AMEDD Semi-Monthly Update by sofiaie

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									                              TRO-South Messenger
                            A Bi-Weekly Update for the Region
                                        Issue 12
                                    January 27, 2010

            This publication can be viewed on the TRO-South website at
                              www.tricare.mil/trosouth.
     Previous editions can be found at www.tricare.mil/trosouth/newsletters.cfm.

 TOPICS OF INTEREST
TRICARE ASSISTANCE PROGRAM (TRIAP): The past year has been a busy one for
TRICARE with the introduction of a new Web-based counseling program and major
enhancements to several other TRICARE benefits.

Introduced Aug. 1, 2009, the TRICARE Assistance Program (TRIAP) uses today’s
constantly evolving Web-based technologies to bring short-term professional counseling
assistance closer to the people who often need it most: service members and veterans
recently returned from overseas and their families who’ve persevered through the
deployment.

TRIAP is available in the United States to active duty service members, those eligible for
the Transition Assistance Management Program (TAMP) and members enrolled in
TRICARE Reserve Select. It is also available to their spouses, no matter their age, and
other eligible family members 18 years of age or older.

From the comfort of their homes, or anywhere else, beneficiaries with a computer, Webcam
and the associated software can speak “face-to-face” with a licensed counselor over the
Internet at any time of the day or night. Eligible beneficiaries can get more information about
TRIAP and other behavioral health resources at www.tricare.mil/mentalhealth.

ECHO benefit increases
TRICARE has increased the amount it pays for certain Extended Care Health Option
(ECHO) benefits. ECHO assists eligible family members of active duty sponsors who are
diagnosed with moderate or severe mental retardation, a serious physical disability, or an
extraordinary physical or psychological condition.

The total TRICARE cost share for training, rehabilitation, special education, and assistive
technology devices was increased to $36,000 per fiscal year. This covers institutional care
in private, nonprofit, public and state institutions and facilities and, if appropriate,
transportation to and from such institutions and facilities. To learn more about ECHO, go to
www.tricare.mil/echo.

Standard preventive care enhanced
Getting clinical preventive services can help prevent major health problems. In September
2009 TRICARE waived all cost shares for Standard beneficiaries for colorectal cancer,
breast cancer, cervical cancer and prostate cancer screenings, immunizations and well-
child visits for children under 6 years of age.


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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. Other services
provided during the same visit are subject to cost shares and deductibles.

New Active Duty Dental Program
On Aug. 1, 2009, TRICARE launched a new dental program for active duty service
members. The Active Duty Dental Program is designed for service members assigned to
locations with no access to a military dental facility, and those referred by their dental
treatment facility (DTF) to the civilian network for specialty care or due to unavailability of
timely DTF appointments.

For more information about this new dental program, go to www.addp-ucci.com.


2008 SURVEY OF HEALTH RELATED BEHAVIORS AMONG ACTIVE DUTY MILITARY
PERSONNEL: The Department of Defense announced the final results of its 2008 Survey
of Health Related Behaviors among active duty military personnel. Active duty Coast Guard
personnel were included in the survey's cohort for the first time since the series of surveys
began in 1980, providing the first comprehensive look at all active military services.

"The 2008 survey indicates that the U.S. Armed Forces are generally strong, healthy, and
ready to accomplish their mission," said Jack Smith, M.D., acting deputy assistant secretary
of defense for clinical policy and program policy. "We are pleased with the continued
increase of healthy behaviors and preventive health practices reported by our service
members." The study shows notable decreases over the past 28 years in the use of
cigarettes and illegal drugs and encouraging indicators of mental well being.

In addition, there are improvements in certain self-reported preventive health measures
since 2005 including increases in moderate or vigorous exercise and a decline in
overweight personnel under age 20. When compared to civilian data adjusted to mirror
military demographic characteristics, the 2008 survey showed that military rates of heavy
drinking were lower than the civilian average among persons aged 46 to 64. For cigarette
use, military rates were slightly higher than civilian rates among persons aged 18 to 35 but
military rates were significantly lower for persons aged 36 and older. The 2008 rate for illicit
drug use, including prescription drugs, was 12 percent, an increase from 5 percent in 2005.
The percentage increase is primarily attributed to the addition of questions that ask for
usage of prescription medication for non-medical reasons. Rates of use of nonprescription
illicit drugs (e.g. cocaine, marijuana, amphetamines) have remained low and stable at about
two percent.

This survey is the 10th in a series of confidential, anonymous standardized surveys that ask
active duty service members about various health related behaviors. In addition to
substance use, the survey also assesses mental well-being, deployment issues, fitness,
nutrition and weight management, and selected national health status goals from the
Department of Health and Human Services' Healthy People 2010 objectives. More than
28,500 service members from the Army, Navy, Marine Corps, Air Force and Coast Guard,
randomly selected to represent men and women in all pay grades of the active force
throughout the world, completed the survey.


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To view a summary of the survey results please visit www.health.mil. The full survey, along
with a survey summary and Q&A, are posted at http://www.tricare.mil/tma/studiesEval.aspx.


DOT MIL DOCS: Located at http://health.mil. Dot Mil Docs is part of the MHS’ ongoing
effort to interact with service members and the general public via “Web 2.0” technology. It is
a weekly DoD-hosted Internet radio show. Military docs and health care experts discuss a
new topic each week. Thousands listen. Those who cannot listen when the show is live, can
listen to archived Dot Mil Docs broadcasts at http://health.mil under the video and audio
section. To set a reminder for the show, visit:
http://www.blogtalkradio.com/stations/PentagonRadioNetwork/Dot-Mil-Docs.

TRO-South POC: 210-292-3278

 TMA PRESS RELEASES

Click on the title to view information or visit: http://www.tricare.mil/pressroom.

  1/15/2010: TRICARE University Provides Online Benefit Education

  1/11/2010: E-mail Updates Deliver the Latest TRICARE News and Benefits

  1/7/2010: Oh, Say, How Can You See? Check at Your Next Eye Exam

  1/7/2010: Toolkit Helps Answer Service Members’ Health Care Questions

  1/6/2010: No Need to Feel SAD During the Winter

  1/5/2010: The Power of Blood Belongs to Donors



TRO-South POC: 210-292-3278


 CLINICAL OPERATIONS DIVISION

MONITORING CLINICAL QUALITY OF CARE: The Department of Defense, through the
TRICARE Management Activity, has delegated the function of monitoring and managing the
clinical quality of care rendered to TRICARE beneficiaries in the purchased care system to
the Managed Care Support Contractor (MCSC). This function is vital to the protection of
TRICARE beneficiaries. In the South region, the MCSC is Humana Military Healthcare
Services (HMHS). Please note that this delegation and function does not apply to
TRICARE beneficiaries that are Medicare primary.
Critical to the function of managing the clinical quality of care is the identification and
reporting of potential quality of care issues (PQIs). For beneficiaries enrolled to the direct
care system, the identification and reporting of PQIs for care delivered by civilian providers
is described in the South Region CORE MOU, Section III, G 15:


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     -   HMHS is responsible for peer review of clinical quality issues for network providers. The
         MTF provides the same oversight for MTF providers. To ensure appropriate review and
         documentation when the MTF identifies potential quality of care issues that concern non-
         MTF providers, MTF quality personnel will notify the TRO Chief of Quality Management
         who will, in turn, notify the HMHS Regional Quality Manager of the issue. This notification
         will be logged into both the MTF and the HMHS peer review minutes. The same process
         will apply in reverse when HMHS identifies potential quality issues involving MTF
         providers, unless otherwise agreed by the TRO Chief of Quality Management.

Therefore, if an MTF provider/MTF staff identifies a PQI from a civilian provider, whether the
provider is network or non-network, please contact the POC below (TRO-S Chief, Quality
Management) for the appropriate referral to HMHS for review, investigation, and potential
intervention. Please understand that any PQI review falls under peer review protections
and cannot be disclosed back to the MTF.
TRO-South POC: Chief, Quality Management, 210-292-3276,


IS IT A GRIEVANCE OR A COMPLAINT? : Regarding care in the purchased care system
in the South Region or concerning the Managed Care Support Contractor (MSCS) Humana
Military Healthcare Services (Humana Military), there is still some confusion in determining
what is considered a complaint and what is considered a grievance. Simply stated, a
complaint is verbal and a grievance is written. A complaint or grievance is any issue
regarding a perceived failure by any member of the health care delivery team including
TRICARE-authorized providers, regional contractors, or subcontractor personnel to provide
appropriate and timely health care services, access, or quality, or to deliver the proper level
of care or service. Any TRICARE civilian or military provider, TRICARE beneficiary,
sponsor, parent or guardian, or other representative of an eligible dependent child may file
a complaint or grievance. Guidelines are:
To file a complaint, go to the nearest TRICARE Service Center and verbally report concerns
or call the Humana Military toll free number at 1-800-444-5445.
To submit a grievance, write to:
      Regional Grievance Coordinator
      Humana Military Healthcare Services
      8123 Datapoint Drive, Suite 400
      San Antonio, Texas 78229
 For behavioral health care concerns, write to:
      Grievance Specialist
      ValueOptions
      P.O. Box 551188
      Jacksonville, Florida 32255-1188
More information may be accessed through the Humana Military web site
http://www.humana-military.com

Note: Any concerns regarding care or processes that occur in a Military Treatment Facility
(MTF) should be reported to the MTF patient advocate.
TRO-South POC: Chief, Quality Management, 210-292-3276

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TRICARE RETIRED RESERVE: A new program will offer “gray area” reservists the
opportunity to purchase TRICARE health care coverage. While qualified members of the
Selected Reserve may purchase premium-based coverage under TRICARE Reserve Select
(TRS), retired National Guard and Reserve personnel did not have TRICARE health
coverage options until they reached age 60. Under a provision of the National Defense
Authorization Act for 2010, that’s all changed.

The new provision will allow certain members of the Retired Reserve who are not yet age
60 (“gray-area” retirees), to purchase TRICARE Standard (and Extra) coverage. TRICARE
Extra simply means beneficiaries have lower out of pocket costs if they use a network
provider.

 “We’re working hard to coordinate all the details of eligibility, coverage and costs, and
expedite implementation of this important program,” said Rear Adm. Christine Hunter,
deputy director of the TRICARE Management Activity. “This is a major benefit program with
implementation on the same magnitude as TRS. It will require detailed design, development
and testing, but qualified retired reservists should be able to purchase coverage by late
summer or early fall of 2010.”

While the health care benefit provided for gray-area retirees will be TRICARE Standard and
Extra – similar to TRS – the new program will differ from TRS in its qualifications,
premiums, copayment rates and catastrophic cap requirements. The program is tentatively
called TRICARE Retired Reserve.

The new statute requires premium rates to equal the full cost of the coverage. That is the
major difference contrasted with TRS, where the statute provides that Selected Reserve
members pay only 28 percent of the cost of the coverage. Premiums for the new gray area
retiree program will be announced after program rules are published in the Federal
Register.

This new program offers an important health coverage option for Reserve and National
Guard members who served their country honorably before hanging up their uniforms at
retirement, said Hunter. For more information about TRICARE benefits go to
http://www.tricare.mil.

 PROGRAMS OPERATIONS DIVISION

THREE VACCINES NOW AVAILABLE AT TRICARE NETWORK PHARMACIES:
TRICARE beneficiaries can now receive select vaccines with no out-of-pocket expense at
retail pharmacies.

For the first time ever, beneficiaries can visit participating TRICARE retail network
pharmacies to receive seasonal flu, H1N1 flu and pneumonia vaccines at no cost. This
expanded coverage is available to all TRICARE beneficiaries eligible to use the TRICARE
retail pharmacy benefit.

Other vaccines must still be administered in a doctor’s office or authorized convenience
clinic to be fully covered by TRICARE’s preventive health services cost-share waiver.

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“Vaccines are the most effective defense against the seasonal and H1N1 flu and
pneumonia,” said Rear Adm. Thomas McGinnis, TRICARE’s chief pharmacy officer. “We
hope this new, convenient and affordable option encourages TRICARE beneficiaries to get
their vaccinations.”

To receive the vaccines, beneficiaries can call their local TRICARE retail network pharmacy
to make sure it participates in the vaccine program and has the vaccine in stock. To locate
a participating retail network pharmacy, go to http://www.express-scripts.com/TRICARE or
call Express Scripts at 877-363-1303.

TRO-South POC: 210-292-3278

 BUSINESS OPERATIONS DIVISION

CLINICAL SUPPORT AGREEMENTS: What to do with your current Clinical Support
Agreements (CSA). Now is the time to plan for the follow-on task order or modification for
your current provider services on your CSAs. TMA’s contracting officer recently notified
HMHS of the TRICARE Management Activities’ intent to execute Option Periods 7 and 8 of
the current T-NEX Managed Care Support Contract (MCSC). This means current CSAs
being provided under a MCSC task order can continue to be provided one more year or
until March 31, 2011. If you are satisfied with the performance of your current services and
want to eliminate the disruption of services that often comes with changing contract vendors
and therefore their providers, then now is the time to notify your supporting contracting
office to take action to ensure the services under your current CSAs continue through the
MCSC’s extended period of performance.

TRO-South stands ready to answer any questions you have regarding CSAs and how your
MTF can take advantage of the Option Period 7 and 8 extensions. The Chief, Contract
Operations Division is available to answer specific contracting questions. She can be
reached telephonically at the number below.

TRO South POC: 210-292-3267

 COMMENTS

Your feedback is very important to us and helps pave the way to enhancing the
service we provide.

If you would like to provide comments or feedback on the TRO-South Messenger or the
services provided by a TRO-South staff member, please access our online customer
feedback section located on our website at TRO-South Comment Card.

If you need immediate assistance with this publication, please call 210-292-3278.

Thank you!




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