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entitled 'DOD and VA Health Care: Access for Dual Eligible 
Beneficiaries' which was released on June 13, 2003.

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June 13, 2003:

The Honorable John Warner:

Chairman:

The Honorable Carl Levin:

Ranking Minority Member:

Committee on Armed Services:

United States Senate:

The Honorable Duncan Hunter:

Chairman:

The Honorable Ike Skelton:

Ranking Minority Member:

Committee on Armed Services:

House of Representatives:

Subject: DOD and VA Health Care: Access for Dual Eligible 
Beneficiaries:

The Department of Defense (DOD) reported that under its current policy, 
beneficiaries eligible for both TRICARE and the Department of Veterans 
Affairs' (VA) health care (dual eligible beneficiaries) are not allowed 
to utilize the services offered by both health care systems for 
treatment for the same episode of care.[Footnote 1] For example, if a 
beneficiary experiences back pain and seeks treatment from VA, the 
beneficiary must then receive all care related to that back pain from 
VA. Should the beneficiary then decide to seek treatment for the back 
pain from TRICARE, any claims related to that care would be denied. 
According to DOD, this policy was established to ensure continuity of 
care for beneficiaries and to ensure that there was no duplication of 
care or of payments from TRICARE or VA. Under the policy, if 
beneficiaries are dissatisfied with the care provided by VA, they are 
unable to switch to TRICARE to receive services for the same episode of 
care.

Section 708 of the Bob Stump National Defense Authorization Act for 
Fiscal Year 2003[Footnote 2] directed the Secretary of Defense to 
establish a process for resolving issues related to patient safety and 
continuity of care for beneficiaries who are concurrently eligible for 
health care through DOD's TRICARE program and through VA. It also 
required that the Comptroller General review and report on issues 
related to dual eligibility.

On April 16, 2003, DOD reported[Footnote 3] to the Congress on a 
proposal to change its policy and promulgate regulations for 
coordinating care between DOD and VA. As agreed, we focused our review 
on the reasonableness of DOD's process. To do so, we reviewed the 
report submitted to the Congress and TRICARE policies, and interviewed 
agency officials from DOD and VA. Our work was conducted in June 2003 
in accordance with generally accepted government auditing standards.

DOD proposes to change its basic policy to enable dual eligible 
beneficiaries to access both systems for the same episode of care, thus 
ensuring full freedom of choice. DOD also proposes to pay for medically 
necessary care to the extent that such care would be covered by 
TRICARE. DOD's proposal appears reasonable, and it is in the process of 
developing regulations to implement it.

An official with the TRICARE Management Activity reviewed a draft of 
this letter and agreed the information in it is correct. We are sending 
copies of this letter to the Secretary of Defense, appropriate 
congressional committees, and other interested parties. We will provide 
copies of it to others upon request. In addition, it is available at no 
charge on the GAO Web site at http://www.gao.gov. If you or your staff 
have any questions, please contact me at (202) 512-7101 or Michael T. 
Blair, Jr., at (404) 679-1944.

Cynthia A. Bascetta:

Director, Health Care--Veterans' Health and Benefits Issues:

Signed by Cynthia A. Bascetta:

(290272):

FOOTNOTES

[1] According to DOD, an episode of care is generally accepted to be 
all care related to a single injury or illness.

[2] Pub. L. No. 107-314, § 708, 116 Stat. 2458, 2585 (2002).

[3] Report to Congress: Department of Defense Plan for Coordinating 
Care Between TRICARE and the Department of Veterans Affairs 
(Washington, D.C.: April 2003).