VA ENROLLMENT FEE UPDATE 01: The President’s proposed 2009 VA budget, once again, calls for an annual enrollment fee for veterans in priority 7 and 8 and an increase in the pharmacy co-pays. Fortunately, unlike DoD the VA did not budget the “savings” that adoption of such proposals would bring into to the healthcare budget. Therefore, if the Military Coalition is once again successful at stopping these proposed increases there will not be a hole in the VA’s healthcare budget. The Budget as submitted presently includes the following tiered annual enrollment fees based on veteran’s family income (Priority 7/8):

Family Income Annual Enrollment Fee

Under $50,000 None

$50,000 -$74,999 $250

$75,000 -$99,999 $500

$100,000 and above $750

It also calls for an increase in pharmacy co-payments from $8 to $15 (Priority 7/8). Last year Congress passed historic increases in the VA budget; $3.7 billion additional funding was given to the VA in emergency funding for this year. Hopefully, permanent additional funding can be added to this already increased budget. [Source: TREA Washington Update 8 Feb 08 ++]

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VET JOB UPDATE 01: Some upcoming Military Job Fairs scheduled for southern California are listed below. For additional info refer to http://hirepatriots.com/:

February 28, San Diego Naval Base, Anchors Club, 10:00-14:00.
July 10, Camp Pendleton Marine Base, So. Mesa Club, 10:00-14:00.
July 31, San Diego Naval Base, Anchors Club, 10:00-14:00.
October 23, Camp Pendleton Marine Base, So. Mesa Club, 10:00-14:00.
November 6, San Diego Naval Base, Anchors Club, 10:00-14:00.
December 4, Miramar Marine Air Station, Officers Club, 10:00-14:00.

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There is a group of disabled veterans on the DOD payroll that are totally excluded from the benefits of the restoration of concurrent receipt: those separated under provision of title 10 US Code Sec 1175 - Voluntary Separation Incentive (VSI) that was used in conjunction with Temporary Early Retirement Authority (TERA, PL 102-484 Sec 4403(f)) to reduce the size of the military establishment during 1992 through 2001. Beginning 31 DEC 92, VSI was offered to service members having at least 6 but less than 20 years of service. They receive an annual amount funded by the Department of defense that equals the multiplication product of four factors: (1) their base pay at separation, (2) number of years of service, (3) 12 and (4) 2.5%. Note that while the annual amount is identical to the 12 times the monthly amount they would have received if retired for the same length of service, the VSI amount is not considered retirement pay. If the VSI recipient later qualifies for VA compensation for service connected disability, the same title 38 US Code sections that require a $1 for $1 offset of military retired pay also require the same offset of the VSI amount.

While the 2003 NDAA included TERA retirees under Concurrent Retirement Disability Pay (CRDP, 10 USC 1414) it excludes VSI recipients because they are not “retired.” The 2008 NDAA includes Chapter 61 medical disability retirees under the Combat Related Special Compensation (CRSC, 10 USC 1413a) but not CRDP. Regardless, one can be retired under Chapter 61 with a minimum of 30 days active service. Extending CRSC to Chapter 61 restores their retirement pay (based on 2.5% x length of service x base pay) that is offset by VA disability compensation. Thus there is some form of relief of the VA disability compensation offset extended to TERA and Chapter 61 retirees, but absolutely no relief for VSI recipients. Those interested in seeing legislation to correct this omission should contact their legislators and request his/her sponsorship of a bill. For sure, the 2009 NDAA should include VSI recipients in concurrent receipt. A suggested editable letter with automatic transmission means can be found at http://capwiz.com/usdr/issues/alert/?alertid=10921911&queueid=[capwiz:queue_id] to assist in this endeavor. [Source: USDR Action Alert 3 Feb 08 ++]

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When a veteran needs emergency medical treatment, the VA allows that veteran to go to the nearest private or community hospital. Once the veteran is stabilized, the veteran must then be transferred to a VA hospital for any necessary continued care. The problem arises when there is a wait for a bed in a VA hospital. Current law does not require the VA to reimburse the hospital for the care given after the point of stabilization. In rural areas, the problem with the current law is particularly pronounced. Often, a patient may be deemed stable but is not necessarily stable enough to make ambulance trips traveling long distances. More specifically, the Veterans Emergency Care Fairness Act of 2007:

• Requires (under current law, authorizes) the Secretary of Veterans Affairs to reimburse certain veterans without a service-connected disability enrolled as active participants of the Department of Veterans Affairs (VA) health care plan for the cost of emergency treatment received in a non-VA facility until such time as such veterans are transferred to a VA facility.

• Requires (under current law, authorizes) the Secretary to reimburse certain veterans with a service-connected disability or a non-service-connected disability associated with or aggravating a service-connected disability for the value of emergency treatment for which such veterans have made payment from sources other than the VA.

Thus, HR 3819 would simply close that loophole and require the VA to reimburse the private hospital for care. Those interested in seeing this legislation become law should contact their legislator and request his/her support of the bill. A suggested editable letter with automatic transmission means can be found at http://capwiz.com/usdr/issues/alert/?alertid=10912651&queueid=[capwiz:queue_id] to assist in this endeavor. [Source: USDR Action Alert 1 Feb 08 ++]

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On 28 JAN 07, the 2008 Military Health System (MHS) “Caring for America’s Heroes” conference began. The goal of this year’s conference was to illustrate the MHS’ role in global healthcare delivery, while featuring plenary sessions aligned with the MHS strategic plan, goals and objectives.

The event brought together over 3,500 military and civilian health professionals, contractors, and veteran advocates. In his opening remarks, Assistant Secretary of Defense for Health Affairs Dr. S. Ward Casscells called on everyone to share lessons learned to make the care of wounded, injured and ill even better Dr. James B. Peake, Secretary of Veterans Affairs (VA), also addressed the group, promising greater collaboration between the two departments in the months to come.

One of the major issues discussed was the need to make a single seamless pathway for our military from point of illness to, and through the VA system. The electronic personal health record is essential, said Dr. Casscells, to clearing a seamless pathway between DoD and VA as well as a critical element to maintain healthcare costs by tracking the progression and treatment of chronic disease.

For years DoD and VA have been developing individual systems that were not interchangeable. More recently, the two departments have undertaken a series of initiatives that will allow data to move rapidly between the two agencies.

Another item receiving heavy emphasis during the conference was accession and retention of health care professionals. The need for physicians, clinicians and nurses has been a continuing concern for the military services. Health care leaders pledged to take a serious look at this area and hope to increase incentives for these critical healthcare providers. Unlike previous years, the issue of retiree health care and the possibility of Tricare fee increases were not on the agenda. [Source: NAUS weekly Update 1 Feb 07 ++]

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Illinois, Ohio, and Massachusetts have recently passed legislation to help veterans transition back into civilian life. Veterans in Massachusetts are entitled to bonuses through the State’s Welcome Home Program. Massachusetts veterans should call the State Treasurer’s office at (617) 367-9333, ext. 859, to request bonus application materials. In Illinois, a new tax law known as the Returning Veterans Homestead Exemption provides a one-time $5,000 reduction to their home’s equalized assessed value. For more information, visit the Illinois Department of Revenue website. Ohio’s governor signed a law that exempts military pensions from State income tax and also prevents discrimination against veterans. [Source: NAUS weekly Update 1 Feb 07 ++]

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Military retirees need to check their beneficiary information on the reverse side of their Military Retiree Account Statement. Some retirees have reported an unauthorized beneficiary name change. The Defense Finance and Accounting Service said it has no way of ascertaining whose identity may have been stolen, resulting in a beneficiary change. If this becomes a widespread issue, they most likely will put out at notice. Those retirees that have the wrong beneficiary on their statement should contact DFAS immediately to change their beneficiary, and let them know it was changed without their authorization. The DFAS number is: 1-800-321-1080. [Source: VetJobs Veteran Eagle 1 Feb 08 ++]

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The independent Commission on the National Guard and Reserves (CNGR) is charged by Congress to recommend any needed changes in law and policy to ensure that the Guard and Reserves are organized, trained, equipped, compensated, and supported to best meet the national security requirements of the United States. The Commission was established by the Ronald W. Reagan National Defense Authorization Act for Fiscal Year 2005. On 31 JAN 08 it recommended sweeping changes to the way U.S. military reserve forces have been structured and have operated for more than a half century and delivered to Congress and Pentagon officials its final report, which includes 95 recommendations on how to transition the reserves into a feasible and sustainable operational reserve.

Today’s reserve components were designed as a strategic reserve during the Cold War era. “The Guard was part of that surge force that would be dusted off once in a lifetime,” commission chairman retired Marine Maj. Gen. Arnold Punaro said. “That is absolutely not the situation we have today.” Nearly 100,000 reserve troops are on active duty, according to DoD reports. In 2006, reserves forces provided 61 million “man days,” or single days of duty, in support of the Defense Department. It would not be feasible to add an equivalent number of forces to active duty, Punaro said in a news conference at the National Press Club. He called increasing active forces so significantly an economically unaffordable option that would cost a trillion dollars. Right now, for about 9% of the DoD budget, the National Guard and reserves provide 44% of manpower available to the Defense Department, Punaro said. Six conclusions serve as the foundation for the 400-page report, which is based on 163 findings, 17 days of public hearings, testimony of 115 officials witness and 800 interviews and site visits by commission members. It is the most comprehensive, independent review of the Guard and reserves in 60 years, Punaro said.

The commission proposed changes in laws and regulations that govern the reserves, as well as how reserve forces train, equip and approach medical readiness. The commission proposed an “integrated continuum of service” between reserve and active forces, offering the same pay, personnel, promotion and retirement systems. The changes would allow a seamless transition by service members over the course of a military career to transition from active to reserve, and to even leave the service temporarily for child rearing or to pursue higher education. Now, when reservists move from one duty status, such as from active duty to state duty, they sometimes face pay problems and delays. The commission recommended moving from the current 29 duty statuses to only two: active duty or not. For health care, a hot-ticket item for activated reservists, the commission proposed more specific, targeted information geared to reservists and their families. Many of those the commission interviewed expressed frustration with trying to understand the medical healthcare system quickly once their spouses were mobilized, commission members said. In personnel changes, the commission recommended a competency-based promotion system that recognizes civilian skills and recruits and retains accordingly.

Many of the changes could be implemented this year if supported by Congress and DoD, Punaro said. Some, though, could require years to debate and implement. The commission also called for better support programs, funding and resourcing for families and defense officials to have an open dialogue with employers who suffer when employees depart on multiple employments. It also recommends expanding the role of the National Committee for Employer Support of the Guard and Reserve, which advocates on the behalf of service members. “During the past few years, DoD has initiated the largest set of changes in policy and statute since the inception of the all-volunteer force. This is transforming the Guard and Reserve from a purely strategic reserve to a sustainable operational and strategic reserve,” Thomas F. Hall, assistant secretary of defense for reserve affairs, said today. Defense Department officials said they are reviewing the report. [Source: AFPS Fred W. Baker III article 31 Jan 08 ++]

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TFL FACTS & TIPS UPDATE 01: Tricare for Life (TFL) is TRICARE’s Medicare-wraparound coverage available to all Medicare-eligible Tricare beneficiaries, regardless of age, provided they have Medicare Parts A and B. Under TFL Medicare is your primary insurance and TRICARE acts as your secondary payer minimizing your out-of-pocket expenses. Tricare benefits include covering Medicare’s coinsurance and deductible. Key features of Tricare for Life include:

• Minimal out-of-pocket costs (aside from Medicare part B premium).

• No enrollment fees for TFL. But, you must purchase Medicare Part B and pay monthly premiums to be eligible for TFL.

• Coordination of benefits between Medicare and Tricare.

• Tricare is the secondary payer for all services covered by both Tricare and Medicare.

• Tricare is the primary payer for those services covered only by Tricare.

• Additional steps may be required in order to coordinate benefits if you have other health insurance in addition to Tricare and Medicare.

• Freedom to manage your own health care.

• No assigned primary care manager.

• Visit any Medicare provider.

• Receive care at a military treatment facility on a space-available basis.

• No claims to file (in most cases).

• Your provider files your claim with Medicare. Medicare processes the claims and forwards them electronically to Tricare.

• Tricare pays similarly to Tricare Standard in those overseas locations where Medicare is not available.

• You can apply to suspend your FEHBP coverage by calling the Office of Personnel Management’s Retirement Information line at 1-888-767-6738 to obtain a suspension form.

• Although the age for full Social Security retirement benefits has increased, the age for Medicare entitlement has not changed; it continues to be age 65.

TFL is available to all Medicare-eligible Tricare beneficiaries, regardless of age, including retired members of the National Guard and Reserve who are in receipt of retired pay, family members, widows and widowers and certain former spouses. Dependent parents and parents-in-law are not eligible for TFL. If you’re under age 65, have Medicare Part B, and live in a Tricare Prime service area, you have the option to enroll in Tricare Prime; Tricare waives your Tricare Prime enrollment fee. You should confirm that your Medicare status is current in the Defense Enrollment Eligibility Reporting System (DEERS). Your uniformed services ID card and your Medicare card, which must reflect enrollment in Medicare Part B, are evidence of your TFL eligibility. To learn more about how TFL works for you, you can enter your profile at http://www.tricare.mil/mybenefit/index.jsp and select “Tricare for Life” as your health plan. For help in determining which plan options are available to you refer to http://www.tricare.mil/mybenefit/ProfileFilter.do?puri=%2Fhome%2Foverview%2FPlanWizard.jsp? After answering a series of questions, it will tell you which plan options you may be eligible for. If you are not sure which plan you are in now, or if you want to compare your options side by side refer to http://www.tricare.mil/mybenefit/ProfileFilter.do?puri=%2Fhome%2Foverview%2FComparePlans. [Source: http://www.tricare.mil/mybenefit/ Jan 08 ++]

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Whether or not to treat prostate cancer is one of the biggest medical dilemmas today. The disease is the most common cancer in American men — about 220,000 cases will be diagnosed this year — but most tumors grow so slowly they never threaten lives. There is no sure way to tell which tumors will. Older men with early stage prostate cancer are not taking a big risk if they keep an eye on the disease instead of treating it right away, suggests the largest study to look at this issue since PSA tests became popular. Only 10% of the 9,000 men in the study who chose to delay or skip treatment had died of prostate cancer a decade later. The vast majority were alive without significantly worsening symptoms or had died of other causes. Even the 30% who eventually sought treatment were able to delay it for an average of 11 years. Chief medical officer of the American Cancer Society Dr. Otis Brawley said, “It is important news. It may persuade some middle-of-the-roaders that we are over treating this disease,” and that PSA testing may be amplifying the problem, he said. The PSA blood test to help detect tumors has been widely used since the 1990s.

PSA tests can help find tumors many years before they cause symptoms, but routine screening of men at average risk of the disease is not recommended, because there is no proof it saves lives. Prostate cancer treatments are tough, especially on older men. Many men are left with sexual or bladder control problems. Some doctors instead recommend “watchful waiting” to monitor signs of the disease and treat only if they worsen, but smaller studies have given conflicting views of the safety of that approach. The new study looked at the natural course of the disease in men who chose that option. It is the first involving so many older men — half were over 75 — and so many whose tumors were found through PSA tests. Using the federal government’s cancer database, researchers studied 9,018 men diagnosed from 1992-2002 with early-stage prostate cancer who did not get surgery, radiation or hormone therapy for at least six months. Most never got any treatment at all. A decade later, 3 to 7% of those with low- or moderate-grade tumors — rated by how aggressive the cells appear — had died of prostate cancer, versus 23% of those with high-grade tumors. Overall, prostate cancer kil