Senate Armed Services Committee Issues Defense Authorization Report – Title VII (Health Care Provisions) (Part 1 of 2)
TITLE VII--HEALTH CARE PROVISIONS
Military health system reform overview
In
In addition to its recommendations to modernize the military retirement system, the Commission recommended major reform of the military health system. Those recommendations offered a plan to improve and sustain operational medical force readiness, improve access to care, and expand beneficiaries' choices of health plans.
The committee has taken a very deliberate approach to enacting major military health system reform legislation. For more than a year, the committee has worked diligently to understand the implications and unintended consequences of any plan to reform the military health system a large, complex health program with over 9.4 million eligible beneficiaries. During this time, the committee held hearings with civilian healthcare experts and
Since 2001, battlefield injury survival rates have been higher than at any time in our nation's history. The committee applauds military healthcare personnel for professionally and compassionately caring for wounded, ill, and injured servicemembers over the last 15 years. Clearly, battlefield medicine is a pocket of excellence in the military health system that must be maintained.
However, it is also clear that the military health system, designed decades ago, has increasingly emphasized delivering peacetime healthcare at the expense of strengthening operational medical force readiness. Prior to 2001, medical force readiness suffered immeasurably, forcing the military Services to build a more robust combat casualty care capability to meet the demands of the wars in
Bloated medical headquarters staffs--over 12,000 persons strong--have failed to take quick action on what needs to be fixed in the direct care component of the military health system. Despite the lack of additional capacity to enroll patients in bottle-necked primary care clinics, beneficiaries continue to be forced to receive care at military hospitals. The Services claim they need more patients in their hospitals to maintain medical force readiness, but the most common health services performed by military providers relate to pregnancy, childbirth, and pediatric care--health services not typically necessary to ensure medical force readiness training.
In addition, the current stove-piped military health system command structure leads to inevitable turf wars among the military Services and the
Moreover, a recent study shows that the Services underestimate the true costs of officer and enlisted medical personnel compared to the total costs for government civilians and contractors. The study concluded that the complete cost to the taxpayer of military medical personnel far exceeded the cost of civilian healthcare providers with comparable skills. Data also show that the total cost to provide healthcare services in military treatment facilities is greater than the cost of providing the same types of services in the private sector yet the Department continues to advocate that military treatment facilities are less expensive than private sector facilities.
The private sector component of the military health system is not without its own flaws. Beneficiaries complain about the cumbersome authorization and referral process for specialty care and a lack of access to care in large TRICARE provider networks. The current TRICARE program's myriad outmoded regulations and policies focus on "the system" rather than doing the right thing for beneficiaries. TRICARE's obsolete medical support contract strategy results in high acquisition costs, routine bid protests, implementation delays, high management costs, and costly contract extensions. Under those contracts, the Department, and ultimately the taxpayers, remain solely at risk for the cost of all healthcare services provided, and the rigid adherence to fee-for-service provider reimbursement fails to encourage individual and institutional network providers to provide higher quality care, better access to care, and higher patient satisfaction at lower costs to the Department and the taxpayers.
As the committee formulated its defense health reform initiatives, we determined not to increase TRICARE fees unless we could create more value--provide higher quality care, better access to care, and a better experience of care. Based on the above findings and many others, the committee developed a comprehensive legislative package that would provide a gold- standard, integrated healthcare delivery system, creating high value for all beneficiaries. The committee mark contains numerous provisions to meet the following reform objectives of the committee. Improve and maintain operational medical force readiness: (1) creates specialized care centers of excellence at major military medical centers; (2) expands military- civilian trauma training sites and requires integrated trauma team training; (3) requires establishment of personnel management plans for important wartime medical specialties; (4) requires development of quality of care outcome measures for combat casualty care; (5) requires greater focus on medical research to understand better the causes of morbidity and mortality of service men and women in combat; (6) requires development of a trauma care registry; (7) requires development of standardized tactical combat casualty care training; and (8) expands eligibility for care in military treatment facilities to veterans and certain civilians.
Enhance access to high quality healthcare: (1) creates local high-performing military-civilian integrated health delivery systems; (2) expands telehealth capabilities in the military health system; (3) creates specialized care centers of excellence at major military medical centers; (4) requires contracts for turn-key primary care/urgent care clinics at military treatment facilities; (5) authorizes a pilot program to give commercial health insurance coverage to reserve component members and their families; and (6) requires a standardized medical appointment system across the military health system.
Improve beneficiaries' health outcomes: (1) increases beneficiary involvement and shared responsibility to improve health outcomes and to lower costs--targets smoking cessation and weight reduction; (2) incentivizes participation in disease management programs; and (3) and incentivizes use of high-value providers.
Create health value: (1) expands and improves access to care by requiring a standardized appointment system in military treatment facilities; (2) expands the full range of telehealth services available to beneficiaries; (3) authorizes lower co- payments for high-value pharmaceuticals and medical services; (4) eliminates the requirement for pre-authorization for specialty care referrals; (5) requires a plan to improve pediatric care and related services; (6) incentivizes participation in disease management programs; (7) authorizes enrollment of eligible beneficiaries in federal dental and vision insurance programs managed by the
Modernize TRICARE medical support contracts: (1) incorporates value-based healthcare methodology and value-based provider reimbursement into TRICARE contracts; (2) expands access to the full range of telehealth capabilities; (3) allows contractors to use the latest innovations in the private sector health plan market; (4) transfers financial risk to contractors and healthcare providers; (5) focuses contracts on building networks of high-value providers; and (6) requires a competitive, continuously open contracting strategy.
Drive efficiencies and eliminate waste: (1) right-sizes the footprint of the military health system to meet operational medical force requirements and the medical readiness of the Armed Forces; (2) realigns the medical command structure and shrinks headquarters staffing creating greater efficiency in the management of the military health system; (3) eliminates graduate medical education training programs not directly supporting operational medical readiness requirements and the medical readiness of the Armed Forces; (4) authorizes conversion of military healthcare provider positions to civilian or contractor positions; (5) requires a multi-year study by the Comptroller General of
Lower the per capita costs of healthcare for
Demand performance accountability: (1) establishes performance accountability for military healthcare leaders throughout the military health system; (2) establishes rigorous criteria for selection of military treatment facility commanders; and (3) establishes minimum lengths of tours of duty for military treatment facility commanders.
The committee believes these significant reforms constitute a critical first step in the evolution of the military health system from an under-performing, disjointed health system into a high-performing integrated health system that gives beneficiaries what they need and deserve: the right care at the right time in the right place. True transformation, however, will require a cultural change across the entire military health system--a change from a system-first culture to a patient-first culture. Such a cross-service cultural shift is essential to building trust with beneficiaries and creating health value for them. The committee expects military health system leaders and their private sector partners to begin immediately advancing a patient-first culture throughout the military health system.
Subtitle A--Tricare and Other Health Care Benefits
Reform of health care plans available under the TRICARE program (sec. 701)
The committee recommends a provision that would amend chapter 55 of title 10, United States Code, to reform health care plans available under the TRICARE program. The provision would establish three health plan choices for families of Active-Duty servicemembers, and retired military members and their families: (1) TRICARE Prime, a managed care option; (2) TRICARE Choice, a self-managed option; and (3) TRICARE Supplemental, an option for retired members and their families, other than TRICARE-For-Life beneficiaries, who have other health insurance. Beneficiaries would be required to enroll in one of the TRICARE options during an annual open enrollment period in order to obtain care through the TRICARE Program.
Under this provision, the Department would offer TRICARE Prime in areas near military treatment facilities (MTFs). Active-Duty family members would be authorized to enroll in TRICARE Prime, and there would be no cost shares. Retirees and their family members would be authorized to enroll in TRICARE Prime in areas where an MTF has a significant number of health care providers, including specialty providers, and sufficient capability to support efficient operations of the MTF. A TRICARE Prime enrollee would be required to obtain a referral for care from a designated primary care manager prior to obtaining care under the TRICARE program. A referral to network providers for specialty care services would not require a beneficiary to obtain a pre-authorization. The provision would require the Secretary to ensure that beneficiaries have the same level of access to care within timelines that meet or exceed those of high-performing health systems in the private sector. The committee believes this should enable beneficiaries to obtain same-day appointment access to most primary and some specialty health care services.
This provision would establish TRICARE Choice in other locations in the country, and beneficiaries may receive care from any health care provider selected by the member subject to any restrictions established by the Secretary.
This provision includes a cost-share table for calendar year 2018 for both TRICARE Prime and TRICARE Choice that would establish rates for annual enrollment fees, annual deductibles, annual catastrophic caps, and co-payments for inpatient visits, outpatient visits, and other services. The provision would gradually increase the annual enrollment fee for military retirees and their families under TRICARE Choice over a period of 5 years through 2023. Subsequently, annual enrollment fees for military retirees and their families in TRICARE Choice after 2023, and for military retirees and their families under TRICARE Prime after 2018, would increase by the annual percent of the Consumer Price Index for Health Care Services, published by the
The provision would authorize the Secretary to adopt special coverage and reimbursement methods, amounts, and procedures to encourage the use of high-value services and products and to discourage the use of low-value services and products.
Under this provision, retirees and their family members with other health insurance would be authorized to enroll in the TRICARE Supplemental option. The provision establishes an annual enrollment fee that would be one-half of the fee for the TRICARE Choice option. Under TRICARE Supplemental, TRICARE would pay the deductible and co-payment amounts under the beneficiary's primary health plan, not to exceed the amount TRICARE would have paid as primary payer to an out-of-network provider.
A number of existing TRICARE programs would remain unchanged under this provision: (1) Extended Health Care Option Program; (2) TRICARE Reserve Select; (3) TRICARE Retired Reserve; (4) TRICARE Dental Program; and the (5) Continued Health Care Benefits Program. This provision would not affect the required cost-shares under the TRICARE Pharmacy Benefits Program, but the annual enrollment fee, annual deductible, and annual catastrophic cap established in this section would apply to the pharmacy program. With this provision, the cost-share requirements for remote area dependents would be the same as those established under the TRICARE Prime Option but without a referral requirement.
Modifications of cost-sharing requirements for the TRICARE Pharmacy Benefits Program and treatment of certain pharmaceutical agents (sec. 702)
The committee recommends a provision that would modify cost-sharing amounts for the TRICARE pharmacy benefits program for years 2017 through 2025. After 2025, the Department could establish cost-sharing amounts equal to the cost-sharing amounts for the previous year adjusted by an amount, if any, to reflect increases in costs of pharmaceutical agents and pharmacy dispensing fees. With this provision, beneficiaries would continue to receive pharmaceuticals at no cost in military medical treatment facilities. Under this provision, there would be no changes to cost-sharing amounts for survivors of members who died on Active Duty or for disabled retirees and their family members.
To encourage use of pharmaceutical agents that provide the greatest value to beneficiaries and the Department, the provision would authorize the Secretary of Defense, upon recommendation from the Pharmacy and
The National Defense Authorization Act for Fiscal Year 2016 (Public Law 114-92) authorized modest cost-share amount increases for certain pharmaceuticals obtained through the TRICARE retail pharmacy network or the mail order pharmacy in fiscal year 2016, but it did not include the Administration's proposal to increase cost-share amounts in subsequent years. In conference deliberations with the
Eligibility of certain beneficiaries under the TRICARE program for participation in the Federal Employees Dental and Vision Insurance Program (sec. 703)
The committee recommends a provision that would amend sections 8951 and 8981 of title 5, United States Code, to require the Secretary of Defense to enter into an agreement with the Director of the
Coverage of medically necessary food and vitamins for digestive and inherited metabolic disorders under the TRICARE program (sec. 704)
The committee recommends a provision that amend section 1077 of title 10, United States Code, to provide TRICARE program coverage for medically necessary food, including the equipment and supplies necessary to administer that food, and vitamins for digestive disorders and inherited metabolic disorders.
Enhancement of use of telehealth services in military health system (sec. 705)
The committee recommends a provision that would require the Secretary of Defense, within 1 year of the date of enactment of this Act, to incorporate the use of telehealth services throughout the direct and purchased care components of the military health system.
The provision would require the Department to make telehealth services available to: (1) improve access to primary care, urgent care, behavioral health care, and specialty care; (2) perform health assessments; (3) provide diagnoses, treatments, interventions, and supervision; (4) monitor individual health outcomes of covered beneficiaries with chronic diseases or conditions; (5) improve communication between health care providers and patients; and (6) reduce health care costs for beneficiaries and the
This provision would require the Secretary to establish standardized payment methods to reimburse health care providers for telehealth services provided to covered beneficiaries in the purchased care component of the TRICARE program to incentivize the provision of telehealth services. The provision would also require the Secretary to reduce or eliminate co- payments or cost-shares for covered beneficiaries for receipt of telehealth services.
The Secretary would be required to submit an initial report, within 180 days of the date of enactment of this Act, to the Committees on Armed Services of the
Early this year, the Assistant Secretary of Defense for Health Affairs published a memorandum that authorized the provision of telemedicine services at a patient's location. The committee considers this policy a good first step, but the additional conditions applied to the policy unduly restrict beneficiaries' full use of the same telehealth capabilities readily available in the private sector. The committee believes the Department should amend its published conditions for the provision of telemedicine services to ensure beneficiaries everywhere have full access to those services.
Evaluation and treatment of veterans and civilians at military treatment facilities (sec. 706)
The committee recommends a provision that would authorize a veteran or civilian to be evaluated and treated at a military treatment facility if the Secretary of Defense determines that: (1) the evaluation and treatment of the individual is necessary to maintain the medical readiness skills and competencies of health care providers at the facility; (2) health care providers at the facility have the competencies, skills and abilities to treat the individual; and (3) the facility has available space, equipment, and materials.
The provision would authorize a military treatment facility to bill and accept reimbursement for services provided to a civilian patient. Under this provision, the Secretary of Defense would be required to enter into a memorandum of understanding with the Secretary of
By authorizing military health care providers to treat eligible veterans and certain civilians in military treatment facilities, this provision would help the
Pilot program to provide health insurance to members of the reserve components of the Armed Forces (sec. 707)
The committee recommends a provision that would authorize the Secretary of Defense to carry out a pilot program jointly with the Director of the
Under the pilot program, the Secretary could contract with qualified health insurance carriers to provide coverage for health care services provided at military treatment facilities to pilot program participants, and the Department would receive payment from those carriers for any services provided at those facilities. Family members of an eligible reserve component member could remain covered under the pilot program even when the reserve component member became ineligible for coverage while serving on Active Duty for a period greater than 30 days.
In addition, an eligible reserve component member would be responsible for payment of all cost sharing amounts applicable to the health benefits plan plus an annual premium amount equal to 28 percent of the total annual amount of the premium under the plan. During a period in which a reserve component member served on Active Duty for more than 30 days, the premium amount and cost shares would be zero for eligible family members.
In consultation with the Secretary of Homeland Security, the Secretary would provide recommendations and data to the Director on matters regarding military treatment facilities, matters unique to eligible reserve component members and their families, and any other guidance necessary to administer the pilot program. The Secretary and the Director would jointly establish a funding mechanism for the pilot program, and the Secretary would make funds available to the Director, without fiscal year limitation, for payment of health plan costs and administrative expenses.
Pilot program on treatment of members of the Armed Forces for post- traumatic stress disorder related to military sexual trauma (sec. 708)
The committee recommends a provision that would authorize the Secretary of Defense to conduct a pilot program, of not more than 3 years duration, to award competitive grants to community partners to provide intensive outpatient programs to treat members of the Armed Forces suffering from post-traumatic stress disorder resulting from military sexual trauma, including treatment for substance use disorder, depression, and other issues related to those conditions. Under this provision, a community partner would be a private health care organization or institution that: 1) provides health care to servicemembers; 2) provides evidence-based treatment for psychological and neurological conditions common to servicemembers; 3) provides health care, support, and other benefits to family members of servicemembers; and 4) provides health care under the TRICARE program. The government share of the costs of programs carried out by community partners could not exceed 50 percent in this pilot program.
Subtitle B--
Consolidation of the medical departments of the
The committee recommends a provision that would require the Secretary of Defense to disestablish the medical departments of the Armed Forces and consolidate all activities of those departments into the
Under this provision, the
The provision would give broad authorities to the Director of the
After careful study, the committee concludes that a single agency responsible for all medical operations of the
In
Unfortunately, the
Accountability for the performance of the military health care system of certain positions in the system (sec. 722)
The committee recommends a provision that would require the Secretary of Defense and the secretaries of the military departments, within 180 days of the date of enactment of this Act, to incorporate performance accountability measures into the annual performance reviews of certain leadership positions in the military health care system. The provision would prohibit payment of a performance bonus to a civilian employee of the
Selection of commanders and directors of military treatment facilities and tours of duty of commanders of such facilities (sec. 723) The committee recommends a provision that would require the Secretary of Defense to develop common qualifications and core competencies required for selection of commanders or directors of military medical treatment facilities. The provision would also establish a minimum length of 4 years for tours of duty, with limited exceptions, for those commanders or directors to ensure greater stability in health system executive management at each facility and throughout the military health system.
The committee is concerned that military treatment facility commanders typically rotate to new duty stations every 2 years, and these frequent transfers lead to great instability in the management of hospitals and clinics. The rapid turnover of military hospital commanders creates turmoil in hospital executive leadership and management, negatively affecting the performance of the local facility and the overall performance of the entire military health system. The committee believes this provision would steady the executive management of military hospitals and clinics and improve the performance of those facilities.
Authority to convert military medical and dental positions to civilian medical and dental positions (sec. 724)
The committee recommends a provision that would amend chapter 49 of title 10, United States Code, to authorize the
In
Since the military services seemingly underestimate the full cost of medical personnel, they incorrectly rely on more military medical personnel than civilians and contractors to provide health care services to beneficiaries. This problem primarily occurs in the
Authority to realign infrastructure of and health care services provided by military treatment facilities (sec. 725)
The committee recommends a provision that would authorize the secretary of a military department to realign the infrastructure of or modify the health care services provided by a military treatment facility (MTF) if a realignment or modification would better: 1) ensure the delivery of safe, high quality health care services; 2) adapt the delivery of health care in a facility to rapid changes in private sector health care delivery models; or 3) maintain the medical force readiness skills and core competencies of health care providers in a facility. Before taking any action under this provision, the Secretary of Defense would be required to submit a report to the Committees on Armed Services of the
Acquisition of medical support contracts for TRICARE program (sec. 726) The committee recommends a provision that would require the Secretary of Defense to conduct a new competition of all medical support contracts, except the overseas medical support contract, with private sector entities under the TRICARE program by
Within 1 year of the award of new medical support contracts, the Secretary would be required to issue an open broad agency announcement to allow potential contractors to propose innovative ideas and solutions to meet the medical support contract needs of the Department. A medical support contract awarded through the open broad agency announcement would be deemed to meet the requirements under section 2304 of title 10, United States Code, relating to use of competitive procedures to procure services.
For new medical support contracts, the Department would be required to include, to the extent practicable: (1) maximum flexibility in network design and development; (2) integrated medical management between military medical treatment facilities and network providers; 3) maximum use of the full range of telehealth services; (4) use of value-based reimbursement methods that transfer financial risk to health care providers and medical support contractors; (5) use of prevention and wellness incentives to encourage beneficiaries to seek health care services from high-value providers; (6) a streamlined enrollment process and timely assignment of primary care managers; (7) elimination of the requirement to seek authorization of referrals for specialty care services; (8) the use of incentives to encourage certain beneficiaries to engage in medical and lifestyle intervention programs; and (9) the use of financial incentives for contractors and health care providers to receive an equitable share in cost savings resulting from improvement in health outcomes and the experience of care for beneficiaries.
In establishing new medical support contracts, the provision would require the Secretary to: (1) assess the unique characteristics of providing health care services in rural, remote, or isolated locations, such as
The committee views this provision as critically important to reform of the TRICARE program. The Department's contract strategy for the next generation of TRICARE managed care support contracts, commonly known as the T-2017 contracts, does not acknowledge the rapid changes in delivery of health care services in the private sector. The T-2017 contract strategy fails to focus on development of high-value provider networks, and the Department remains fixed on reimbursing network providers solely on the number and types of services provided rather than on improvement in beneficiaries' health outcomes and the experience of care.
Moreover, the Department's current strategy of essentially awarding 5-year contracts (1 base-year with 4 option-years) results in a winner-take-all approach that limits competition and stifles adoption of innovations in health care delivery. The Department and the American taxpayers continue to assume all financial risk in those contracts while that risk, if transferred to health care providers and medical support contractors, would encourage more efficient, effective delivery of health care services. The committee firmly believes that multiple local, regional, and national TRICARE medical support contracts, which transfer financial risk from the government to contractors and health care providers, would improve beneficiaries' health outcomes, simplify the onerous, costly contracting process, and ultimately lower health care costs for the Department.
Authority to enter into health care contracts with certain entities to provide care under the TRICARE program (sec. 727)
The committee recommends a provision that would authorize the Secretary of Defense to enter into contracts to provide health care, including behavioral health care, to covered beneficiaries under the TRICARE Program with any of the following: (1) the
Improvement of health outcomes and control of costs of health care under TRICARE program through programs to involve covered beneficiaries (sec. 728)
The committee recommends a provision that would require the Secretary of Defense, by
The committee believes that the
In addition, the committee is concerned about the high number of failed medical appointments in the military health system. From
Establishment of centers of excellence for specialty care in the military health system (sec. 729)
The committee recommends a provision that would require the Secretary of Defense to establish regional centers of excellence for the provision of specialty care to covered beneficiaries at major medical centers of the
Furthermore, the provision would specify the types of centers of excellence that the Secretary could establish while allowing for the establishment of additional centers when appropriate. The centers of excellence established under this provision would serve as the primary sources for specialty care within the direct care health system, and health care providers throughout the system would refer beneficiaries to those facilities. The provision would require the Secretary to submit a report to the Committees on Armed Services of the
After careful study, the committee concludes that establishment of specialty care centers of excellence in the military health system would result in the delivery of superior health care for specialized procedures, therapies, and services, and improve health outcomes for beneficiaries. By concentrating military specialty care providers in regional major medical centers, such as
Program to eliminate variability in health outcomes and improve quality of health care services delivered in military treatment facilities (sec. 730)
The committee recommends a provision that would require the Secretary of Defense to conduct a program, not later than
The provision would require the Secretary, during the conduct of the program, to continuously monitor and adjust the health care services delivered at military treatment facilities and the number of patients enrolled at those facilities to ensure: (1) a high degree of safety and quality in the delivery of health care at those facilities; and (2) the delivery of only those health care services critical for maintaining operational medical force readiness and the medical readiness of the Armed Forces.
Establishment of advisory committees for military treatment facilities (sec. 731)
The committee recommends a provision that would require the Secretary of Defense to establish an advisory committee for each military medical treatment facility. Each advisory committee would include six beneficiaries eligible for health care services in the military health system: (1) two Active- Duty servicemembers; (2) two Active-Duty family members; and (3) two military retirees. The committee recognizes that beneficiaries need an official forum to provide guidance on the operations of military treatment facilities. Advisory committee members would regularly engage with the executive management of each military treatment facility to discuss concerns and to provide feedback on matters relating to the provision of health care services in the facility.
Standardized system for scheduling medical appointments at military treatment facilities (sec. 732)
The committee recommends a provision that would require the Secretary of Defense to implement, by
The committee regularly hears from beneficiaries that the multiple medical appointment systems used across the military health system lead to extended delays in getting timely care and result in poor patient satisfaction. The committee believes the current appointment scheduling systems lead to waste, inefficiency, and lower provider productivity. The Department should quickly implement a new appointment scheduling system, universally applied in each military treatment facility, which enables beneficiaries to make appointments rapidly and stress- free. The new, standardized appointment system should enable beneficiaries to make appointments at least 1 year in advance, and it should send automatic appointment reminders by email, telephone or text message.
Display of wait times at urgent care clinics, emergency departments, and pharmacies of military treatment facilities (sec. 733)
The committee recommends a provision that would require the commander or director of a military treatment facility, by
Improvement and maintenance of combat casualty care and trauma care skills of health care providers of
The committee recommends a provision that would require the Secretary of Defense to implement measures to improve and maintain the combat casualty care and trauma care skills for health care providers of the
Adjustment of medical services, personnel authorized strengths, and infrastructure in military health system to maintain readiness and core competencies of health care providers (sec. 735)
The committee recommends a provision that would require the Secretary of Defense to implement measures, within 180 days of the date of enactment of this Act, to maintain the critical wartime medical readiness skills and core competencies of health care providers within the Armed Forces. The provision would require the Secretary to implement a measure to ensure the military Services do not substitute a medical specialty required for medical force readiness with another medical specialty. Additionally, the provision would require the Secretary to: (1) modify medical services; (2) reduce authorized strengths of military and civilian personnel; and (3) reduce or eliminate unnecessary infrastructure in the military health system such that military treatment facilities would provide only those services required to maintain the critical wartime medical skills and core competencies of health care providers and to ensure the medical readiness of the Armed Forces.
Moreover, this provision would require the Comptroller General of
In
The IDA report clearly showed that the military services' medical force authorized strengths exceed current operational medical force readiness requirements. The committee expects the Department to: (1) adjust downward the total medical force mix to coincide with rational and appropriate operational medical force requirements; (2) eliminate health care services provided in military treatment facilities that do not directly support operational medical force readiness and the medical readiness of the Armed Forces; and (3) eliminate excess infrastructure in military hospitals and clinics. In making these necessary adjustments, the Department should ensure eligible beneficiaries unable to receive health care services in military treatment facilities have access to high-value primary and specialty care services in the private sector.
Establishment of high performance military-civilian integrated health delivery systems (sec. 736)
The committee recommends a provision that would require the Secretary of Defense, by
The committee believes that implementation of this provision would improve health outcomes and enhance the experience of care for beneficiaries as local military treatment facilities create strong synergistic relationships with private sector health systems to form integrated high performance health systems. These formal relationships would foster innovation in military treatment facilities, enhance operational medical force readiness, improve access to specialized medical care, and strengthen care coordination through integration of all activities of these new health delivery systems.
Contracts with private sector entities to provide certain health care services at military treatment facilities (sec. 737)
The committee recommends a provision that would require the Secretary of Defense to enter into centrally-managed, performance-based contracts with private sector entities to augment the delivery of health care services at military treatment facilities with limited or restricted ability to provide services such as primary care or expanded-hours urgent care. Under this provision, contracts would be designed to purchase improvement in health outcomes for covered beneficiaries seeking health care services in military treatment facilities.
The provision would require the Secretary to submit a plan to the Committees on Armed Services of the
Modification of acquisition strategy for health care professional staffing services (sec. 738)
The committee recommends a provision that would amend section 725(a) of the Carl Levin and Howard P. "Buck" McKeon National Defense Authorization Act for Fiscal Year 2015 (Public Law 113-291), which would require the
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