TREA WASHINGTON UPDATE FOR SEPTEMBER 11, 2009
Today we remember and honor those who died in the attacks on America eight years ago. May we never forget what happened on 9-11-01 and remember that eternal vigilance is the price of liberty.
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Upon returning from their August recess Congress resumed its work this week. Without a doubt this recess was one of the most memorable in recent history because of the contentious town hall meetings held by many members in their states and districts. We hope many TREA members took the opportunity to attend the meetings and express their opinions to their Senators and Representatives.
While the debate about overhauling the health care insurance system continues to be the main topic of discussion on Capitol Hill, they did manage to accomplish other things this week. But the end of the fiscal year, which is September 30, is quickly approaching and Congress is running out of time if it hopes to complete its work on the fiscal year 2010 appropriations bills. In fact, House Majority Leader Steny Hoyer of Maryland said this week that the House will pass a stopgap funding bill later this month in order to insure the federal government can keep running after September 30 because he doesn’t expect the FY2010 appropriations bills to be completed until the end of October. While the House has passed all 12 of its annual appropriations bills for 2010, the Senate has passed only four: Agriculture, Energy and Water, Homeland Security, and Legislative Branch. None of those has yet gone to conference committee. In fact, while the Senate has named its conference committee members for those bills, the House has not.
Senate Majority Leader Harry Reid has said he hopes to pass seven or eight spending bills before the end of September, but the focus on the health care issue leads us to believe that is very unlikely to happen.
1) Senate Appropriations Committee Passes Defense Bill
2) Why Will There Be No COLA This Year?
3) Congressman Buyer Remains Concerned About VA Health Care
4) TRICARE Standard Pays to be Preventive
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INTRODUCING - NEW TREA PARTNERSHIPS
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1) Senate Appropriations Committee Passes Defense Bill - On Thursday, the Senate Appropriations Committee passed the FY2010 Defense spending bill with a unanimous vote. The most controversial items were whether or not to spend money for more F-22 fighters and for a second F-35 jet engine. The President has said he would veto a defense bill that contained either of those items and because of that the Senate did not include money for either of them. However, the House version of the Defense spending bill does contain funding for parts for a dozen F-22s, so that will be one issue that the conference committee will have to settle. Overall, the Senate bill contains $3.9 billion less than the President requested, but it matches the $636.3 billion contained in the House version of its FY2010 Defense spending bill. Assuming that the entire Senate passes the Defense bill without making any changes, it is the differences in how that money is spent that must be settled by a House-Senate conference committee.
The good news as far as we’re concerned is that the Defense health care program has been fully funded for FY2010, meaning there will be no attempt by DoD to raise TRICARE fees or co-pays. However, we remain very concerned that when Congress starts work on the FY2011 Defense bill, which will happen within the next few months, there very well could be a push to increase those fees. TREA will watch these developments very carefully and alert you as soon as we hear anything.
2) Why Will There Be No COLA This Year? - We have previously reported to you that it is highly unlikely there will be any COLA this year. Some phone calls we have had have questioned why that is and some have blamed the President or the Congress for taking it away.
However, neither the President nor the Congress had anything to do with why there will be no COLA next year. First of all, it must be remembered that the COLA stands for “Cost Of Living Adjustment.” Many retirees seem to have gotten the idea that the COLA is a pay raise. But that is simply not the case.
The process currently used to determine the Social Security COLA, upon which all the other COLAs are based, was first instituted in 1975. Prior to that time any increases were set by legislation. That resulted in a situation where increasing inflation meant that the various earned benefit payments made by the government decreased in value because inflation ate them away. There was a realization that many government beneficiaries were heading into poverty because their payments purchased less and less. That’s why it was decided that government should not benefit from inflation and that Social Security, military retirement and disability payments must be adjusted every year to account for inflation.
The COLA is determined every year by a formula that is set in law. It cannot be changed or manipulated by the President or any other individual. In order to change the formula Congress would have to pass a new law. Last year, because of the rapid increase in the cost of living, the COLA was 5.8 percent. That compares to an average COLA of 3.1 percent over the last ten years.
However, as overall prices have fallen during the past year, the cost of living has decreased, and that will result in no COLA. That doesn’t mean that some prices for the things you buy haven’t increased. It just means that overall price increases in some areas have been offset by price declines in other areas. The most notable of these is the decline in the price of gasoline over the past year.
3) Congressman Buyer Remains Concerned About VA Health Care - Congressman Steve Buyer, Republican of Ohio and the ranking member on the House Veterans Affairs Committee, has continued to express his concern about VA health care in relation to the proposals in the House of Representatives regarding health care insurance reform. He issued the following press release this week. TREA takes his concerns seriously and we are carefully monitoring all of the proposals for health care insurance reform and how they may affect both VA and military health care.
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From the office of Congressman Buyer:
Healthcare Reform Could Hurt Veterans
Washington, D.C. – Today Congressman Steve Buyer released the following statement in response to President Obama’s address last night to a joint session of Congress on healthcare reform.
“Once again, President Obama has attempted to ease the concerns of millions of American veterans by saying that nothing in the national healthcare reform legislation would change the coverage they have,” said Buyer who serves as the Ranking Member of the House Committee on Veterans’ Affairs. “What the President fails to say, and continues to ignore, is that there are a number of reasons for veterans to be deeply concerned about how national healthcare reform could adversely affect them and their families.”
“The most pressing issue is that in its current form, H.R. 3200 could result in bureaucratic determinations that veterans enrolled in VA healthcare do not meet acceptable coverage standards, exposing them to a new 2.5 percent punitive individual income tax. This is just one of several provisions in the bill that could harm veterans.”
During a joint House and Senate hearing today on the legislative priorities of the American Legion, Buyer thanked the 3 million member organization for its advocacy on correcting provisions adverse to veterans within H.R. 3200.
“I share many of the same policy concerns as the Legion with regard to healthcare reform, and I commend you for standing up to ensure nothing in the bill will have a negative impact on veterans. Much remains to be done and your voices will be critical in the weeks ahead.”
“While I have received tentative support for fixing these problems from the Chairman Waxman, I will continue to hold the majority leadership accountable, until veterans see the changes to the legislation that they deserve and expect.”
4) TRICARE Standard Pays to be Preventive - Obtaining clinical preventive services helps prevent illness before major health problems occur. Section 711 of the National Defense Authorization Act of 2009 encourages eligible TRICARE Standard beneficiaries to use preventive health services by waiving all cost shares for certain types of these services starting Sept. 1. These services include screenings for colorectal cancer, breast cancer, cervical cancer and prostate cancer; immunizations; and well-child visits for children under 6 years of age.
Also, for all beneficiaries over age 6, when a visit to a health care provider includes one or more of the benefits listed above, the cost share for the visit is waived. However, other services provided during the same visit are subject to cost shares and deductibles.
“Early disease detection and chronic condition management programs result in the prevention of long term health conditions and add savings for beneficiaries and the government in the long term,” said Navy Rear Adm. Christine S. Hunter, deputy director of the TRICARE Management Activity. “It’s a great new benefit under TRICARE Standard.”
The cost share waiver applies to non-Medicare eligible, TRICARE Standard or Extra beneficiaries; even if the beneficiary hasn’t met the annual deductible. Beneficiaries enrolled in TRICARE Prime are unaffected, since they do not have copayments for preventive services.
Medicare-eligible beneficiaries are covered by TRICARE For Life (TFL), which generally pays the remainder of any costs not paid under Medicare, including amounts for the listed preventive services. However, preventive services and all immunizations not covered by Medicare require TRICARE Standard cost shares and deductibles for TFL beneficiaries.
Criteria such as age, frequency of care and family history have to be met in order to waive cost shares for the six clinical preventive services. All other preventive services not included in the services listed in Section 711 are subject to cost shares and deductibles. This benefit can be applied to any services received on or after Oct. 14, 2008. Beneficiaries can request reimbursement for services received after Oct. 14, 2008, and before the implementation date of Sept. 1, 2009.
Reimbursement requests can be made by phone or in writing to the region where the beneficiary lives.
For requests by phone:
North Region
Net Federal Services, LLC
1-877- 874-2273 1-877- 874-2273
South Region
Humana Military Healthcare Services, Inc.
1-800-444-5445 1-800-444-5445
West Region
TriWest Healthcare Alliance
1-888-874-9378 1-888-874-9378
Requests submitted in writing to the regional claims processor should include the sponsor’s social security number, full names and dates of birth of all dependents and current mailing address. For written requests:
North Region
Health Net Federal Services, Inc.
c/o PGBA, LLC/TRICARE Claims Correspondence
PO Box 870141
Surfside Beach, SC 29587-9741
South Region
Humana Military Healthcare Services, Inc.
P.O. Box 740062
Louisville, KY 40201-7462
West Region
West Region Customer Service
P.O. Box 77029
Madison, WI 53707-7029
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INTRODUCING -- NEW TREA PARTNERSHIPS:
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