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Tricare Philippines Newsletter 20120402

Posted by Service Officer on 1st April 2012

U.S. Military Retirees of the Philippines Group

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Tricare Philippines Newsletter 20120402

Background of TRICARE in the Philippines and the policies implemented under the guise of fraud prevention


As military retirees living in the Philippines know their TRICARE plan is inherently different from any other plan offered by the TRICARE Management Activity (TMA).  TMA generally refuses to discuss these differences with affected retirees while claiming the policies are necessary to preclude fraud. The truth is TMA is responsible for much of the fraud through their past neglect, lack of action and because of some policies that promote fraud and poor controls over their contractor.
Why did TMA feel these policies were necessary in the Philippines?
The TRICARE Overseas Program (TOP) became reality in 1996 which extended benefits to eligible beneficiaries overseas. TMA was ill prepared to initiate, manage and monitor this program as the DODIG indicated in multiple investigations. In the U.S. fraud prevention for government sponsored medical programs like TRICARE is accomplished by other agencies so TMA had no background or experience with dealing with fraud and resisted involvement, claiming it wasn’t their responsibility. This standoff allowed the fraud to continue unabated for ten years. The second largest overseas population of beneficiaries was in the Philippines. It was also distinguished in that TMA had no local representation to monitor the program or educate beneficiaries unlike in places like Germany where every military hospital had multiple Health Benefits Advisors who assisted with obtaining care on the local economy and filing claims. So beneficiaries in the country with the second largest overseas population were left to their own devices and to fend for themselves. This combination made the Philippines ripe for fraud and should have come as no surprise to TMA.
Defense Criminal Investigators tell me that about 10% of providers in the states are involved in fraud and the same percentage was valid in the Philippines, based on their 12 years of working with fraud here. So it was not surprising when fraud got a foothold in the Philippines TRICARE program. Even then it wasn’t Filipinos but an American that developed the first major fraud through Health Visions Corp. (HVC). Within the first year of operation retirees reported that they suspected fraud and continued to report fraud for ten years. Yet TMA did little or nothing to stop the fraud and even ignored DODIG recommendations to use administrative controls that would have put a stop to the fraud early on. Instead they allowed the fraud and bleeding to continue for ten years and then tried to place the blame on retirees for using these services. See page 17, Audit Response, of the DODIG report 06-051. TMA continued to ignore the remedies they had at hand and continued to ignore the DODIG calls for administrative action in favor of more draconian measures. See DODIG report 08-045
In November 2006 TMA started to implement measures which would have far reaching affects on beneficiaries.
What are these policies that were unique to the Philippines?
1.      Stop Paying Health Visions Corporation (HVC)
2.      Legislative Changes to Sanction Beneficiaries
3.      Review Supplemental Insurance Plans for validity
4.      Cap Coverage and Adequacy
5.      Eliminate Third Party Billing
6.      Increase Medical Reviews on Claims
7.      Develop a Provider Network
Stop Paying Health Visions Corporation (HVC): TMA stopped paying HVC in November 2006 but also secretly stopped paying claims from beneficiaries without notifying them by ceasing payment of claims involving about 95% of all hospitals within the Philippines. This process appears to have been applied deliberately to harm the very people they were charged with providing health care. Most of the hospitals that were on the denial list did not benefit from the HVC fraud and their investigations had to have shown that.
Finally, about six months later, beneficiaries were notified of the freeze on payments via a notice on the internet. An uproar resulted and they dropped all but six facilities owned by HVC from the freeze. I suspect they realized they were on shaky ground. Their 2006 Report on Fraud conveniently ignores that they did this but thousands of beneficiary filed claims were not paid for more than six months. This was followed by threatening letters to a significant number of the original hospitals, many of which were not involved in the fraud. While TMA later backed off from these threats, they never apologized to those falsely accused and it set the tone for how hospitals and physicians feel about TRICARE in the Philippines from that point forward.
Legislative Changes to Sanction Beneficiaries: They went to congress and asked that they be given administrative authority to unilaterally suspend benefits, for up to ten years, of any retiree they felt was a party to fraud or hadn’t paid their co-pays. There was no appeal process and no due process. Congress did not approve this back in 2007 but that hasn’t stopped them from continuing to ask congress for this power to this day.
Review Supplemental Insurance Plans for validity:  The initial outcome of this policy was TMA notifying their claims contractor to deny all Philippine claims where the beneficiary indicated they had OHI on the claim form but failed to provide an EOB; most often due to the family having Philhealth. The new policy required that the beneficiary include an EOB from Philhealth before the claim would be considered. Since Philhealth doesn’t provide a standard EOB recognized by TMA, these claims were simply denied. Our group worked with TMA and after about six months we got them to recognize a local form we created and they modified that, when submitted with claims from the Philippines, would be recognized in lieu of an EOB from Philhealth. However TMA doesn’t seem inclined to advertise this or make it easy to find. A copy is available from us, OHI Checklist.
Cap Coverage and Adequacy: This is better known as the CMAC or CHAMPUS Maximum Allowable Charge table and one of the major causes for limited access to care and claims denial and to a large extent because TMA had little idea of how to do it. Nor were they too concerned with the consequences to beneficiaries or providers; it was just one of their rapidly put together methods to stop fraud to pacify the DODIG and congress. TRICARE CMACs in the U.S. are a derivative of Medicare CMACs so this was their first attempt at developing one from scratch and they wanted to make it fast and simple. Their approach was to tag onto a report from the World Bank, International Comparison Program (ICP), and from that extract what is called Purchasing Power Parity (PPP) rates for the Philippines. In a nutshell the medical PPP rate is an average across all levels of care in a country, public and private, and reported as a percentage of U.S. cost based on the current exchange rates at the time the data was gathered. It’s well documented that these rates are not appropriate to use as TMA intend to use them but it met the fast and simple criteria. History now clearly demonstrates that retirees are required to shoulder an increasing share of legitimate health care costs because the allowable charges computed with this system are generally lower than local normal and reasonable costs charged to local citizens.
Using this rate they proposed to take the average CMAC rate in the U.S., there are hundreds of rates designed for every state by urban and rural areas to account for regional differences, to create one set of rates for the entire Philippines. The percentage they proposed was 22.9% of that in the U.S. which the PPP rate suggested. Our group fought these rates as to low because the percentage included an average that included government hospitals, where as TRICARE beneficiaries would be using private facilities and physicians which were at the higher end of medical care costs. We were successful in getting them changed to 52% for outpatient and inpatient care and raised to 100% of the Puerto Rico rates for ancillaries including laboratory and radiology. However even this did not truly address the actual local costs and rate setting and didn’t solve many of the problems with the CMAC. What these are and how to overcome some of them will be discussed in later newsletters.
Eliminate Third Party Billing: The plan was to remove the ability of someone, other than the actual provider, from submitting claims for the provider in the name of the billing activity. This is one of the tactics HVC used. They would use a local provider to see a beneficiary, pay them the local rate, and then bill TRICARE 3 to 5 times the local rate in their name. Their plan failed primarily because their contractor failed to enforce this policy and in, at least the past, extracted payments from these groups to certify them even though they did not meet requirements.[i]
Increase Medical Reviews on Claims: The purpose of this policy was to place some providers and beneficiaries under increased scrutiny if they were suspected of fraud. However the rules or criteria are not published but we know, based on recent written comments by TMA, that they claim 64% of all Philippine providers are under prepayment review and 77% of all beneficiaries. They further claim 90% of all their fraud resources are dedicated to checking these claims. To put this into prospective, a family of four would have three beneficiaries suspected of being involved in fraud. If this same family of four sees a total of four providers then two to three of them are suspected of being involved in fraud as well. Obviously these figures are questionable but further TMA’s case to congress to approve their ability to unilaterally impose beneficiary sanctions and maybe the reason they claim they are so high.
From a beneficiaries’ prospective this means that a growing number of providers refuse to accept TRICARE and process claims; many are now even refusing to be certified as shown by the recent wholesale refusal to be certified by two national pharmacy chains; not the comment on the bottom of the Certified Provider web page. WebPage Beneficiaries on prepayment review find that their claims take longer to process and every minute detail is questioned including the double proof of payment requirement being triggered at a much lower dollar threshold. In the case of beneficiaries on prepayment review many items that would normally be approved without question are kicked back for further proof of care or denied.
Develop a Provider Network: According to an article by Mr. Daniel M. Boucek, Special Agent in Charge, Defense Criminal Investigative Service, DoD all the members of a workgroup accept TMA agreed that the best and most effective approach to reducing fraud while maintaining a high level of access to care was a locally contracted network such as a local PPO and even recommended at least one such group[ii]. The article goes on to indicate that TMA tends to resist changes and in particular changes they did not bring to the table. So instead of taking this approach which would have greatly increased access to care, eliminated the need for beneficiaries to pay for care up front and eliminate most of the fraud they opted, as indicated in the article, to implement the more draconian measures they came up with and addressed above; most of which have proven to be ineffective in stopping fraud but instrumental in greatly reducing access to care and reducing reimbursement of claims to almost nothing. The full article describing the workgroup, the issues involved and the recommendations can be seen by going to Boucek Article.
Recently TMA started looking into a modified local provider network, they call it their “Closed Network”, but instead of leveraging a local group as recommended by every other member of the group they are trying to design one with the look and feel of a Prime network in the U.S. and based on U.S. standards including detailed coding and costing of claims all of which is completely foreign to the local medical community. A later newsletter will address what we know of this proposed program and the issues we see coming from it.
What next?
In future newsletters we will address in more detail the consequences of these policies that negatively impact on access to care and reimbursement for care. We will explain how they work in practice, how and why they cause reduced access and increased claims denial. We will provide work-a-rounds and other steps beneficiaries can take to alleviate or minimize the adverse affects these policies have on their ability to obtain and be reimbursed for care.
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[i] The implementation of the Certified Provider requirement occurred as an administrative action shortly after HVC can into existence and has been a contributor to fraud in the Philippines since. When TMA added the Philippine unique requirement that claims would be paid for care provided by certified providers, the stated purpose was to insure that only care provided by licensed and properly trained providers would be considered. In reality the contractor and or its staff used this process to their own advantage. We have proof that the contractor used to extract payment to certify providers who were not eligible for certification in exchange for a fee. (We reported this and other fraud for years but no action was taken. But recently TMA posted on the TRICARE Pacific webpage a notice declaring their contractor does not charge fees for certification and asks to be notified if it happens. While this seems to be an admission of past fraud there is still no apparent action against the contractor.) WebPage But even today we know of admin offices certified as Physician Groups and local providers certified as working at these groups so the local group can still pay the provider for care provided in their office and bill TRICARE at well over the local rates. Even as late as 2010, we were aware that some physicians that the contractor certified as a hospital were still billing as a hospital and being paid although it was reported to TMA by us in 2007. This may be still going on. A review of the 2009 claims data also points to the TMA contractor over charging for Prime care that they paid for and then processed claims for reimbursement; similar to what HVC did. These and other acts on the part of the contractor have a continued detrimental effect on our access to care and claims payment because TMA wrongly points to beneficiaries and local providers as the responsible parties for this fraud.

[ii] TMA’s continued reluctance to take any action to address the HVC fraud prompted the formation of this group made up of the Defense Criminal Investigative Service (DCIS), the investigative arm of the Department of Defense (DoD) Office of Inspector General (OIG), along with the United States Attorney’s Office in Madison, Wisconsin and TMA. It appears TMA brought the draconian measures to the table while the rest brought one recommendation which was a contract with a local, in country, contractor to provide the care such as a PPO or HMO, which has yet to be considered by TMA.

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U.S. Military Presence in Philippines January 27, 2012

Posted by Service Officer on 27th January 2012

Talks Ongoing

U.S. Military Presence in Philippines: Two decades after evicting U.S. forces from their biggest base in the Pacific, the Philippines is in talks with the Obama administration about expanding the American military presence in the island nation, the latest in a series of strategic moves aimed at China. Although negotiations are in the early stages, officials from both governments said they are favorably inclined toward a deal. They are scheduled to intensify the discussions in late JAN in Washington before higher-level meetings in March. If an arrangement is reached, it would follow other recent agreements to base thousands of U.S. Marines in northern Australia and to station Navy warships in Singapore. Among the options under consideration are operating Navy ships from the Philippines, deploying troops on a rotational basis and staging more frequent joint exercises. Under each scenario, U.S. forces would effectively be guests at existing foreign bases.

The sudden rush by many in the Asia-Pacific region to embrace Washington is a direct reaction to China’s rise as a military power and its assertiveness in staking claims to disputed territories, such as the energy-rich South China Sea. “We can point to other countries: Australia, Japan, Singapore,” said a senior Philippine official involved in the talks, speaking on the condition of anonymity because of the confidentiality of the deliberations. “We’re not the only one doing this, and for good reason. We all want to see a peaceful and stable region. Nobody wants to have to face China or confront China.” The strategic talks with the Philippines are in addition to feelers that the Obama administration has put out to other Southeast Asian countries, including Vietnam and Thailand, about possibly bolstering military partnerships. The United States already has about 600 Special Operations troops in the Philippines, where they advise local forces in their fight with rebels sympathetic to al-Qaeda. But the talks underway between Manila and Washington potentially involve a much more extensive partnership. Officials in the Philippines — which has 7,107 islands — said their priority is to strengthen maritime defenses, especially near the South China Sea. They indicated a willingness to host American ships and surveillance aircraft.

Although the U.S. military has tens of thousands of troops stationed at long-standing bases in Japan, South Korea and Guam, as well as the island of Diego Garcia in the Indian Ocean, it is seeking to solidify its presence in Southeast Asia. Some of the world’s busiest trade routes pass through the South China Sea and the nearby Strait of Malacca. Instead of trying to establish giant bases reminiscent of the Cold War, however, Pentagon officials said they want to maintain a light footprint. “We have no desire nor any interest in creating a U.S.-only base in Southeast Asia,” said Robert Scher, a deputy assistant secretary of defense who oversees security policy in the region. “In each one of these cases, the core decision and discussion is about how we work better with our friends and allies. And the key piece of that is working from their locations.” The distinction is critical in the Philippines, which kicked the U.S. military out of its sprawling naval base at Subic Bay in 1992 after lawmakers rejected a new treaty. Along with the nearby Clark Air Base, which the Pentagon abandoned in 1991 after a volcanic eruption, Subic Bay had served as a keystone of the U.S. military presence in Asia for nearly a century.

.Manila and Washington signed a subsequent agreement that allows U.S. forces to visit the archipelago or deploy there periodically while remaining under U.S. legal jurisdiction. The constitution of the Philippines forbids foreign military bases without a treaty. “There are political sensitivities, and the U.S. is aware of that,” said a senior Philippine official, speaking on the condition of anonymity to discuss confidential deliberations. “So how can we achieve that presence without it costing too much in terms of political friction?” Philippine officials said they favor allowing the United States to deploy more troops or ships, as long as they rotate periodically or are considered temporary. Temporary, however, can still mean a long time. The 600 U.S. Special Operations troops in the Philippines have been on the southern island of Mindanao since 2002, and there is no firm timetable to withdraw them. The number of port visits by U.S. Navy ships has soared in recent years. The Philippines recently acquired a cutter from the U.S. Coast Guard and is seeking two more of the ships to boost its naval forces. It also wants to buy F-16 fighter jets from Washington.

In interviews, neither Philippine nor Obama administration officials would rule out a return by U.S. ships or forces to Subic Bay. The harbor is now a thriving economic hub and free-trade zone, so any American military presence would pale in comparison with the old days. But even a small, visiting U.S. force in the Philippines would send a strong signal to Beijing. Although Washington has said it is not trying to contain China’s rise as an economic and military superpower, Obama announced a new military strategy this month under which the Pentagon will “rebalance” the armed forces toward the Asia-Pacific region in the aftermath of the wars in Iraq and Afghanistan. Some advocates said the shift in emphasis to Asia was long overdue, given its economic importance and China’s rise. “I don’t really see this as a pivot. .?.?. What I see now is a return to a necessary normal,” said Sen. James Webb (D-VA), chairman of the Senate Foreign Relations subcommittee on East Asia and Pacific affairs. “The presence of the United States has become the essential ingredient for stability.”

In addition to the Philippines, Vietnam — another country that once shunned the U.S. military — is restoring ties. In August, a U.S. Navy ship visited the Vietnamese naval base at Cam Ranh Bay for the first time in 38 years. Cam Ranh Bay is a deep-water harbor that served as one of the largest American military installations during the Vietnam War. Vietnam, which has its own territorial disputes with China, has slowly opened its bases to the U.S. Navy for port visits and ship repairs since 2009. “I don’t see in the near future an American base in Vietnam, but we have seen much more increased military cooperation,” said Webb, a former Navy secretary who fought in Vietnam as a Marine. “They’re not shutting down their relationship with China, but they’re attempting to balance it.” Adm. Jonathan W. Greenert, chief of naval operations, has called Southeast Asia the region with “perhaps the greatest potential in the future” for the Navy to increase its presence through military partnerships. In a Jan. 10 speech to the Center for a New American Security in Washington, he singled out the Philippines as a country “where perhaps there will be more opportunities emerging,” although he didn’t elaborate. Greenert cautioned that some of those partnerships would be limited, saying, “Not everybody is interested in getting in an alliance and getting tied up in a long term.” He cited Vietnam as an example. “We don’t want to push it too hard,” he said. “If you move a little too fast, there’s a hesi¬ta¬tion.” [Source: Washington Post Craig Whitlock article 25 Jan 2012 ++]

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Military ID Card Requirements October 14, 2008

Posted by Service Officer on 14th October 2008

NEW MILITARY ID CARD PROCEDURE: EFFECTIVE 25 SEP 08, ALL PERSONNEL BEING ISSUED IDENTIFICATION CARDS, INCLUDING DEPENDENTS (AGE 18 AND OLDER), AND RETIREES MUST PRESENT TWO FORMS OF IDENTIFICATION… AT LEAST ONE OF THE TWO ID’S MUST HAVE A PHOTOGRAPH AND BE FROM “GROUP A”. THE NEW REQUIREMENT IS BEING MANDATED BY THE DoD’S DEFENSE MANPOWER DATA CENTER. THE COMPUTER SOFTWARE IS SEQUENCE-BASED AND REQUIRES TWO FORMS OF ID TO BE SCANNED BEFORE IT WILL PROCEED TO THE NEXT SEQUENCE TO ISSUE A NEW CARD.

GROUP A (PICTURE ID)

-MILITARY DEPENDENT ID/DRIVER’S LICENSE OR ID CARD ISSUED BY FEDERAL STATE

OR– LOCAL GOVERNMENT AGENCIES OR ENTITIES (INCLUDING PHOTO) / U.S.

PASSPORT/US COAST GUARD, MERCHANT MARINER CARD/SCHOOL ID WITH PHOTO/SPONSOR DOD ID CARD/GREEN CARD.

GROUP B (NON-PICTURE)

-CERTIFICATE OF CITIZENSHIP OR NATURALIZATION/FOREIGN PASSPORT/VOTER REGISTRATION CARD/US SOCIAL SECURITY CARD/CERTIFICATION OF BIRTH ABROAD/ORIGINAL OR CERTIFIED COPY OF A BIRTH CERTIFICATE/DAYCARE OR NURSERY SCHOOL RECORD /CLINIC, DOCTOR OR HOSPITAL RECORD/SCHOOL RECORD OR REPORT CARD/FOREIGN NATIONAL ID/w PHOTO.

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Naval Recruiter To Visit Angeles City RAO October 11, 2008

Posted by Service Officer on 10th October 2008

Below is a message from the Angeles City RAO:

 

GREETINGS FROM THE USAF RAO, ANGELES CITY….

THE U.S. NAVY RECRUITERS WILL BE AT OUR OFFICE BETWEEN 0930-1600HRS ON OCT 22, 2008 (NOT 0800 AS LISTED BELOW)… REQUIREMENTS LISTED BELOW… PLEASE NOTE OTHER LOCATIONS THEY WILL BE DURING THEIR VISIT 2008…

HAVE A TEXAS DAY

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Deers Workstation Closure October 10, 2008

Posted by Service Officer on 9th October 2008

Alcon,

The DEERS/Rapids workstation located at the US Embassy in Manila will be closed on 21 October 2008. Normal operation will resume 23 October, thank you.

V/R

SPC Babcock, Jeremy L

DEERS/ADMIN/SUPPLY

JUSMAG – Philippines

United States Embassy

1201 Roxas Blvd., Ermita

Manila, Philippines

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USN Recruiters to Visit Philippines October 09, 2008

Posted by Service Officer on 9th October 2008

USN RECRUITERS TO VISIT PI: The U.S. Navy is currently taking applications to fill positions in the below job fields. Salaries start at $27,000 annually. All positions include free medical, dental, over $36,000 for college & 30 days paid vacation:

Aviation, Administration, Accounting, Computers, Engineering, Electronics, Intelligence, Telecommunications, Hotel Restaurant Management, Construction, Medical

To qualify applicants must:

1. Be U.S. Citizen or have an alien registration (ins/I-551 greencard).

2. Have a U.S. Social Security Number (SSN Card).

3. Be between the ages of 17-34.

4. Be high school diploma graduate.

5. Meet Navy height & weight standards.

6. Have no felony convictions.

7. Meet Navy medical requirements.

8. Be able to pass the ASVAB with a score of 35 or better.

9. Be willing to travel.

For more info meet the U.S. Navy recruiters in the Philippines during their scheduled recruiting trip 21-31 OCT 2008. Their itinerary is:

• OCT 22 – RAO Office Angeles City (0800 – 1600) at 1925 Macarthur Hi-way., Balibago, Angeles City 2009 Tel: [45] 888-2748 • OCT 23-24 – RAO Office Subic Olongapo City (0800 – 1600) at 34 National Hi-way (i.e. Beach Blvd.) in Barrio Barretto, Olongapo City Tel: 47-222-2314 • OCT 27-28 – RAO Office Baguio City(0800 – 1600) at Red Lion Pub, 92 Gen Luna, cnr Leonard Rd & Brent Rd. Baguio City 2400 Cell: 0915-361-3503 • OCT 29-31 – RAO Office Manila (0800-1600) at Unit P, Manila Bay Arcade, 2150 Roxas Blvd. Corner Quirino Ave. Malate 1004, Metro Manila Tel: 524-2164/2169 Cell: 0920-677-4299.

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SSA MILITARY WAGE CREDITS UPDATE September 14, 2008

Posted by Service Officer on 14th September 2008

In JAN 02, Public Law 107-117, the Defense Appropriations Act, stopped the special extra earnings that have been credited to military service personnel. If you earned military pay while on active duty since 1957 (including active duty time for training), Social Security taxes were paid on those earnings. And since 1988, inactive duty service in the reserves (such as weekend drills) has also been covered by Social Security. Under certain circumstances, special extra earnings for your military service from 1957 through 2001 can be credited to your record for Social Security purposes. These extra earnings credits may help you qualify for Social Security or increase the amount of your Social Security benefit. Special extra earnings credits are granted for periods of active duty or active duty for training, but not for inactive (reserve) duty training. If you served on active duty:

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DOD VET BETRAYAL CLAIM September 14, 2008

Posted by Service Officer on 14th September 2008

In a letter sent to members of Congress in early SEP, the directors of two major veterans’ groups say the Pentagon’s personnel chief has intentionally withheld benefits from wounded service members. “We need your immediate assistance to help end the Defense Department’s deliberate, systemic betrayal of every brave American who [dons] the uniform and stands in harm’s way,” states the letter, signed by David Gorman, executive director of Disabled American Veterans (DAV), and Paul Rieckhoff, executive director of Iraq and Afghanistan Veterans of America (IAVA). “Sadly, the 2007 Walter Reed scandal, which resulted mostly from poor oversight and inadequate leadership, pales in comparison to what we view as the deliberate manipulation of the law” by David S.C. Chu, undersecretary of defense for personnel and readiness, and his deputies, the letter states.

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GREYHOUND MILITARY DISCOUNT September 14, 2008

Posted by Service Officer on 14th September 2008

Greyhound Bus Company is offering a fare discount to active duty and retired military personnel and their family members. The offer is a 10% discount off the Greyhound walk-up (unrestricted) fare and a maximum fare of $198 round trip anywhere in the continental U.S. The following terms apply:

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MILITARY COMPENSATION REVIEW UPDATE September 14, 2008

Posted by Service Officer on 14th September 2008

The new report of the Quadrennial Review of Military Compensation (QRMC) proposes a number of changes in military pay and benefits. Under the law, the Defense Department must conduct a QRMC every four years. MOAA previously addressed concerns about the QRMC’s proposed changes in the military retirement system (refer to “Purposes and Pitfalls of Retirement Reform” at www.moaa.org/lac/lac_asiseeit/lac_asiseeit_2008/lac_asiseeit_080813.htm). Now they have provided an assessment of the QRMC health care recommendations. The Military Officers Association of America (MOAA) is in agreement with proposals to stress preventive care by removing copays and deductibles for procedures and medications that are intended to guard against health problems, including colonoscopies, mammograms, and medications intended to control chronic conditions such as diabetes. Similarly, they think the QRMC is on the right track in outlining a variety of initiatives to improve recruiting and retention of the full spectrum of military medical professions and expand contract, reimbursement, and other options to attract the needed level of civilian providers to meet the military community’s needs. But they have a pretty big hiccup on QRMC proposals to:

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