The West Report

By Kathy McGuire, Chief Operating Officer and Acting Regional Director

The West Region’s T-3 Managed Care Support Contract was recently awarded to UnitedHealth Military & Veterans Services. TRO-W has begun to execute the planned strategy to ensure a smooth transition for our beneficiaries in the West Region.

With so much change coming in the future, now is a great opportunity to review the latest guidance regarding the Supplemental Health Care Program (SHCP) from Dr. Jonathan Woodson.

On February 21, 2012, the Assistant Secretary of Defense for Health Affairs, Dr. Woodson, signed a memorandum addressed to the Services’ Assistant Secretaries for Manpower and Reserve Affairs and the Commander, Joint Task Force National Capital Region-Medical regarding the use of SHCP funds for Non-Covered TRICARE Health Care Services. The SHCP is intended to ensure that Service members have access to the most current, promising medical technologies and procedures while simultaneously ensuring that such care is safe and effective.

The memorandum provided important information on the SHCP including:

1. Service members are entitled to medical and dental care in Military Treatment Facilities (MTFs) and also in private facilities (purchased care) using SHCP funds.
2. A MTF or the designated Service Point of Contact (SPOC) may authorize services in the purchased care sector that are within the established scope of the Basic Program Benefits for Service members under SHCP.
3. The SHCP does not allow MTFs and SPOCs to authorize services without a properly approved waiver, that are excluded from the Basic Program Benefits by statute, regulation or policy; exclusions include unproven drugs, services, supplies and equipment.
4. The Director of TRICARE Management Activity (TMA) is authorized to exercise discretionary authority to waive any requirements of TRICARE regulations, including the TRICARE Basic Program Benefits, except those specifically set forth in statute.
5. The SHCP waiver process provides an avenue to lawfully cover otherwise non-covered services for Service members in certain circumstances that will enable them to return to full duty/worldwide deployable status, or to reach their maximum rehabilitative potential.
6. Should a waiver be granted, and the treatment remain a non-covered TRICARE benefit, any follow-on care, including care for complications, will not be covered by TRICARE once the Active Duty Service member (ADSM) separates or retires, and individuals may then be financially responsible for the costs of follow-on care.
7. These excerpts from Dr Woodson’s memo highlight some of the key elements that MTFs and SPOCs need to consider when referring an ADSM to the civilian sector.

It is important to remember, the SHCP waiver process is intended to ensure approved care is safe and effective and members are not subjected to undue risk, or rendered unfit for continued service, as a result of complications arising from unproven medical care.

As leaders in the Military Health Care System, I encourage you to read Dr. Woodson’s memorandum and become more familiar with the SHCP and its governing policy/regulations. Access the memorandum online.

Change is inevitable; however, it provides the opportunity to refine the TRICARE program and the delivery of health care to West Region beneficiaries. Please be assured that the TRO-W team is here to help MTF Commanders and the almost 3 million West Region beneficiaries through the transition.

Thank you for your continued support and partnership as we move forward through these exciting and challenging times. Keeping the beneficiaries as our top priority will allow us to capitalize on opportunities as they arise.