oversight

DOD and VA Health Care: Access for Dual Eligible Beneficiaries

Published by the Government Accountability Office on 2003-06-13.

Below is a raw (and likely hideous) rendition of the original report. (PDF)

United States General Accounting Office
Washington, DC 20548




          June 13, 2003

          The Honorable John Warner
          Chairman
          The Honorable Carl Levin
          Ranking Minority Member
          Committee on Armed Services
          United States Senate

          The Honorable Duncan Hunter
          Chairman
          The Honorable Ike Skelton
          Ranking Minority Member
          Committee on Armed Services
          House of Representatives

          Subject: DOD and VA Health Care: Access for Dual Eligible Beneficiaries

          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.1 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.

          Section 708 of the Bob Stump National Defense Authorization Act for Fiscal Year
          20032 directed the Secretary of Defense to establish a process for resolving issues
          related to patient safety and continuity of care for beneficiaries who are concurrently
          eligible for health care through DOD’s TRICARE program and through VA. It also


          1
            According to DOD, an episode of care is generally accepted to be all care related to a single injury or
          illness.
          2
            Pub. L. No. 107-314, § 708, 116 Stat. 2458, 2585 (2002).


                                                         GAO-03-904R DOD and VA Health Care for Dual Eligibles
required that the Comptroller General review and report on issues related to dual
eligibility.

On April 16, 2003, DOD reported3 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.

An official with the TRICARE Management Activity reviewed a draft of this letter and
agreed the information in it is correct. We are sending copies of this letter to the
Secretary of Defense, appropriate congressional committees, and other interested
parties. We will provide copies of it to others upon request. In addition, it is
available at no charge on the GAO Web site at http://www.gao.gov. If you or your
staff have any questions, please contact me at (202) 512-7101 or Michael T. Blair, Jr.,
at (404) 679-1944.




Cynthia A. Bascetta
Director, Health Care—Veterans’
 Health and Benefits Issues




(290272)


3
Report to Congress: Department of Defense Plan for Coordinating Care Between TRICARE and the
Department of Veterans Affairs (Washington, D.C.: April 2003).


2                                       GAO-03-904R DOD and VA Health Care for Dual Eligibles
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