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FOR SEPTEMBER 7, 2012

And now focus has turned to the Democratic National Convention in Charlotte North Carolina. This is the last week before members of Congress return to town and turn to the question of financing the federal government in the new fiscal year (Starting on October 1.) But it is already the end of unofficial summer and government departments are putting out information and plans for the fall.


1) TRICARE Requiring Proof of Payment for All Overseas Claims
2) TRICARE Will Cover ABA Therapy for Retiree Families (For, At Least the Time Being) and Congress is Looking at it Also
3) Watchdog Report Says That DOD Isn’t Implementing Military & Overseas Voting Act
4) Study to Find Out if War Causes Advanced Aging
5) DFAS Presenting Retiree Seminars Throughout The Country
6) President Expands Military Suicide Prevention Programs

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1) TRICARE Requiring Proof of Payment for All Overseas Claims

Starting on September 1, 2012 TRICARE beneficiaries must send proof of payment for all medical treatment received abroad. This includes treatment you receive when traveling overseas. (Overseas Active Duty Dental Program claims also require proof of payment if the service member pays the dentist directly.)

Below please find DoD’s directions as to how to submit a claim. You can also go to www.tricare.mil/proofofpayment, for more information.

Please let us at TREA know how this new system works. We need to know how it is affecting our members

Proof of Payment for Overseas Claims

Beginning September 1, 2012, beneficiaries will be required to submit proof of payment for all overseas health care and pharmacy claims, including claims for care received when traveling overseas.

Sending Proof of Payment

So that we may process your claim quickly and correctly, we recommend you write if you paid the provider directly and the amount paid at the top of the TRICARE DoD/CHAMPUS Medical Claim-Patient's Request for Medical Payment (DD Form 2642) (http://www.dtic.mil/whs/directives/infomgt/forms/eforms/dd2642.pdf). You should also include the following:

  • an itemized bill or invoice
  • diagnosis describing why the medical care is needed
  • an explanation of benefits from your other health insurance (if applicable)

As proof of payment, send any of the following items along with the provider's invoice or bill, based on the guidelines below:

  • cancelled check
  • credit card receipt
  • electronic funds transfer receipt

You may have to send additional proof to process your claim. For example, if you paid the provider with cash, you may have to show proof of the cash withdrawal from your financial institution.

Guidelines for Proof of Payment Requirements
To avoid unnecessary delays, please follow the guidelines below.

Beneficiary-Paid Amount

What is Needed for Proof of Payment

Health Care Claims for Less Than $1,000

If the provider invoice/bill clearly identifies the amount you paid to the provider, then the provider invoice/bill is acceptable as the proof of payment.
If the provider invoice/bill does not clearly identify the amount you paid to the provider, then you must include a copy of your cancelled check, credit card receipt, or electronic funds transfer to show proof of payment.

Health Care Claims for $1,000 or More

A copy of your cancelled check, credit card receipt or electronic funds transfer to show proof of payment.

Pharmacy Claims for Less Than $1,000

A copy of pharmacy invoice/bill with the list of prescribed drug(s) is acceptable as the proof of payment.

Pharmacy Claims for $1,000 or More

A copy of your cancelled check, credit card receipt or electronic funds transfer to show proof of payment.

Bundling Claims

If you are bundling more than one claim on a single claim form, you must submit a proof of payment for each service. Each individual claim will be reviewed as if it was submitted separately, based on these guidelines. Any items that do not have proof of payment will be returned to you for further documentation.

Questions about Proof of Payment Requirements
If you have questions about proof of payment, submitting claims or about the status of a claim you've already submitted, please e-mail or call your TRICARE Oversea Program Regional Call Center. If calling, press Option 2 for claims assistance.

Eurasia-Africa

tricarelon@internationalsos.com
+44.20.8762.8384
1.877.678.1207 (toll-free from U.S.)

Latin America & Canada

tricarephl@internationalsos.com 1.215.942.8393
1.877.451.8659 (toll-free from U.S.)

Pacific-Singapore

sin.tricare@internationalsos.com
+65.6339.2676
1.877.678.1208 (toll-free from U.S.)

Pacific-Sydney

sydtricare@internationalsos.com
+61.2.9273.2710
1.877.678.1209 (toll-free from U.S.)

Last Modified:July 18, 2012

2) TRICARE Will Cover ABA Therapy for Retiree Families (For, At Least the Time Being) and Congress is Looking at it Also

The Department of Defense has been ordered in a pending class action to cover Applied Behavior Therapy (ABA) for children of military retirees who suffer from autism. Until this time ABA therapy was provided only to active duty TRICARE beneficiaries under the Extended Health Care Option (ECHO) program. TRICARE states that coverage will continue until the end of litigation. The pending case, Kenneth Berg v. U.S. is being heard by Judge Reggie Walton of U.S. District Court for the District of Columbia. He ruled in the still pending litigation that DoD’s refusal to cover TRICARE retirees beneficiaries was “arbitrary and capricious.”

The case was brought by Kenneth Berge on behalf of his son who was diagnosed with autism after Air Force Col. Berge retired. The ECHO program defines ABA therapy as medical intervention and covers up to $36,000 a year for the therapy. But retirees do not qualify for the TRICARE ECHO program. The basic TRICARE program (which covers military retirees) defines ABA as educational intervention and does not cover it

(Additionally, the Federal Employee Health Benefits Plan also covers ABA as medical intervention. Department of Defense civilian employees are covered under FEHBP.)

While DD is still contesting the case Congress is also looking at this question. The House of Representative’s version of the FY2013 NDAA includes provisions to both cover all TRICARE beneficiaries for ABA therapy and to abolish the $36,000 a year cap for the therapy. The Senate‘s version of the NDAA (which has not yet been voted on by the full Senate is silent on this issue. (But there are rumors that such a provision may very well be included.) Thirty two states also mandate that medical insurance cover ABA therapy. So this may very well be settled by a change in the law before the case is finally decided. In the meantime for more information go to: www.tricare.mil/abatherapy.

Applied Behavior Analysis Therapy

A class action suit was filed in U.S. District Court on behalf of military retirees who have children with autism, alleging that TRICARE did not provide coverage for applied behavior analysis (ABA) therapy under the medical benefit. Previously, the TRICARE program only provided coverage for ABA therapy under the TRICARE Extended Care Health Option (ECHO) program for active duty military family members. The judge sent the class-action suit back to TRICARE with instructions to provide coverage for ABA therapy for all beneficiaries who otherwise qualify for reimbursement.

  • As a result of the court order, TRICARE Management Activity (TMA) will cover ABA therapy under the TRICARE medical benefit for all eligible beneficiaries in accordance with applicable requirements that ensure the need and quality of the care. This benefit will remain in effect until litigation is complete.  
  • Although an interim policy is in place, covering ABA therapy under the TRICARE medical benefit is extremely complex and further guidance is forthcoming. 
  • The coverage is retroactive to February 16, 2010 in the United States and February 16, 2008 overseas, in accordance with TRICARE filing deadlines and policy. 
  • The implementation of ABA therapy under the TRICARE medical benefit is separate from the Autism services or the Enhanced Access to Autism Services Demonstration available to Active Duty family members enrolled in the ECHO program.  
  • ABA services under the TRICARE medical benefit will require a specific autism spectrum disorder (ASD) diagnosis rendered by a TRICARE authorized primary care provider or specialized ASD provider, as follows:  
    • Primary Care Manager (PCM) under the TRICARE Prime or TRICARE Prime Remote for Active Duty Family Member (TPRADFM) programs; 
    • TRICARE-authorized family practice, general medicine, internal medicine, and pediatric physicians under the TRICARE Standard program; or 
    • Military Treatment Facility (MTF) provider or team of providers or a network provider to whom a beneficiary is assigned for primary care services at the time of enrollment in TRICARE Prime. 
    • Physician board-certified or board-eligible in behavioral developmental pediatrics, neurodevelopmental pediatrics, pediatric neurology or child psychiatry; or  
    • Ph.D. clinical psychologist working primarily with children 

Beneficiaries must receive prior authorization from regional health care support contractors for treatment under all TRICARE medical plans, to include TRICARE Standard. To be covered as a medical benefit under TRICARE Standard/Extra or Prime, ABA services must be provided in accordance with program guidelines by a TRICARE authorized masters-level Board Certified Behavior Analyst (BCBA) or a doctoral-level clinical psychologist.

Contact information for regional health care support contractors is at www.tricare.mil/contactus.

Check this page frequently for the latest information and sign up for e-mail updates (above) about coverage of ABA services under the TRICARE medical benefit.

3) Watchdog Report Says That DOD Isn’t Implementing Military & Overseas Voting Act

The Pentagon’s Inspector General (IG) has issued a report that says the military hasn’t established offices on all overseas bases to help service members vote, as required by law. The Department of Defense says that it has failed to do so because of fiscal constraints.

The Military and Overseas Voter Empowerment (MOVE) Act was passed by Congress in 2009 and signed into law by President Barack Obama to make it easier for both troops deployed overseas and U.S. civilians living abroad to cast ballots back in their home states.

The law requires each military branch to create an Installation Voting Assistance Office (IVAO) for every military base outside of an immediate combat zone.

The Pentagon’s IG issued a report Tuesday that said the IG’s attempts to contact IVAOs failed about 50 percent of the time. It reached the conclusion that the various military services had not established all the IVAOs as intended by the MOVE Act because the funding was not available. The Pentagon has estimated it could cost $15 million to $20 million a year to create all the offices required by the law.

Apparently, instead of complying with the law, the Pentagon used advertising and digital outreach efforts to educate overseas troops instead of creating the voting assistance offices. DOD argued that since the majority of the military population is 18-14 years old, IVAOs were likely not the most cost effective way to reach out to them since on-line social media and other internet sources were where they preferred to get their information.

The full report can be read here: http://www.dodig.mil/SPO/Reports/DODIG-2012-123.pdf

TREA: The Enlisted Association supports further study to find out the best way to reach military voters to convince them to sign up for absentee ballots. If it is found that reaching the younger generation through electronic sources is more effective, then we believe that the law should be changed to mandate the more effective form of communication. We will keep you posted on any developments.

4) Study to Find Out if War Causes Advanced Aging

According to an article in USAToday this week, a Harvard Medical School professor of psychology is leading a research project to learn more about what appears to be early aging among veterans. Among the diseases being seen in veterans in their 20’s and 30’s are early signs of heart disease and diabetes, slowed metabolisms and obesity, all of which are issues more commonly seen in middle aged or older individuals.

While the research is still in its early stages, it appears these problems are occurring most often in those veterans who suffered both blast-related concussions and PTSD. There even appears to be evidence of diminished gray matter in high-functioning areas of the brain, something which shouldn’t be happening until much later in life.

The article says the Pentagon has reported that since the year 2000, the number of servicemembers who have suffered mild to severe traumatic brain injuries is about 244,000.

In addition, a study released last month by the Centers for Disease Control and Prevention “found that veterans ages 25-64 had more than twice the rate of diabetes, hypertension, heart disease and cancer than non-veterans.”

TREA has argued for years that military service is not like any other job. The sacrifices are real and the consequences can be serious and life-changing.

We will continue to monitor this study and make members of Congress aware of its findings.

5) DFAS Presenting Retiree Seminars Throughout The Country

This fall the DFAS is participating in a series of retiree seminars throughout the country. If you are interested please go to : http://www.dfas.mil/retiredmilitary/newsevents/
seminars.html?utm_source=facebook&utm_medium=
post&utm_campaign=ra_seminar_090512fb  and see where and when a seminar is near you.

6) President Expands Military Suicide Prevention Programs

Last Friday President Obama issued an executive order directing all relevant federal departments and agencies to expand their mental health and suicide prevention programs for all service members, veterans and their family members.

The order directs the Department of Veterans Affairs to hire 800 military veteran support counselors to provide peer counseling; and to” use its pay-setting authorities, loan repayment and other incentives to recruit and hire 1,600 mental health care providers by June 2013.”

This is in addition to the 3,500+ new mental health providers that the VA has hired since 2009.

In addition the VA and HSS are directed to set up 15 pilot sites where the “ VA will contract with community health centers, community mental health clinics, community substance abuse treatment facilities and other HHS grantees and community resources to help reduce VA mental health waiting lists.,” The 2 Departments are also ordered to focus on providing more mental health services in rural and other underserved areas of the country.

The Order stated that:“The need for mental health services will only increase in the coming years as the nation deals with the effects of more than a decade of conflict.” It also created a government wide taskforce to “study and recommend ways to improve mental health and substance abuse treatment programs for service members, vets and their families.”

Over 2 million service members have been deployed to Iraq and Afghanistan since 9/11.

 

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