Retiree & Veteran Affairs News 10 December 2015
NEW RULES ANNOUNCED FOR THE VETERANS’ CHOICE PROGRAM
The Surface Transportation and Veterans’ Health Care Choice Improvement Act of 2015, signed into law July 31, included provisions designed to make participation in the Veterans’ Choice Program easier and more convenient. The Department of Veterans’ Affairs (VA) announced that the changes will be effective immediately.
Under the old policy, a veteran was eligible if he/she had enrolled in the VA healthcare system by August 2014; had experienced an unusual or excessive burden because of geographical challenges, environmental factors or a medical condition impacting the ability to travel; and lived more than 40 miles driving distance from the closest VA medical facility.
Now under the updated eligibility requirements, a veteran is eligible for the program if he/she is enrolled in the VA health care system and meets at least one of the following criteria:
- Cannot get an appointment at a VA facility within 30 days;
- Lives more than 40 miles driving distance from the closest VA medical facility with a full-time primary care physician;
- Needs to travel by air, boat or ferry to reach the VA medical facility closest to his/her home;
- Faces an unusual or excessive burden in traveling to the closest VA medical facility based on geographic challenges, environmental factors, a medical condition, the nature or frequency of the care needed and whether an attendant is needed; or,
- Lives in a State or Territory without a full-service VA medical facility which includes: Alaska, Hawaii, New Hampshire (Note: Veterans in New Hampshire who live within 20 miles of the White River Junction VAMC are excluded) and the United States Territories (excluding Puerto Rico, which has a full service VA medical facility).
“As we implement the Veterans Choice Program, we are learning from our stakeholders what works and what needs to be refined,” said VA Secretary Robert A. McDonald. “It is our goal to do all that we can to remove barriers that separate Veterans from the care they deserve.” To date, more than 400,000 medical appointments have been scheduled since the Veterans’ Choice Program went into effect on November 5, 2014.
To confirm Veterans who wish to eking to use the Veterans’ Choice Program or wanting to know more about it, can call1-866-606-8198 to confirm their eligibility and to schedule an appointment.
TRICARE BENEFICIARIES MUST MOVE MAINTENANCE DRUGS OUT OF RETAIL
A new law, mandated by the fiscal 2015 National Defense Authorization Act, requires TRICARE beneficiaries to refill prescriptions for select maintenance drugs through TRICARE Pharmacy Home Delivery or at a military pharmacy. Maintenance drugs are those you take on a regular, ongoing basis for chronic, long-term conditions such as those used to control blood pressure. This does not include drugs your doctor prescribes for a short-term condition, such as antibiotics.
The Defense Health Agency and Express Scripts, the TRICARE pharmacy contactor, advises that if TRICARE beneficiaries continue to fill the prescription at a retail pharmacy, they will pay 100% of the costs.
The law was effective on October 1, 2015, but allowed two 30-day refills of an affected drug from a retail pharmacy. For many, those two refills will run out in December.
The change does not apply to:
- active duty military members,
- short-term medications, such as antibiotics,
- generic medications,
- beneficiaries living overseas,
- beneficiaries who have other prescription drug coverage,
- beneficiaries who apply for and receive a waiver to continue having their prescriptions filled at a retail pharmacy. Waivers can be obtained by calling Express Scripts at 1-877-363-1303.
For more information call Express Scripts at 1-877-882-3335 or visit http://www.tricare.mil/RxNewRules.
The Affordable Care Act, your taxes and you
Under the Affordable Care Act (ACA), all Americans including all military members (active duty, retired, Selected Reserve, or Retired Reserve) and their eligible family members must have health care coverage that meets a minimum standard called minimum essential coverage or pay a fee. Your TRICARE coverage meets the minimum essential coverage requirement under the ACA.
"The term "active duty" means full-time duty in the active service of a uniformed service for more than 30 consecutive days".
Beginning in January 2016, DFAS will be providing IRS Form 1095-C to all U.S. military members, and IRS Form 1095-B to all Retirees, Annuitants, former spouses and all other individuals having TRICARE coverage during all or any portion of tax year 2015. An IRS Form 1095 documents you (and your family members, if applicable) have the minimum essential coverage. More information will be forthcoming about the delivery method of these forms.
These forms will document the information that DFAS will provide to the IRS on yourself and your authorized family members. The forms will be required to be reported with your 2015 federal tax return. DFAS will provide you with IRS Form 1095 series forms no later than Jan. 31, 2016.
You can act now to make sure your forms remain secure once they are available using myPay. Just look for the link to "Turn On/Off Hard Coy of IRS Form 1095" in your account and select Electronic Delivery Only. Your information will remain safe until you need it.
VA Continues to Roll Out Choice Act Consolidation Plan
The Department of Veterans' Affairs has streamlined eligibility requirements for the Choice Program.
Under the old policy, a Veteran was eligible for the Veterans Choice Program if he or she met the following criteria:
· Enrolled in VA health care by 8/1/14 or able to enroll as a combat Veteran to be eligible for the Veterans Choice Program;
- Experienced unusual or excessive burden eligibility determined by geographical challenges, environmental factors or a medical condition impacting the Veteran’s ability to travel;
- Determined eligible based on the Veteran’s current residence being more than 40 miles driving distance from the closest VA medical facility.
Under the updated eligibility requirements, a Veteran is eligible for the Veterans Choice Program if he or she is enrolled in the VA health care system and meets at least one of the following criteria:
· Told by his or her local VA medical facility that they will not be able to schedule an appointment for care within 30 days of the date the Veteran’s physician determines he/she needs to be seen or within 30 days of the date the Veteran wishes to be seen if there is no specific date from his or her physician;
- Lives more than 40 miles driving distance from the closest VA medical facility with a full-time primary care physician;
- Needs to travel by air, boat or ferry to the VA medical facility closest to his/her home;
- Faces an unusual or excessive burden in traveling to the closest VA medical facility based on geographic challenges, environmental factors, a medical condition, the nature or simplicity or frequency of the care needed and whether an attendant is needed. Staff at the Veteran’s local VA medical facility will work with him or her to determine if the Veteran is eligible for any of these reasons; or
- Lives in a State or Territory without a full-service VA medical facility which includes: Alaska, Hawaii, New Hampshire (Note: this excludes New Hampshire Veterans who live within 20 miles of the White River Junction VAMC) and the United States Territories (excluding Puerto Rico, which has a full service VA medical facility).
Veterans seeking to use the Veterans Choice Program or wanting to know more about it, can call1-866-606-8198 to confirm their eligibility and to schedule an appointment. For more details about the Veterans Choice Program and VA’s progress, visit: www.va.gov/opa/choiceact.
This opens Choice to 160,500 more veterans enrolled in VA care. Another Dec. 1 change lifts a requirement that to qualify for Choice a veteran must have enrolled in VA health care by Aug. 1, 2014. That date is removed, making 26,000 recent enrollees eligible for Choice automatically because they live more than 40 miles from VA primary care.
At a hearing of the Senate Veterans' Affairs Committee (SVAC) last week senators from rural states including Alaska, West Virginia and Kansas expressed disappointment with how Choice operates today.
Senator Johnny Isakson (R-GA), the SVAC chairman, and the committee’s ranking member, Senator Richard Blumenthal (D-CT), agreed the plan to consolidate purchased care leaves Congress with many critical decisions to make and a lot of money at stake.
The task of combining the patchwork of programs is urgent and apparently very expensive — VA asked for $1.9 billion merely to begin its consolidation plan.
The new plan involves consolidating Choice, the Patient-Centered Community Care networks (PC3), Project ARCH, two different VA-paid emergency care plans, VA affiliations with other federal agencies and various academic partners, and numerous individual agreements between VA health facilities and community care providers into one workable program.
“Each has its own requirements, different eligibility rules, reimbursement rates, different methods of payment and different funding routes,” Deputy VA Secretary Sloan Gibson said. “It’s all too complicated — for veterans, for community providers and for VA staff as well.”
The consolidation plan, he said, will focus on five goals: Establishing a single set of eligibility criteria based on distance, wait time and availability of VA care, and expanded outside urgent care too; improving access by simplifying authorization and referral processes; partnering with federal, academic and community providers to offer a tiered provider network; better coordination of care by deploying an improved health information exchange; ensuring prompt payment with better billing and claim processing.
US Corporations Commit to Hiring 1 Million Veterans
A U.S. Chamber of Commerce Foundation called “Hire 500,000 Heroes” has collected promises from more than 2,000 businesses to hire at least 200,000 more veterans or their spouses. Wal-Mart alone says that it has met its goal of hiring 100,000 military veterans and has upped its commitment to 250,000. A coalition of more than 200 other companies has vowed this month to make a million hires.
All of this veteran hiring is taking place in an economy where veterans have an overall unemployment rate of just 3.9% as of October. The most recent unemployment rate for veterans who served after 9/11 was 4.6% — essentially the same as the rate for civilians, which is at 5.0% overall.
In addition to the corporate hiring campaigns, the White House has an initiative known as Joining Forces announced this year that it had secured new commitments from the private sector to hire or train 90,000 veterans and military spouses, in addition to 100,000 already brought on board.
The employment situation has changed sharply from five years ago, when the country was in the grips of recession, U.S. troops were still immersed in Afghanistan and Iraq, and being a recent veteran seemed to be a disadvantage in the job market.
Many employers hesitated to hire reservists, who could be deployed at any time. The stigma of post-traumatic stress disorder is also thought to have hurt job prospects.
The youngest veterans fared worst, with unemployment rates in some months that were double those of other workers their age. But the latest data show that among 18- to 24-year-olds, unemployment rates for veterans and civilians were statistically equal, at just over 10%.
While it unclear exactly how many veterans have been positively impacted by corporate American and government hiring pledges, the most important contribution of the hiring campaigns may be their underlying message: veterans are not the damaged people that many Americans imagine but valuable members of the workforce.
And as long as people are hiring veterans, which is the first and most important step towards reintegrating them back into society after they leave the service. If you have a job, you have a chance. And that is all anyone can ask for.
List of Navy Ships Covered by Presumption for Agent Orange Exposure Updated by VA
VA maintains a list of U.S. Navy and Coast Guard ships associated with military service in Vietnam and possible exposure to Agent Orange based on military records. This evolving list helps Veterans who served aboard ships, including "Blue Water Veterans," find out if they may qualify for presumption of herbicide exposure.
Veterans must meet VA's criteria for service in Vietnam, which includes aboard boats on the inland waterways or brief visits ashore, to be presumed to have been exposed to herbicides. Veterans who qualify for presumption of herbicide exposure are not required to show they were exposed to Agent Orange or other herbicides when seeking VA compensation for diseases related to Agent Orange exposure.
Ships or boats that were part of the Mobile Riverine Force, Inshore Fire Support (ISF) Division 93 or had one of the following designations operated on the inland waterways of Vietnam. Veterans whose military records confirm they were aboard these ships qualify for presumption of herbicide exposure.
During your Vietnam tour, did your ship or boat have one of the following designations?
- AGP (Assault Group Patrol/Patrol Craft Tender)
- LCM (Landing Craft, Mechanized)
- LCU (Landing Craft, Utility)
- LCVP (Landing Craft, Vehicle, Personnel)
- LST (Landing Ship, Tank)
- PBR (Patrol Boat, River)
- PCF (Patrol Craft, Fast or Swift Boat)
- PG (Patrol Gunboat)
- STABS (Strike Assault Boats)
- WAK (Cargo Vessel)
- WHEC (High Endurance Cutter)
- WLB (Buoy Tender)
- WPB (Patrol Boat)
- YFU (Harbor Utility Craft)
Alphabetized ship list
If your vessel is not included in the Mobile Riverine Force, ISF Division 93 or above designations, check VA's alphabetized ship list.
TRICARE Benefit Expands to Cover New Hip Surgery
The 2015 National Defense Authorization Act created a provisional coverage program that allows TRICARE to provide coverage for emerging treatments and technologies. The first treatment to be evaluated and approved under this new program is surgical treatment of a hip condition called Femoroacetabular Impingement (FAI). FAI can occur when the bones of the hip are abnormally shaped. Because they do not fit together perfectly, the hip bones rub against each other and cause damage to the joint. Symptoms include pain in the hip or groin area which limits or hinders mobility.
Provisional coverage for FAI surgery begins January 01, 2016. At that time, your health care provider can give you a referral for treatment if you are diagnosed with this condition and meet certain clinical criteria. You will be able to get FAI surgery from any TRICARE authorized orthopedic surgeon who performs this procedure. Your costs will vary by plan, but will be lower if you use a network provider. The surgery must be pre-authorized by your regional contractor. Pre-authorization lets your provider present additional information so TRICARE and our contract partners can make an individual review of your care. There is no retroactive preauthorization or coverage prior to January 01, 2016.
The American Orthopaedic Society for Sports Medicine reports that some people may have FAI their entire lives, and never have any problems. However, if symptoms develop, it usually means there is damage to the cartilage and the condition is likely to get worse.
“TRICARE can now review emerging health care products and services that are not currently covered under the TRICARE program but may provide a benefit to patients under a provisional coverage status.” said Dr. James Black, Medical Director, Clinical Support Division, Defense Health Agency. “We will evaluate other emerging treatments and technologies for consideration and make public announcements when additional ones are approved.”
For more information about the TRICARE health plan and current covered services, visit the TRICARE website.
Avoid Higher TRICARE Copayments for Maintenance Drugs
In October, TRICARE implemented a change made by the National Defense Authorization Act that requires select brand-name maintenance drugs to be filled at military pharmacies or through TRICARE home delivery. The new rule allowed beneficiaries to get two 30-day refills of an affected drug from a retail pharmacy. For many, those two refills will run out in December and their next prescription refill needs to be through home delivery or at a military pharmacy. Those who do not move their prescriptions will be required to pay the full cost at retail pharmacies. Active duty service members, overseas beneficiaries and other beneficiaries who are prescribed generic drugs can continue using retail pharmacies. To learn more about the rule change, request a waiver, or learn how to switch to home delivery or a military pharmacy, cl ick here. For a list of affected prescription drugs, click here.
MIA Recovery Update
The Defense POW/MIA Accounting Agency recently announced identifications of remains and burial updates for one Marine and three soldiers who had been missing in action from World War II, Korea and Vietnam. Returned home are:
- Marine Corps Cpl. James D. Otto, 20, of Los Angeles, will be buried with full military honors at Arlington National Cemetery on Dec. 8. He was killed in action on Nov. 20, 1943, while fighting on the Pacific island of Tarawa. He was assigned to Company L, 3rd Battalion, 8th Marines, 2nd Marine Division. Read more.
- Army Sgt. Robert C. Dakin, 22, will be buried with full military honors on Dec. 12 in his hometown of Waltham, Mass. He was assigned to Company L, 3rd Battalion, 31st Infantry Regiment, 7th Infantry Division, when he was lost in North Korea on Dec. 12, 1950.
- Army Sgt. Billy J. Williams, who was assigned to the 2nd Reconnaissance Company, 2nd Infantry Division, was lost in North Korea on Feb. 14, 1951.
- Army Sgt. 1st Class Billy D. Hill, 21, of Fallon, Nev., was assigned to the 282nd Aviation Company, 14th Aviation Battalion, 17th Aviation Group, 1st Aviation Brigade, when he was lost in Vietnam on Jan. 21, 1968.
Congress Works to Change Military Health Care
Twice last week we had confirmation that Congress intends to try and change the TRICARE health care system next year. This is something we have been warning you about for several weeks.
First there was an article in MilitaryTimes.com. You can read the entire article here: http://www.militarytimes.com/story/military/benefits/2015/11/18/mcrmc-heritage-benefits/76008874/.
The article proved a point that we’ve made for a long time. Belonging to TREA and other military and veterans associations is your best hope for protecting your promised and earned military benefits because we are the only ones fighting for you.
The big military contractors pour millions of dollars into election campaigns for members of Congress and in return they expect to get a major share of the defense budget.
Here’s what former Congressman Steve Buyer said in the article about that: “Buyer said he worries that military personnel budget accounts too often are seen as potential sources of easy cuts for cash-strapped military planners.
'This defense industrial base has built itself as a powerful force,” he said. “So the prime target when you enter a sequestration era is to target personnel costs, and that will drive savings you can move over to save on equipment.'”
Congressman Buyer is exactly right and we applaud him for his willingness to tell the truth about what goes on when DoD looks for ways to cut its budget. Unfortunately, many current members of Congress are not willing to be so honest about the facts.
The other article, titled “Overhauling Military Health Care Presents a Political Minefield,” appeared in CQRollCal.coml, which is a publication mainly seen in Washington, D.C. Unfortunately, it cannot be seen online because it is available by subscription only. But here are some key quotes from the article:
“Health care is a tough sell in general, but it’s a tough sell in this particular case because the obvious thing is to ask people to pay more,” former Nebraska Democratic Sen. Bob Kerrey, a member of the [Military Compensation and Retirement Modernization] commission, tells CQ. “And I for one don’t think that’s unreasonable at all. Personally, I don’t think it’s going to make it difficult either to recruit or retain.”
“[Senate Armed Services Committee Chairman John] McCain and [House Armed Services Committee Chairman Mac] Thornberry have yet to say how many, if any, of the commission’s health benefit recommendations they might adopt, but they have credited the panel for highlighting issues in Tricare that need changes. The conference report for the fiscal 2016 defense bill expressed Armed Services leaders’ commitment to make changes next year and pledged that all aspects of Tricare would be on the table, stating that ‘increases to fees and copays will be a necessary part of such a comprehensive reform effort.’”
Earlier in the article it is pointed out that the recommendations on changing military health care that came from the Military Compensation and Retirement Modernization Commission (MCRMC) did not recommend increasing costs for Medicare-eligible retirees, but the Pentagon has been pushing for that for a long time and Congress does not have to follow the recommendations of the MCRMC.
We are gearing up for this fight, which we believe will be the biggest battle we have ever faced when it comes to protecting your benefits. We will keep you advised as we hear more about what Congress might try to do, but in the meantime, please get ready to write emails, letters and make phone calls to your members of Congress when we ask for your help next year.
DOD/VA Claim New System Allows for Better Health Record Transfer
Department of Defense and Department of Veterans Affairs officials are highlighting the capabilities of the new Joint Legacy Viewer (JLV), a Web-based software program that allows medical personnel in both departments to see and work with each others' records.
The JLV gives military and VA health providers read-only access to health records from multiple sources, including those maintained for Tricare beneficiaries, DOD,VA and certain private-care providers.
The JLV also has features that let users drill down into the data, searching for and sorting information to get a better picture of a patient's medical history — radiology test results, prescriptions, doctors' notes and much more.
JLV meets the requirements set by Congress for DOD to certify that its medical records are interoperable with VA and some private-sector medical providers, although it is not a full-fledged joint electronic health record. The JLV makes the data accessible across the world, by any military or VA provider.This should allow VA and DOD doctors see the same information, to make the better decisions and to allow service members to make sure all their information is there on the VA side when they leave service.
According to MilitaryTimes.com, Defense officials could not provide details on the cost of development or implementation of JLV, which they said is based on software architecture developed by Tripler Army Medical Center in Hawaii and the VA Pacific Island Health Care Systems in 2003.
Legislative push on the Hill to create new antibiotics
On Wednesday the PEW Foundation held a brief for staffers on the Hill highlighting how crucial a need there is to develop new antibiotic. The briefing, which was focused on several different areas of the medical crisis. There are 9 bills pending in the House and Senate that would take various steps to encourage the creation of new antibiotics to treat “superbugs” that have developed resistance to our present antibiotics. (including S.185 the PATH Act (Promise for Antibiotics and Therapeutics for Health) introduced by Senator Orrin Hatch (R-UT) and H.R. 6 21st Century Cures Act introduced by Rep Fred Upton (MI ) which funds the FDA and allows the FDA to give antibiotics in development to patients who are failing to respond to present antibiotics.
These “superbugs” are extremely dangerous to the young and the old and members of the military who have been wounded.
The briefing also urged doctors to stop overprescribing antibiotics and farmers to stop feeding their animals antibiotics to keep them healthy rather than when they are sick. Both practices have helped cause the present problem.
Hearing on Pending Health Legislation
On Tuesday, the House Veterans’ Affairs Subcommittee on Health held a hearing to consider a number of important bills. Subcommittee members discussed a range of issues, including access to mental health for military sexual trauma victims, surveys used to gauge veteran experiences, and improving the safety of adaptive automobile grants. VFW Senior Legislative Associate Carlos Fuentes testified, offering the VFW’s support for most of the bills and recommendations to strengthen others. In his testimony, Fuentes urged the subcommittee to consider improving the VA’s patient advocate program. View a video of the hearing.
House Holds Hearing on VA OJT Program
On Wednesday, the House Veterans’ Affairs Subcommittee on Economic Opportunity held a hearing to examine the VA On-the-Job Training (OJT) and Apprenticeship Program. Under the Post-9/11 GI Bill, veterans can receive benefits while participating in OJT programs and apprenticeships. The subcommittee stated that the OJT program provides an excellent opportunity for those who participate, but focused on specific improvements needed, as outlined by a recent Government Accountability Office report. These included recommendations that the VA improve awareness of the program, ease administrative burdens, and develop better outcome measures. The VA concurred with the recommendations and has begun implementing them. The VFW strongly supports the OJT program. Learn more about the OJT program.
Longtime Advocate Confirmed to Lead DOL VETS
On Thursday, the Senate unanimously confirmed former member of Congress, Michael Michaud, to be the next assistant secretary of the Department of Labor-Veterans Employment and Training Service. Michaud has been a longtime veterans’ advocate and was the ranking member of the House Veterans’ Affairs Committee before leaving Congress in 2014. Michaud has been a longtime friend of the VFW, and we look forward to working with him again in his new position.
Nomination Hearing for the VA Inspector General
On Thursday, the president nominated former federal and congressional investigations counsel, Michael J. Missal, to be the next VA Inspector General. The position has been vacant for two years, but the office has played an integral role in exposing system-wide wrongdoing and data manipulation issues that have contributed to the VA health care access crisis. The VFW is hopeful that permanent leadership in this important position will lead to better accountability at the VA. To read Mr. Missal’s testimony or view a video of the hearing, click here.
House Passes Several Veterans' Bills
This week, the House of Representatives passed several pieces of veteran-related legislation. These included H.R. 1694, which sets aside federal transportation contracts for veterans; H.R. 3114, which gives funding to the Army Corps of Engineers to hire veterans to assist with historic preservation; and H.R. 1338, which requires the VA to study and report on veterans’ unclaimed remains in national cemeteries. Also approved by the House was H.R. 1384, the Honor America’s Guard-Reserve Retirees Act, which extends veterans’ status to reserve component retirees who are never activated. The VFW supports each of these bills. Stay tuned to the Action Corps Weekly for updates as they move through the Senate.
The DOD Unveils Initial "Force of Future" Plan
On Wednesday, Defense Secretary Ash Carter unveiled his department’s initial plans for a military force of the future. The details released were less than anticipated, but the VFW did learn during a teleconference prior to the unveiling that the new plan will expand internship and fellowship opportunities, create new doctoral programs, and bring in new ideas and talent, including entrepreneurs, to keep DOD forward thinking and ready for the future. More plans are expected to be released. Learn moreabout the initial plan.
New JCS Senior Enlisted Advisor Announced
The chairman of the Joint Chiefs of Staff, Marine Corps Gen. Joseph F. Dunford, Jr., has selected Army Command Sgt. Maj. John W. Troxell as his new senior enlisted advisor. Troxell is currently stationed in South Korea and wears three hats as the command senior enlisted advisor to United Nations Command, Combined Forces Command and U.S. Forces Korea. He enlisted in the Army in 1982 as an armored reconnaissance specialist, and has five combat tours that include Operations Just Cause and Desert Shield/Storm, two tours in Iraq and one in Afghanistan. Troxell will replace Marine Corps Sgt. Maj. Bryan Battaglia, who is retiring after 36 years of service.
Vietnam War MIA Recovery
The Defense POW/MIA Accounting Agency announced the identification of remains belonging to Army Staff Sgt. Kenneth L. Cunningham, 21, of Ellery, Ill. On Oct. 3, 1969, then Private 1st Class Cunningham was an observer in an OV-1C Mohawk aircraft on a surveillance mission over the tri-border area of Cambodia, Laos and South Vietnam. Contact was lost and the aircraft was found two days later on top of a 7,000 foot peak in a mountain range north of Kontum. His remains were not recovered. He was assigned to the 225th Aviation Company, 223rd Aviation Battalion, 17th Aviation Group, 1st Aviation Brigade.