 to ensure individualized treatment. What began with five participants is now fully booked. From 2010 to 2011, the number of people referred to the program jumped 41%. As with other veterans courts, if a judge's criteria are met, charges can be dropped or reduced. Those in Lindey's program share more than battlefield experience. All had been diagnosed with post-traumatic stress disorder, often with additional war-related complications, such as traumatic brain injury. She hadn't been looking for these conditions as a requirement. Paul Freese, vice president of the Public Counsel Law Center, calls Lindley's court the “gold standard. This is by far the model we want people to emulate,” he said. “Individuals don't have to go from place to place to place to get the services that they need.”
Los Angeles County launched a veterans court in 2010 and accepts only veterans facing felony charges, not misdemeanors. It expects its first graduates 27 MAR. “If these guys don't get help, I think they're going to deteriorate,” said Superior Court Judge Michael Tynan, who oversees about 75 veterans in the L.A. County program. As for Whittington's case, the story is familiar. Deployed as a mortar man in the Iraq invasion, he returned to civilian life in 2005. The transition was fitful at best. He was diagnosed with PTSD and, later, traumatic brain injury. There are scraps of war memories, like bullets whistling past him, inches from his head. There was a recurring nightmare from the battlefield. He was angry, depressed. Fearing he might hurt his then-wife, he started sleeping in a different bed. Vices took hold. He started popping narcotic pain relievers and smoking meth. Then he found himself in Lindley's court. “You start coming out of a coma, pretty much,” said Whittington, who checked into an in-patient treatment center during Phase 1. “You start realizing all the damage you did to the people around you.” [Source: http://latimesblogs.latimes.com/lanow/2012/03/courts-help-veterans-in-orange-county-and-around-the-nation.html Mar 2012 ++

Following is the current schedule of Congressional hearings and markups pertaining to the veteran community. Congressional hearings are the principal formal method by which committees collect and analyze information in the early stages of legislative policymaking. Hearings usually include oral testimony from witnesses, and questioning of the witnesses by members of Congress. When a U.S. congressional committee meets to put a legislative bill into final form it is referred to as a mark-up. Veterans are encouraged to contact members of these committees prior to the event listed and provide input on what they want their legislator to do at the event. Membership of each committee and their contact info can be found at http://www.congress.org/congressorg/directory/committees.tt?commid=svete:
March 29, 2012. HVAC, Subcommittee on Disability Assistance and Memorial Affairs will hold a legislative hearing on the following bills:
 H.R. 4142 – American Heroes COLA Act
 H.R. 4114 – Veterans’ Compensation Cost of Living Act of 2012
 H.R. 2051 – Veterans Missing in America Act of 2011
 H.R. 2498 – Veterans Day Moment of Silence Act
 H.R. 2377 – Rating and Processing Individuals’ Disability (RAPID) Claims Act
 H.R. 2717 – A bill to direct the Secretary of Veterans Affairs to designate one
city in the United States each year as an “American World War II City,” and for
other purposes;
 H.R. 4168 – A bill to direct the American Battle Monuments Commission to
provide for the ongoing maintenance of Clark Veterans Cemetery in the
Philippines. 10:00 A.M.; 340 Cannon
[Source: Veterans Corner w/Michael Isam 29 Mar 2011 ++]