May is National Military Appreciation Month—a time to honor, appreciate, and remember military personnel and their families for their service to our country. It recognizes those on active duty, the National Guard and Reserves, retirees, veterans and all their families and survivors. Although the listing below is not all inclusive of state benefits available to veterans , it does indicate how many states show appreciation to the military in unique ways:

• Alabama. Operation Grateful Heart is a program to ensure all military personnel and their families receive appropriate recognition, tangible support, and neighborly care. It is focused on assisting those who are called upon to serve in the fight against terrorism and the defense of freedom, while they are serving on active duty and upon their return to communities in Alabama. http://www.governor.state.al.us/ogh/

• Alaska. Spouses and dependent children of a military member who is deceased or a POW/MIA may qualify for free tuition for the pursuit of an undergraduate degree at any state-supported educational institution within the state.

http://www.ak-prepared.com/vetaffairs/state_benefits.htm#Free%20Tuition

• Arizona. Military retirement payments and/or survivor benefits up to $2,500 per year are exempt from state taxes. http://myarmybenefits.us.army.mil/EN/Benefits/FactSheets/Regional/AZ/

• Arkansas. Veterans may camp for half price in Arkansas State Parks.

• California. Education benefits are offered to dependents of qualified veterans by waiving mandatory system-wide tuition and fees at any State of California Community College, California State University, or University of California campus. www.military.com/benefits/veteran-benefits/california-state-veterans-benefits

• Colorado. Museum of Science and Nature gives free Museum admission to all active and retired military and their spouses, parents, siblings and children (18 and under).

• Connecticut. Tuition waivers for veterans cover 100% of tuition for General Fund courses at all public colleges and universities and 50% for Extension Fund and summer courses at Connecticut State Universities.

http://myarmybenefits.us.army.mil/EN/Benefits/FactSheets/Regional/CT/

• Delaware. Military members, while stationed in the state, may obtain fishing, hunting, or trapping licenses at the resident rate, regardless of residency status.

http://myarmybenefits.us.army.mil/EN/Benefits/FactSheets/Regional/DE/

• Florida. Several counties have established Active Military Combat Duty Grant Programs. The grant programs, which include property tax grants and direct grants, are designed to assist service members who are fighting in the Global War on Terrorism.

• Georgia. Military personnel stationed in Georgia are allowed to obtain fishing and hunting licenses at the resident rate. www.georgiaoutdoors.com/fishing/freshnonresident.asp

• Hawaii. Most businesses, museums, tourist attractions and restaurants that offer a kama’ aina [discounted] rate to Hawaii residents extend the same privilege to military and their dependents.

• Idaho. Air Force Appreciation Day is celebrated every year, to encourage neighborly growth and express their gratitude for the economic benefits the Air Force brings to Southern Idaho. www.mountain-home.org/chamber/afad/index.htm

• Illinois. The Illinois Military Family Relief Fund (IMFRF) provides monetary grants to families of Illinois National Guard members and Illinois residents serving in the U.S. Armed Forces Reserves. www.operationhomefront.org/Benefits/benefits_fund.shtml

• Indiana. Members of the Indiana National Guard have 100% of their tuition paid when attending state colleges or universities for a first Associates or Bachelors degree.

http://myarmybenefits.us.army.mil/EN/Benefits/FactSheets/Regional/IN/

• Iowa. Certain National Guard members and retirees are eligible for property tax exemptions.

http://myarmybenefits.us.army.mil/EN/Benefits/FactSheets/Regional/IA/

• Kansas. The University of Kansas, in conjunction with the Army, has created the "Wounded Warrior Education Initiative" which allows wounded service members meeting the criteria to obtain a master’s degree. www.military.com/military-report/kansas-offers-wounded-warrior-education

• Kentucky. The Kentucky Military Family Assistance Trust Fund will provide up to $5,000 in a 12-month period for emergencies and hardships that are directly caused by deployment outside the United States. www.dma.ky.gov/Military+Family+Assistance+Trust+Fund.htm

• Louisiana. Members of the United States Armed Forces on active duty are given resident privileges for fishing and hunting licenses.

• Maine. The Maine Military Family Relief Fund provides emergency assistance to qualified military members and dependents.

• http://myarmybenefits.us.army.mil/EN/Benefits/FactSheets/Regional/ME/

• Maryland. Its “Salute to the Services” offers discounts to those who serve our country. Service members are invited to visit Ocean City, Maryland from May 17th to June 18th, 2008. Everything from lodging and dining and other activities are discounted as a way to say "Thank You" to those serving their country. Maryland also exempts the first $5,000 of military retired pay from MD State and local income taxes. www.salutetotheservices.com/index.php

• Massachusetts. Citizens of Massachusetts who are members of the National Guard (or any Reserve component) are eligible to receive monetary donations from The Friends of National Guard and Reserve Families Foundation to help ease financial hardship due to activation or extended military commitment. http://www.mangfriends.org/index.html. Military retired pay is not taxed. http://myarmybenefits.us.army.mil/EN/Benefits/FactSheets/Regional/MA/

• Michigan. Fishing licenses are available for $1 for service members stationed outside the state who have maintained residence status.

• Minnesota. Citizens show their support and thanks to the military community by proudly sponsoring the Minnesotan’s Military Appreciation Fund, a state-wide fundraising initiative, which offers grants to military families, and sponsors Military Family Days at MN Twins and MN Timberwolves games. www.thankmntroops.org/index.html

• Mississippi. Military personnel stationed in Mississippi are classified as state residents for the purposes of payment of tuition at state colleges and universities.

• Missouri. The Kansas City Royals baseball team provides complimentary admission for all active and retired military personnel and their families to any Monday home game.

• Montana. To show appreciation for the unparalleled sacrifices members of the military make, Montana offers “challenge coins” through the Montana Military Appreciation Project. These coins are presented to Montana residents who are members of any of the branches of the Services who have served overseas in the war against terrorism, and family members of service men who are killed. http://www.mtmap.org/

• Nebraska. The University of Nebraska extends in-state residency status to active duty military personnel and their dependents whose permanent duty station or Home of Record is in Nebraska. www.admissions.unl.edu/residency

• Nevada. Active duty service members and their families are exempt from university fees while permanently stationed on a military facility within Nevada.

http://myarmybenefits.us.army.mil/EN/Benefits/FactSheets/Regional/NV/

• New Jersey. An individual who is active duty military is allowed to hunt with a resident license, regardless of residency status.

• New Mexico. Children between the ages of 16-26 whose veteran parent was killed in action or died as a result of their wounds incurred in battle, qualify for a full-tuition waiver at any state funded post-secondary school. www.dvs.state.nm.us/benefits.html

• New Hampshire. Any resident who is a member of the U.S. Armed Forces is allowed to renew a driver’s license without a fee.

• New York. Military retired pay is not subject to state income tax.

http://myarmybenefits.us.army.mil/EN/Benefits/FactSheets/Regional/NY/

• North Carolina. To thank all military personnel, North Carolina is hosting MAD III (Military Appreciation Day) on June 7, 2008. http://www.militaryappreciationday.org/

• North Dakota. A dependent of a resident veteran, who was killed in action, is allowed to obtain a Bachelors degree or certificate of completion, free of any tuition and fee charges. www.military.com/benefits/veteran-benefits/north-dakota-state-veterans-benefits

• Ohio. Military retired pay received after Dec. 31, 2007, is exempt from state income taxes.

• Oklahoma. Oklahoma’s Tuition Aid Grant (OTAG) may cover up to 50 percent of tuition costs depending upon eligibility. http://myarmybenefits.us.army.mil/EN/Benefits/FactSheets/Regional/OK/

• Oregon. National Guard service members are exempt from jury duty.

http://myarmybenefits.us.army.mil/EN/Benefits/FactSheets/Regional/OR/

• Pennsylvania. The Military Family Relief Assistance Program (MFRAP) provides financial assistance, in the forms of grants, to eligible Pennsylvania service members and their families.

http://myarmybenefits.us.army.mil/EN/Benefits/FactSheets/Regional/PA/

• Rhode Island. The National Guard State Tuition Exemption Program provides one free course per semester at the Community College of Rhode Island, University of Rhode Island, or the Rhode Island College. http://myarmybenefits.us.army.mil/EN/Benefits/FactSheets/Regional/RI/

• South Carolina. The Friends of Our Forces program works diligently to encourage a healthy and strong relationship between the armed forces and the business community, encouraging ALL businesses to offer discounts to military personnel and their families. www.columbiachamber.com/programsservices.htm

• South Dakota. Military personnel stationed in South Dakota are eligible to obtain fishing and hunting licenses at the resident rate.

• Tennessee. Military personnel stationed in Tennessee may obtain fishing and hunting licenses at the resident rate.

• Texas. Military retired pay is exempt from state income taxes.

http://myarmybenefits.us.army.mil/EN/Benefits/FactSheets/Regional/TX/

• Utah. Residents who are members of the U.S. Armed Services and are stationed out of state may obtain certain property tax and vehicle exemptions. www.dmv.utah.gov/registernonresidents.html

• Vermont. Service members and veterans are offered special discounts including, property tax exemptions, state employment preferences, education and tuition assistance, vehicle tags, and hunting and fishing license privileges. http://myarmybenefits.us.army.mil/EN/Benefits/FactSheets/Regional/VT/

• Virginia. The Military Survivors and Dependents Program (MSDEP) provides education benefits to spouses and children of service members killed, missing in action, taken prisoner, or who became at least 90 percent disabled as a result of military service in an armed conflict. www.military.com/benefits/veteran-benefits/virginia-state-veterans-benefits

• Washington. Qualified veterans are offered reduced fees and/or free passes to State parks and recreation facilities.

• West Virginia. A fishing license is not required for residents on active duty in the U.S. Armed Forces while on military leave. www.wvdnr.gov/fishing/license.shtm

• Wisconsin. The State GI Bill provides a waiver (“remission”) of tuition and fees for eligible veterans and their dependents for up to 8 full-time semesters or 128 credits at any institution in the University of Wisconsin System (UWS), http://www.wisconsin.edu/, or Wisconsin Technical College System (WTCS), http://www.witechcolleges.com/.

• Wyoming. Free tuition and fees for education are offered to the spouse and children of deceased veterans (whose death is service connected). www.military.com/benefits/veteran-benefits/wyoming-state-veterans-benefits

[Source: NMFA Newsletter May 08 ++]

Budgetary rules forced a House subcommittee to take the unprecedented step of creating a new Tricare preventive health care program that does not apply to 1.5 million Medicare-eligible retirees and their families in the Tricare for Life (TFL) program. Rep. Susan Davis (D-CA), chairwoman of the House Armed Services military personnel panel, said the plan, approved 7 APR as part of the 2009 defense authorization bill, is aimed at cutting the military’s long-term health care costs by providing preventive care. The personnel portion of the defense policy bill, approved by voice vote and with no debate, includes:

• A 3.9 percent military pay raise.

• Increases in Army and Marine Corps active-duty personnel and in Army National Guard and Army Reserve support personnel on full-time active duty.

• A tuition assistance program for military spouses.

• Permission for a Pentagon-proposed experiment under which active-duty members could take a break of up to three years in their military career.

Davis said her subcommittee rejected a Pentagon request for a $1.2 billion increase in Tricare health and pharmacy fees but wants to look for other ways to hold down costs, which is why expanding preventive care is attractive. She called the initiative “preferable” to the Pentagon’s proposed increase in Tricare fees. The preventive care plan would waive co-payments for certain treatments such as vaccinations, smoking cessation help, and breast and colorectal cancer screening. It would apply to Tricare Standard, Tricare Select and Tricare Reserve beneficiaries — but, because of budgetary procedures, not TFL. Aides named two areas in which TFL beneficiaries would be treated differently than other Tricare users: shingle vaccinations and MRIs for mammograms. Younger retirees would receive these services for free, but TFL users would have to pay, either directly or by buying supplemental Medicare insurance, aides said. Rep. John McHugh of New York, the subcommittee’ s ranking Republican, said this would be the first instance of differences in what is covered under Tricare, and also promised to work to try to find funding to offset that action.

There are two kinds of spending in the defense budget: discretionary, which applies to personnel, operating and acquisitions costs and construction programs; and mandatory, also known as direct spending, for programs such as retired pay, GI Bill benefits for reservists, and some health care expenses, including TFL. Davis said only congressional leaders can resolve the funding problem because direct spending involves programs such as Social Security, Medicare, Medicaid and federal civilian retired pay that fall outside the jurisdiction of the armed services committee. Congressional leaders could agree to an offset by cutting other direct spending or could find another way to fund preventive care, subcommittee aides said. Steve Strobridge, government relations director for the Military Officers Association of America, said he understands the dilemma facing the subcommittee and agrees that what they did “is certainly preferable to not doing anything.” “We have been very supportive of preventive care programs,” he said. “It only makes common sense that if you come up with programs like smoking cessation that it is going to save money in the long run.” [Source: NavyTimes Rick Maze article Posted 7 May 08 ++]

The Department of Veterans Affairs seemed to be standing in front of a fast-moving train 7 MAY when a top official said VA would need two years of preparation to come up with a payment system for a proposed overhaul of GI Bill education benefits. The warning flags were waved by Keith Pedigo, VA’s associate deputy undersecretary for policy and program management, who said meeting an 1 AUG 09, effective date for the benefits increases, under what lawmakers are calling the 21st Century GI Bill of Rights (S.22), would be extremely difficult. Because the proposal calls for the maximum benefit to be different in each state, payments would have to be manually, rather than automatically, processed, Pedigo said. “VA does not now have a payment system or the appropriate number of trained personnel to administer the program,” Pedigo said, predicting it would take two years to develop a payment system to provide the new benefits. Those benefits include paying the full cost of tuition and fees for the most expensive four-year public college or university in each state, plus a monthly living expense, an annual payment for books and other expenses, as well as up to $1,200 for tutorial assistance. Pedigo, testifying before the Senate Veterans’ Affairs Committee, also warned about the potential for large overpayments because the bill calls for lump-sum tuition payments directly to a school at the start of a quarter or semester, without specifying what would happen if a student drops out. Pedigo also warned of fundamental unfairness in a proposed housing allowance that would be based on where a school is located, rather than where a student lives, which could encourage veterans to enroll in online learning programs offered by schools in high-cost areas.

His warnings come as the House and Senate are poised to attach S.22 to a wartime supplemental funding bill in an effort to overcome questions about how to pay for the benefits and the administrative costs. Attaching S.22 to the wartime funding bill also would put pressure on the Bush administration to sign onto a generous overhaul of veterans benefits in order to secure funding to continue military operations in Iraq and Afghanistan. Congressional leaders derive an additional benefit from attaching the GI Bill increases to the supplemental — it would attract more votes for the measure at a time when many lawmakers are reluctant to continue funding Iraq operations. The Pentagon, VA and the White House’s Office of Management and Budget oppose S.22, either as a separate bill or combined with the supplemental. But Bush administration opposition — and VA’s warning about implementation problems — do not seem to counter the growing push from veterans’ groups to pass what Sen. Jim Webb (D-VA), S.22’s chief sponsor, calls a move to “give first-class futures to the people who serve.”

The Congressional Budget Office (CBO), the nonpartisan analytical arm of Congress, said in a report 8 MAY that enactment of S.22 could lead to a 16% drop in re-enlistments. The Defense Department could counter that drop only by increasing re-enlistment bonuses. Fully offsetting the draw of a better veterans’ education program would require a $25,000 re-enlistment bonus for every first-term service member, something that would cost the Pentagon about $6.7 billion over five years. However, that cost would be offset by lower recruiting costs, the report predicts. It estimates there would be a 16 percent boost in recruits, which would allow a cut in enlistment bonuses and in other recruiting expenses that would result in $5.6 billion in savings over five years. The combination of better recruiting but weaker re-enlistments would leave the military with a $1.1 billion cost over five years to maintain the current force, the report said. Overall, CBO’s cost estimate is slightly lower than the estimated price tag issued by the Bush administration. Congressional budget analysts predict S.22 would have an overall cost of $680 million in the first full year and $51.8 billion over 10 years. VA officials told the Senate Veterans’ Affairs Committee on Wednesday that the proposal would cost $64.9 billion over 10 years. Currently, 75% of Army, 70% of Marine, 50% of Navy and 49% of Air Force enlistees who complete their first enlistment term get out of the military,

The House of Representatives could pass a war supplemental soon that includes Webb’s GI Bill proposal, and the Senate plans to take up the bill when they do. In the Senate, Republicans are expected to offer their alternative bill, the Enhancement of Recruitment, Retention and Readjustment through Education Act (S.2983), that pays a little less to veterans and includes a Pentagon-requested provision that would allow career service members to transfer all or part of their benefits to family members, but they do not appear to have the votes to block S.22, which has 57 Senate co-sponsors, including 10 Republicans. Veterans’ groups, who have been pushing for years for an overhaul of the current Montgomery GI Bill, have picked Webb’s bill as their favorite. Carl Blake, national legislative director for Paralyzed Veterans of America, told the Senate committee that S.22 is better because it “accomplishes our goal of returning the GI Bill to the level established following World War II.” Blake also objected to Pentagon criticism that better GI Bill benefits, designed to encourage people to go to college, are bad for the nation. [Source: AirForceTimes Rick Maze articles posted 8 & 9 May 08 ++]

AGENT ORANGE LAWSUITS UPDATE 12: On 8 MAY the U.S. Court of Appeals for the Federal Circuit unfortunately reversed the decision of the U.S. Court of Appeals for Veterans Claims in Haas v. Peake. The U.S. Court of Appeals for Veterans Claims had previously found that Vietnam War blue water veterans who had served on ships off the coast of Vietnam but had never set foot within the land borders of Vietnam were entitled to a presumption of service connection disability if they suffer from one of the listed diseases associated with Agent Orange exposure. Also, they had ruled that the VA’s regulatory interpretation that the veteran needed to have “set foot within the land borders of Vietnam” was unduly restrictive. The higher Court of Appeals for the Federal Circuit reversed and ruled: “We hold that the agency’s requirement that a claimant have been present within the land borders of Vietnam at some point in the course of his duty constitutes a permissible interpretation of the statute and its implementing regulation, and we therefore reverse the judgment of the Veterans Court.” This was a 2-1 decision with a thoughtful dissent by Judge Fogel so the Claimant may attempt to appeal to the U.S. Supreme Court which Commandeer Haas has said he will do. You can find the full 57 page decision in the list of decisions at http://www.cafc.uscourts.gov/dailylog.html

Most likely VA will now move quickly to resolve (decide) claims that have been placed on hold awaiting this decision. These claims will almost certainly be denied unless they can show that their ship operated within the inland waterways of Vietnam or entered port in Vietnam. While ships logs do not routinely show crewmembers leaving their ship, they will show whether the ship entered an inland waterway (e.g. the Saigon River) or put into port. VA will generally concede the issue if service records show a veteran was attached to a ship during the period that the ship put into port in Vietnam. The negative decision in the Haas case does not relieve VA from the responsibility of making a legally correct decision that discusses all pertinent evidence and the reasons and bases for the decision. The VA in their written decision should specifically address the evidence of service in or visitation to Vietnam. They must discuss ships ‘ movements either shown by ships’ history or logs. If the veteran has admitted never setting foot in Vietnam, VA must also discuss whether evidence shows that the ship operated in the inland waterways of Vietnam.

The Haas decision does not apply if a claimant has alleged exposure to herbicides on a direct basis, such as loading drums of defoliant on board helicopters or decontaminating aircraft or helicopters, VA must discuss such allegations and resolve them. Claimants who are denied have several legal moves available to them. They can ask the Court of Appeals to review the case using all the judges on the Court. While the Court may decide to conduct an en banc review it doe not have to. Failing that, they could appeal to the Supreme Court. During any given year the Supreme Court takes up only about 1 in 20 cases to decide. Success at the Supreme Court is a long shot. [Source: TREA Washington Update & NVS Update 9 May 08 ++]

On 7 MAY, the Senate Veterans’ Affairs Committee met to receive testimony on 28 separate veterans’ bills. One area of testimony of great interest to many veterans was enactment of the "Belated Thank You to the Merchant Mariners of World War II Act (S.961/H.R.23). The VA does not support S. 961 as they believe it would create a "service pension for a particular class of individual based on no eligibility requirement other than a valid certificate of qualifying service from the Secretary of Transportation or Secretary of Defense. Further, this bill would authorize the payment of a greater benefit to a Merchant Mariner…than a veteran currently receives for a service connected disability rated as 60% disabled. The second panel of veterans service organizations, for the most part did not object to S. 961, except for the costs involved and that it might take money from other programs. The final panel of former Merchant Mariners H. Gerald Starnes and Charles Dana Gibson was enlightening in expanding on some of the experiences and exploits of the men who transported all the necessary supplies to fight WW II on two fronts. The most surprising testimony was from Mr. Gibson, who as an historical writer had done extensive research on the Merchant Marine and Army Transport Service during the war. He dispelled one of the myths that the Merchant Marine had gone on strike during the war. In fact they had signed an agreement to not strike while hostilities continued and they didn’t. To read the complete testimonies of all the participants refer to http://www.senate.gov/~veterans/public/index.cfm?pageid=12&release_id=11685 [Source: NAUS Weekly Update 9 May 08 ++]

Everyone in Congress wants to stop a 10.6% cut in Medicare and TRICARE payments to doctors scheduled to take place on July 1. Medicare administrators don’t want the cut to happen either, but they’re worried about how to administer the program if Congress waits until the end of June — or worse yet, until sometime in July or later — to change the law. In early MAY Medicare officials told Congress that the law needs to be changed by 16 JUN in order to allow Medicare computers to be reprogrammed by 1 JUL. If they don’t get updated guidance by that date, Medicare will have to implement the cut on 1 JUL and undo all the erroneous payments later if and when Congress changes the law. The same thing happened a couple of years ago, when Congress had to make a retroactive payment fix. But it’s a nightmare for Medicare (and TRICARE) administrators, and even more so for the doctors who have to suffer the income and book-keeping consequences. Veteran organizations worry that such frustration may cause some doctors to stop seeing elderly and military beneficiaries. The American Medical Association released a survey of nearly 9,000 doctors showing that if the payment cut went into effect:

• 60% of doctors would limit the number of new Medicare patients they accept;

• More than two-thirds would defer the purchase of needed information technology in 2008;

• 50% would reduce their staff; and

• 14% would stop treating patients entirely.

Congressional leaders would love nothing better than to meet the 16 JUN deadline, but they’re struggling to find ways to pay for the $15-$18 billion cost of the fix that a majority of legislators are willing to accept. Like it or not, that’s turned into a political football, with Republicans and Democrats preferring different options. And many on the Hill seem in no mood to compromise in this election year. MOAA said, it’s unacceptable to hold TRICARE and Medicare-eligibles’ access to care hostage to these kinds of political considerations. Congressional leaders need to work out a compromise — and fast — to stop that from happening. Veterans can help by visiting the MOAA or USDR websites http://capwiz.com/moaa/issues/alert/?alertid=10534466 & http://capwiz.com/usdr/issues/alert/?alertid=11354701&queueid=[capwiz:queue_id] to send a suggested message to urge their legislators to act fast. [Source: MOAA Legislative Update 11 May 08 ++]

Suicides by veterans of wars in Iraq and Afghanistan could well top the combat deaths in the two conflicts, according to the top official of National Institute of Mental Health. On 5 MAY, Dr. Thomas Insel, director of the National Institute of Mental Health, told reporters at an annual meeting of the American Psychiatric Association in Washington that it was possible that "suicides and psychiatric mortality…could trump combat deaths." Insel said he based this assessment in part on figures from a recent Rand Corp. study as well as suicide rates for patients who have substance abuse problems and other complications of post-traumatic stress disorder (PTSD) as a result of combat. Insel’s comments were put in context on 6 MAY during a House Veterans Affairs Committee hearing, when Dr. James Peake, secretary of VA, said that the number of suicide attempts by all veterans under treatment by the department could exceed an earlier official estimate of 1,000 a month. The Defense Department estimates that slightly more than 4,500 troops have been killed in combat in Afghanistan and Iraq. The RAND study determined that up to 300,000 returning U.S. troops from those wars suffer from PTSD. The same study concluded that 320,000 troops returning from Afghanistan and Iraq have suffered traumatic brain injury (TBI), with only half of those veterans seeking treatment.

During the hearing, Peake told lawmakers that the number of suicide attempts could be more than 1,000 a month because of "underreporting" within the VA. Dr. Ira Katz, deputy chief patient care services officer for mental health at the Veterans Health Administration, testified that his earlier estimate of 1,000 suicide attempts per was based on only three months of data from the department’s mental health co-coordinators. Laurie Tranter, a VA spokeswoman, told Government Executive that the data Katz based his earlier estimate on was derived from a suicide tracking system and suicide prevention program. She said both are at various stages of deployment throughout the Veterans Health Administration. Rep. Bob Filner (D-CA), chairman of the House Veterans Affairs Committee accused Peake of "criminal negligence" in trying to cover up the number of suicide attempts by veterans. He said the VA’s actions fit a pattern of trying to cover up or deny serious medical problems suffered by veterans from the Korean, Vietnam and Gulf Wars. Peake said that all veterans from Afghanistan and Iraq receive a mental health screening by a general practitioner. Filner said he wants VA and Defense to provide a mandatory, one-hour mental health check-up conducted by a psychiatrist for all combat veterans.

Secretary Peake told the Committee that no single agency has accurate statistics on veteran suicides, but he is implementing ways to improve data collection and reduce suicide rates, including hiring suicide coordinators in VA facilities, establishing a suicide prevention call center, and pushing outreach and prevention efforts for veterans and their families. Peake assured the committee that his agency would be more forthcoming with information in the future and would work toward more transparency in the VA system. A Government Accountability Office offered additional recommendations, including:

• Ensuring timelier referral to care.

• Developing a comprehensive substance abuse program.

• Enhancing access to mental health care.

• Coordinating efforts between VA and non-VA health care providers.

• Fostering increased communication with veterans and their families

[Source: GOV.EXEC.com BoB Brewin article 6 May 08 ++]

Every year, the federal government tweaks the elaborate system that determines the amount doctors get paid for care and procedures, known as “reimbursement rates”. Those changes, in turn, translate into changes in cost shares, or co-pays, for Tricare beneficiaries. Payment for inpatient hospital stays in specified locations outside the 50 United States and the District of Columbia, are made utilizing the lesser of (a) billed charges or (b) the prospectively determined per diems adjusted by a country specific index (CSI). The per diem rates are developed into reimbursement groupings by utilizing diagnosis codes as contained in the International Classification of Diseases, 9th Revision, and Clinical Modification (ICD-9-CM). The per diem rates are the maximum allowable amounts that Tricare shall reimburse and the amount on which patient cost-shares are calculated. The National U.S. per diem rate is multiplied by a unique CSI factor which adjusts the National U.S. per diems for the applicable country. The country specific hospital per diem, for those specified locations outside the 50 United States and the District of Columbia is the product of the National U.S. per diem and the CSI. This payment system applies to all hospitals providing hospital inpatient services and professional provider reimbursements in the Philippines, Panama, and other overseas areas as designated by the Government.

The CSI is a factor obtained from the World Bank’s International Comparison Program. The index factor is based on a large array of goods and services or market basket within the specific country which is then standardized and weighted to a U.S. standard and currency. The use of the CSI enables a conversion and therefore creates parity between the U.S. and the specific country in the purchasing of the same amount and type of medical services. Tricare is utilizing a two year phase in approach for the implementation of the World Bank’s International Comparison Program CSI. Per change 77 dated 7 APR 08 to the Tricare Reimbursement Manuel for the Philippines and Panama, the first year of the CSI phase in has been set at 0.52 and 0.70 through 28 FEB 08. The second year of the CSI phase in has been set at 0.229 for the Philippines and 0.60 for Panama effective 1 MAR 09. However, their is a requirement that all providers that submit bills to Tricare and are effected by the changes must be given at least 100 days notice so it is likely that the changes will not take effect until AUG 08 and AUG 09 respectively. The change equates to a 27.1point index reduction (52%) for the Philippines and a 10 point index reduction (15%) for Panama assuming nothing is done to reverse these reductions. For additional info refer to http://manuals.tricare.osd.mil. [Source: Tricare Reimbursement Manual 6010.55-M w/Change 77 Chap 1 Sect 34 & 35dtd 7 Apr 08 ++]