Summary
In February 2005, GAO reported that weaknesses in the Army's Active Duty Medical Extension (ADME) process caused injured and ill Army National Guard and Reserve (reserve component) soldiers to experience gaps in pay and benefits. During the course of GAO's previous work, the Army implemented the Medical Retention Processing (MRP) program in May 2004 and Community-Based Health Care Initiative (CBHCI) in March 2004. CBHCI allows reserve component soldiers on MRP orders to return home and receive medical care through a civilian health care provider. As directed by congressional mandate, GAO determined whether (1) MRP has resolved the pay issues previously identified with ADME and (2) the Army has the metrics it needs to determine whether it is effectively managing CBHCI program risks. GAO's scope did not include the medical, facilities, or disability ratings issues recently reported by the media at Walter Reed Army Medical Center.
The Army's MRP program has largely resolved the widespread delays in order processing that were associated with ADME. As a result, injured and ill reserve component soldiers retained on active duty through MRP have not experienced significant gaps in pay and benefits. The Army has addressed 17 of the 22 recommendations GAO made previously, which include developing comprehensive guidance for retaining injured and ill reserve component soldiers on active duty, providing a more effective means of tracking the location of soldiers in the MRP program, addressing problems related to inadequate administrative support for processing active duty retention orders, and developing performance measures to evaluate MRP. Of the five recommendations the Army has not fully implemented, two are related to providing adequate training to reserve component soldiers in the MRP program and Army personnel responsible for managing the program and three deal with improving the Army's order-writing, pay, personnel, and medical eligibility systems. Although the Army has issued a soldiers' handbook for soldiers in the MRP program and developed a biannual training conference for Army personnel responsible for managing these soldiers, the Army lacks consistent, Army-wide training standards for injured reserve component soldiers in the MRP program and Army personnel responsible for managing the program. Because of an Army-wide system integration challenge that affects all soldiers, not just those in the MRP program, information is not always updated in the order-writing, pay, personnel, and medical eligibility systems as it should be. As a result, 7 of the 25 randomly selected soldiers GAO interviewed reported that their families' medical benefits were temporarily disrupted when they transitioned to MRP orders. The lack of integrated systems also caused overpayment problems when soldiers were released from active duty but still had time left on their MRP orders. Over a nearly 3-year period, GAO estimates that the Army overpaid these soldiers by at least $2.2 million. Although, according to the Army, soldiers participating in CBHCI are at greater risk of being retained on active duty longer than medically necessary, the Army currently lacks the data needed to determine whether it is effectively managing this risk. According to the Army's metrics, soldiers treated by civilian providers through CBHCI are, on average, retained on active duty 117 days longer than soldiers treated at military treatment facilities (MTF). According to the Army, the metrics for soldiers treated at MTFs are skewed lower because of the Army's CBHCI selection criteria-- which exclude soldiers whose injuries or illnesses are expected to be treated within 60 days. However, until the Army obtains more comparable information for the patient populations treated through CBHCI and MTFs, the Army cannot reliably determine whether it is effectively managing the program's risk.
Recommendations
Our recommendations from this work are listed below with a Contact for more information. Status will change
from "In process" to "Implemented" or "Not implemented" based on our follow up work.
Director:
Team:
Phone:
McCoy Williams
Government Accountability Office: Financial Management and Assurance
(202) 516-6906
Recommendations for Executive Action
Recommendation: The Secretary of the Army should direct the Assistant Secretary of Manpower and Reserve Affairs, in coordination with the Army's Office of the Surgeon General, the Installation Management Command, and the Defense Finance and Accounting Service, to develop and apply consistent Army-wide standards for installation level training of new medical retention processing unit staff, including the use of desk procedures, to help ensure that they are adequately trained before they assume their new job responsibilities.
Agency Affected: Department of Defense: Department of the Army
Status: In process
Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Recommendation: The Secretary of the Army should direct the Assistant Secretary of Manpower and Reserve Affairs, in coordination with the Army's Office of the Surgeon General, the Installation Management Command, and the Defense Finance and Accounting Service, to develop and apply consistent standards for training of reserve component soldiers in the MRP program to ensure that they understand the requirements, benefits, and processes associated with the program.
Agency Affected: Department of Defense: Department of the Army
Status: In process
Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Recommendation: The Secretary of the Army should direct the Assistant Secretary of Manpower and Reserve Affairs, in coordination with the Army's Office of the Surgeon General, the Installation Management Command, and the Defense Finance and Accounting Service, to develop and disseminate points of contact, including the names, telephone numbers, and e-mail addresses, for the Army officials responsible for assisting injured or ill reserve component soldiers with resolving discrepancies in pay or benefits. Also include in this information the name, telephone number, and e-mail address of the Defense Finance and Accounting Service ombudsman responsible for assisting injured or ill reserve component soldiers with pay-related issues.
Agency Affected: Department of Defense: Department of the Army
Status: In process
Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Recommendation: The Secretary of the Army should direct the Assistant Secretary of Manpower and Reserve Affairs, in coordination with the Army's Office of the Surgeon General, the Installation Management Command, and the Defense Finance and Accounting Service, to require that the local finance offices at Army installations reconcile all discrepancies between the stop pay date recorded in the Army's payroll system and the separation date recorded in the Army's personnel system and adjust the Army's payroll and personnel systems accordingly.
Agency Affected: Department of Defense: Department of the Army
Status: In process
Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Recommendation: The Secretary of the Army should direct the Assistant Secretary of Manpower and Reserve Affairs, in coordination with the Army's Office of the Surgeon General, the Installation Management Command, and the Defense Finance and Accounting Service, to evaluate the efficacy of allowing reserve component soldiers to take unused leave before they are released from active duty.
Agency Affected: Department of Defense: Department of the Army
Status: In process
Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Recommendation: The Secretary of the Army should direct the Assistant Secretary of Manpower and Reserve Affairs, in coordination with the Army's Office of the Surgeon General, the Installation Management Command, and the Defense Finance and Accounting Service, to develop metrics that will allow comparison between the length of stay for soldiers treated through CBHCI and those treated at MTFs to determine whether the Army is effectively managing the additional risk associated with CBHCI.
Agency Affected: Department of Defense: Department of the Army
Status: In process
Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
