Presentation on theme: "Guard & Reserve Healthcare in the Pacific Territories Issues and Solutions."— Presentation transcript:
Guard & Reserve Healthcare in the Pacific Territories Issues and Solutions
TRICARE Pacific 2 The Setting Guam, Saipan and American Samoa USARPAC RC Duty Status Pre-Mob: Pre Mob order date or 90 days before report for active duty Mobilized: Duration of mobilization De-Mob: TAMP (Transition Assist Mgm. ’ t Program) 180 days RC Numbers (RC/FM) Guam/Saipan: 671 A. Samoa:299
TRICARE Pacific 3 The Benefit Coverage Options TRICARE Global Remote Overseas (Prime) AD/FM, Pre-Mob and Mob RC/FM (not TAMP) No co-pay, No deductible and No premium Covered travel benefit TRICARE Reserve Select (Standard) AD/FM non-Mob 20% Co-Pay, Annual premium = $81 Member / $253 Member & Family No deductable No travel benefit Decline coverage / Island Gov ’ t Health Plan
TRICARE Pacific 4 The Issues Real & Perceived TRICARE Access and Payment Health Care Quality TRICARE Coverage for Inactive Reservists Access to Off-Island Care Funding for Medical Travel/Per Diem Adequate TRICARE Staffing
TRICARE Pacific 6 TRICARE Access and Payment “ Providers do not accept TRICARE Standard ” Capabilities Guam: MTF ’ s & TC participating providers Saipan: TGRO network & TC participating providers Commonwealth Health Center & most private clinics A. Samoa: Only LBJ public hosp is TC participating Solutions Briefs to explain TRICARE programs to beneficiaries Site visits to providers to accept TRICARE payments and relieve beneficiaries of upfront payments ?
TRICARE Pacific 7 Health Care Quality “ Island care not equivalent to CONUS standard ” Medical infrastructure is limited Specialty care/Diagnostic testing availability is an issue Access to available care is not an issue Medical infrastructure is not within TMA purview Territorial Gov ’ t, & Dept of the Interior Solutions: TAO-P: MOU between ISOS & VA estab new VA Clinic as TGRO network facility that Reservists can utilize USARPAC: Drilling medical Reservists/TDY TAMC staff assist VA has offered space if USARPAC/TAMC will equip DOI, DVA and DOD(HA): Pacific Insular Health Care Conference Results yet to be announced
TRICARE Pacific 8 TRICARE Coverage for Inactive Reservists Those in TAMP/TRS are not TGRO eligible Prime Areas and OCONUS w/MTF RC on TAMP can enroll in Prime Remote Areas RC on TAMP cannot enroll in Prime (TGRO) Solutions Policy change to allow RC on TAMP in remote area to enroll in TGRO? Policy change to waive cost share for RC on TAMP? Policy change to make TRICARE Reserve Select equivalent to Prime vice Standard? ?
TRICARE Pacific 9 Access to Off-Island Care Those in TAMP/TRS do not have Prime or JFTR Travel Benefit Issue is off-island access to locally unavailable med services TRS has air ambulance benefit, but upfront payment and file claim RC wants TGRO Prime benefit for TAMP/TRS for urgent/emergent care so it is “cashless/claimless” Solutions: Offer TGRO to TAMP/TRS TMA authorized to guarantee payment for TRS beneficiaries vice beneficiary paying upfront Change JFTR to permit funding TAMP/TRS med travel TPMRC capacity to support urgent/emergent movement ?
TRICARE Pacific 10 Funding for Medical Travel/Per Diem Who pays for medical travel? Reserve units currently responsible for funding Difficult to predict year to year Impacts on mission accomplishment Solution: Fund through Defense Health Program (DHP) USARPAC reprograms RC medical travel funds to DHP ?
TRICARE Pacific 11 Adequate TRICARE Staffing No permanent, full time, culturally sensitive TRICARE reps. Background Remote Pacific = 30 countries, benes are a few to hundreds Saipan RC benes 2 to 250, A.Samoa benes 20 to 450 depending on RC activation Remote TRICARE POC’S Remote commands designate individual(s) to assist beneficiaries TMA provided training and support RC request full-time, permanent BCAC for each location Solutions: NDAA 2004, Section707 “TRICARE will designate one full-time person to serve as a BCAC for each Region for RC beneficiaries and RC will provide eleven (11) assets to support this requirement” ?