RAO Bulletin Update
October 1, 2006

THIS BULLETIN UPDATE CONTAINS THE FOLLOWING ARTICLES:

NDAA 2007 UPDATE 12:  
Work continues on the 2007 Defense Authorization Bill (S. 2766/H.R.5122).  While information on progress in the conference committee remains tightly held, conversation with conferees and congressional staff indicates that the steep increase in TRICARE fees proposed by DoD has been rejected.  However, it is reported that language dealing with pharmacy issues remains under negotiation.  The House bill contains a provision to increase pharmacy costs from $3 to $6 for generic drugs and from $9 to $16 for brand name.  The Senate language would keep copays at current levels.  Also at stake in the conference is advance on the SBP/DIC offset, military pay raises, concurrent receipt changes and a number of other issues important to veterans. Though most of the bill apparently has already been settled, nothing is finished until the conference report is filed. 
     It appears that the House provision on providing postal assistance to families with loved ones overseas may not make the final cut.  The provision would help families and friends with troops deployed in Iraq and Afghanistan get limited free mail privileges to send letters and care packages to those defending our freedom. Although a letter or package from home is always appreciated by troops stationed overseas, lifting morale and bringing a welcomed reminder of home this does not seem sufficient to allow approval.  Evidently, DoD and the Senate think there is a possibility that the free postage could result in transportation complications due to the upswing in mail that would result from the proposal. 

     From an article in USA TODAY, it appears that the chairman of the Senate Armed Services Committee Sen. John Warner (R-VA) has rejected House Speaker Dennis Hastert (R-IL-14) and Sen. Bill Frist (R-TN) effort to add amendments to his bill on Military Pay. Hastert wanted to add an amendment to the NDAA that would allow all judges to carry handguns and another amendment that pertained to Homeland security. First wanted to add an amendment that would curb internet gambling. Among other things Warner said in a memo to Frist that he is "Firmly Opposed" to including unrelated items to the Defense Bill. Hastert's spokesman said that after agreeing in July to remove the court security provisions from the Child Protection and Safety Act, the speaker received a promise from the Senate leadership that the legislation would be added to a legislative vehicle prior to the November elections. With Hastert sticking to his guns, the defense authorization bill appears primed to be delayed into November's lame-duck session

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NDAA 2007 UPDATE 13:
The House and Senate conference committee on 21 SEP agreed to a final version of H.R. 5631, the Defense Appropriations bill and on 26 SEP voted overwhelmingly, 394-22 to approve the final version. Acceding to reported pressure from the White House to limit any cuts in the Presidents request, the final amount of $447.6 billion includes $70 billion in emergency supplemental spending for the wars in Iraq and Afghanistan. Additionally the bill includes a continuing resolution that will fund programs in bills not completed by the start of the new fiscal year on 1 OCT. This measure, known as a “stop-gap” will fund those programs at their 2006 levels through 17 NOV. Delay is anticipated since Congress will recess for the NOV elections. The conference report was completed on 25 SEP and the Senate passed 100-0 the Defense Appropriations Act, which the House had already approved earlier in the week. The measure now goes to the President for signature into law. For defense, this action represents one-half of the equation. Yet to be completed is passage of the 2007 National Defense Authorization Act.

An initial scan of the Preliminary Appropriations Compromise Report received by NAUS indicates:

• There are provisions in the bill to stop any DoD requested Tricare enrollment fees or pharmacy co-pay increases. This favorable action is only in place for the new fiscal year and it is expected to be brought up again by DoD next year.
  
• It restricts unscrupulous lending practices by imposing 36-percent annual interest rate cap on loans to servicemembers, along with other It provides a 2.2% pay raise for military personnel vice the 2.7% sought.  This is the  smallest military pay raise in more than a decade.
  
• It does not mention the SBP/DIC Offset or the "paid-up" provision for SBP for those 70 years and older and who have paid premiums for 30 years or more.
  
• There is no mention of the Mail Voucher provision that would provide a monthly postal benefit to families with loved ones overseas in combat or recovering from wounds as a result of actions in Afghanistan or Iraq.
  
• It contains changes to improve Tricare benefits for Guard and Reserves.
  
• It dropped the Senate-recommended provision to provide full, immediate concurrent receipt for disabled retirees designated "unemployable" by the VA.
  
• It dropped the Senate-recommended provision to reduce retirement age by 3 months for every 90 days mobilized since 9/11.
  
• It dropped Senate-recommended provision requiring additional incentive payments to doctors to take TRICARE patients in areas with physician shortages.
  
• It provides $400,000 free SGLI coverage for members assigned to Iraq and Afghanistan.
  
• It authorizes permanent ID cards for permanently disabled dependents of retirees, and requires a Pentagon report on giving members an option to have their Social Security numbers removed from ID cards
  
• It makes all drilling reserve members eligible for Tricare coverage at the lowest current premium (28% of cost) and requires a Pentagon study of partially subsidizing continuation of a private employer's coverage of family members during periods of mobilization.
  
• It dropped a proposal to mandate use of the mail-order pharmacy for all refills of maintenance medications.
  
• It dropped initiatives to eliminate copays for most drugs dispensed through the mail-order system and to require drug companies to give TRICARE equal price discounts on drugs dispensed through retail pharmacies. 

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VA CLAIM DENIAL UPDATE 01:
A new case decided on 27 JUL 06 by the U.S. Court of Appeals for the Federal Circuit could have negative ramifications for veterans and their dependents.  The Court held that "where the veteran files more than one claim with the VA Regional Office at the same time, and that office's decision acts (favorably or unfavorably) on one of the claims but fails to specifically address the other claim, the second claim is deemed denied, and the appeal period begins to run."  The case was Andrews v. Nicholson, 421 F.3d 1278 (Fed. Cir. 2005)] which can be viewed at www.fedcir.gov/opinions/05-7155.pdf. This means, in contravention of 38 U.S.C. Sec. 5104 and 38 U.S.C. Sec. 3.103, that:

• VA does not have to provide the claimant with notice of the claim or claims that have been deemed denied or the reasons for the denial; and
  
• The period in which to submit a notice of disagreement with the claims deemed denied begins to run from the date of the decision on any of the other simultaneously submitted claims; and
  
• An unrepresented or poorly represented claimant could have the time to appeal the deemed denied claims run out without even knowing that the claims had been denied!

The new ruling also puts in question existing sections of 38 U.S.C. which state:

1. In the case of a decision by the Secretary under section 511 of this title [38 USCS § 511] affecting the provision of benefits to a claimant, the Secretary shall, on a timely basis, provide to the claimant (and to the claimant's representative) notice of such decision. The notice shall include an explanation of the procedure for obtaining review of the decision.
   
2. In any case where the Secretary denies a benefit sought, the notice required by subsection (a) shall also include (1) a statement of the reasons for the decision, and (2) a summary of the evidence considered by the Secretary.
   
3. Statement of policy. Every claimant has the right to written notice of the decision made on his or her claim, the right to a hearing, and the right of representation. Proceedings before VA are ex parte in nature, and it is the obligation of VA to assist a claimant in developing the facts pertinent to the claim and to render a decision which grants every benefit that can be supported in law while protecting the interests of the Government. The provisions of this section apply to all claims for benefits and relief, and decisions thereon, within the purview of this part 3.
   
4. The right to notice -- (1) General. Claimants and their representatives are entitled to notice of any decision made by VA affecting the payment of benefits or the granting of relief. Such notice shall clearly set forth the decision made, any applicable effective date, the reason(s) for the decision, the right to a hearing on any issue involved in the claim, the right of representation and the right, as well as the necessary procedures and time limits, to initiate an appeal of the decision.  

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VA DATA PRIVACY BREACH UPDATE 25
The stolen desktop computer containing sensitive data on about 16,000 patients at Veterans Affairs Department medical centers has been recovered, and a suspect has been arrested.  Washington DC resident 21 year old Khalil Abdullah-Raheem was charged in federal court 13 SEP with the theft of government property and released on a $50,000 personal recognizance bond, according to the VA Inspector General’s Office. Abdullah-Raheem was employed by a company that provides temporary labor to VA contractor Unisys Corp. Unisys was hired by VA to assist in insurance collections for various VA medical centers.  Officials do not believe Abdullah-Raheem targeted the data, but the FBI is conducting a forensics analysis to determine if the data was compromised. The computer, owned by Unisys, contained insurance claim information for about 16,000 living patients treated in VA medical centers in Pittsburgh and Philadelphia. The computer just recovered was not encrypted.

      VA Secretary James Nicholson praised the investigative work of the IG and the FBI. Senate Veterans’ Affairs Committee Chairman Larry Craig, R-Idaho, called the recovery a shining moment for both organizations. Craig said, “This is the second time law enforcement has come through. Let’s hope there is no need for a third time.” The computer was stolen from a Unisys facility in Reston, VA. Abdullah-Raheem was working there temporarily as a building maintenance employee. The company had been offering a reward of up to $50,000 for information leading to the equipment’s recovery.  Investigators think the computer was taken in order to record music. Since a separate early May incident endangering personal information on 26.5 million veterans, Nicholson has vowed to make VA’s information security the best in the government by instituting a series of reforms of what critics say is a dysfunctional IT organization. One month ago, the VA announced that it will begin encrypting all agency computers through a $3.7 million contract to Systems Made Simple Inc. in Syracuse, N.Y. All agency laptops were to be encrypted by 15 SEP 06.  As of 26 SEP VA had installed encryption software on nearly 15,000 laptop computers.  In testimony before the Senate Veterans' Affairs Committee the department's acting chief information officer Robert Howard, said this represents most of VA's laptops. However,  his office was unable to encrypt fewer than 100 laptops because they would not accept software from GuardianEdge, a San Francisco-based data security company and these will not be used until they are properly secured. Desktop computers are next on the list for encryption.

VA RETRO PAY PROJECT UPDATE 03:
Retirees do not need to apply. All retirees who may be eligible for additional money are expected to be identified by 1 OCT 06. Once all eligible retirees have been identified, DFAS will publish a general schedule on their Web site. DFAS says a small group of disabled military retirees in SEP will be the first of 133,000 to receive lump-sum back payments, which are tied to start-up challenges for two concurrent receipt programs enacted since 2003.  The trickle of back payments will become a small geyser at the end of October. By then, officials say, another 40,000 retirees will see their catch-up payments deposited electronically in their bank accounts by either the VA, DFAS or by both.  Back payments will vary in size from several hundred dollars up to $10,000 or more. The average payment, by one estimate, will be $3700. Almost all retirees in line for the back pay served 20 or more years and all have disabilities that made them eligible for Concurrent Retirement and Disability Pay (CRDP) or Combat-Related Special Compensation (CRSC).

     DFAS’ deputy director for operations Pat Shine said that a majority of the back payments will be made within the next six months, with DFAS focusing first on older cases.  It could take up to six more months to calculate and pay the most complex retro pay file. These involve multiple VA rating adjustments since CRSC and CRDP began, shifts by retirees between these two types of payments, ex-spouse pay entitlements and any other issues that requires lengthy record searches.  DFAS officials are calling the $500 million back pay effort the "VA Retro Pay Project." A VA Retro Award hotline at 1(877) 327-4457. has been set up by DFAS to field questions M-F  08-1600 EST from CRSC and CRDP recipients who believe they might qualify. DFAS has also assembled a Frequently Asked Questions page on its Web site. It can be found at www.dod.mil/dfas/retiredpay/frequentlyaskedquestions/retroactivepaymentofcrscandorcrdp faqs.html.By late SEP, DFAS officials hope to have posted a detailed explanation of the back pay program on its website at: www.dod.mil/dfas.  The assistant director for policy with VA's Compensation and Pension Service in Washington D.C., Thomas J. Pamperin said, "We have been working with DFAS for almost 18 months. The back pay issue is something where neither one of us can do it by ourselves. We need a lot of information exchanged.  DFAS and VA now are testing files that have been transferred back and forth between us. We are going to have a final test the last week in September to make sure that all the [software] logic is working to identify eligible retirees and calculate retro payments."

     VA figures to pay 80% of money owed. Some retirees will receive two checks, one from the VA and another from DFAS. Before payments are deposited, affected retirees will get letters explaining reasons for the back pay and how the amounts were calculated.  Most of the shortfalls resulted from VA withholding too much disability compensation after CRSC and CRDP began. Traditional VA and DFAS rules on withholding failed to take account of changes to concurrent receipt law. This resulted in a situation where people's entitlement to disability pay had a [start] date prior to the date we actually started paying it. The pay shortfalls can be blamed in part on the considerable complexity of CRDP and CRSC. Congress designed the programs to alleviate, but only for certain career retirees, a century-old ban on concurrent receipt of both military retirement and VA disability compensation.  Until CRSC began on 1 JUN 03 and CRDP began on 1 JAN 04 all military retirees with service-related disabilities had to accept a dollar-for-dollar reduction in taxable retired pay in order to receive tax-free VA compensation for their service-related injury or illness.  CRSC allows retirees with at least 20 years of service to receive tax-free pay to replace any offset in taxable retired pay required on receipt of VA disability compensation. For CRSC, retirees must have combat-related injuries or ailments and apply to their service to establish eligibility.  CRDP, on the other hand, is paid automatically if the retiree served 20 years and has service-related disabilities rated 50 percent or higher by VA. The full CRDP is being phased in for most of its 170,000 recipients, adding another layer of complexity to the back payment effort. Retirees can be eligible for both CRSC and CRDP but can receive only one.

     Before these programs took effect, Shine said, VA and DFAS didn't need to worry about tracking retroactivity of payments. When a retiree's VA rating was approved or raised, VA knew to withhold the additional compensation from the retiree until it got word from DFAS that military retirement had been reduced. This avoided government overpayments. Retirees impacted by such withholding simply notified the IRS, on their next tax return, to treat any portion of their retired pay received after their VA benefits kicked in as non-taxable compensation.  This arrangement between VA and DFAS no longer worked after CRSC and CRDP took effect and indeed it created compensation shortfalls. Of 220,000 retirees now drawing one of these payments, 60% are owed back pay, and most can of that be traced to over withholding by VA. Retirees who received retroactive pay in SEP represent the sampling of files that DFAS and VA used test their revised pay software and data exchange processes. Back payments owed to the remaining 133,000 retirees have been separated by levels of difficulty. The easiest to calculate, using only computers, are 40,000 files prepared for OCT 06 delivery to VA.  VA back payments will be made near the end of the month. DFAS can make batches of back payments weekly, starting in October. "Our target is to get the majority of the [back pay] population done within six months," said Shine. "But we also recognize that, because some of these cases are just a lot more difficult and involved, it could take as much as 12 months to get all payments completely satisfied. To be eligible, you must:

• Be a military retiree (Army, Navy, Air Force or Marine Corps); and
  
• Meet all the requirements for either CRSC or CRDP eligibility; and
  
• Have received payment(s) of either CRSC on or after 1 JUN 03 for CRSC and/or CRDP on or after 1 JAN 05; and
  Have been awarded one or more increase(s) in your percentage of disability by the VA on or after 1 JUN 03.

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CERVICAL CANCER UPDATE 01:
Women patients at Walter Reed Army Medical Center can now get vaccinated against certain subtypes of the virus that can lead to cervical cancer, a deadly cancer in women. Walter Reed is one of the first military hospitals to begin using a Food and Drug Administration-approved “breakthrough” vaccine that can be administered to women ages 11 to 26 to protect them against human papillomavirus (HPV) type 6, 11, 16, and 18. The vaccination is offered in the Pediatric Clinic and the Allergy and Immunology Clinic. Vaccinating against HPV type 6, 11, 16, and 18 is a three-step process given over a six-month period. The HPV vaccine is only effective for patients who don’t have an active ongoing HPV infection in one of the effected strains.  However it’s not likely that if you’re infected with one, you’re infected with all four, so it’s still effective against three of the four even if you have one of the strains. HPV infection is not necessarily an indication that an infected woman will get cervical cancer. If infected it’s very common that it will regress on its own within six to 12 months. If it does go away you can then get vaccinated against it. It’s the HPV infections that don’t go away; those which are persistent, that cause doctors to be particularly concerned. Persistence can lead to cervical dysplasia, or abnormal cells on the cervix which can lead to pre-invasive cervical cancer and invasive cervical cancer.

     Regular gynecological exams are important for early detection and potential treatment of cervical cancer. Women who have regular Pap tests are least likely to get cervical cancer, according to the American Cancer Society. Cervical cancer can result in loss of fertility, because it requires either the removal of the uterus or treatment with chemo radiation. Genital warts are a physically and socially debilitating disease in the sense that when somebody gets tagged with the moniker of having warts, not only are they visible, but it’s psychologically impairing to the patient. The vaccine that can prevent 90% percent of all vulvar warts.  Parents with teenage daughters tend to become defensive when the vaccination option is offered for teenage girls. They insist their daughters aren’t having sex. But the denial is pointless, because the vaccine can protect them whether they are sexually active now or in the years to follow. Eighty-five percent of all college-aged students and high school seniors have been or are currently sexually active.

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TFL CLAIM PROCESSING UPDATE 03:
Military associations received word on 24 SEP that the Tricare Management Activity (TMA) has postponed implementation of a policy that would deny claims from beneficiaries who enter into private contracts with providers who have opted out of Medicare. Certain providers are allowed to “opt out” of Medicare for a period of two years and enter into private contracts with their patients who are Medicare-eligible beneficiaries. When a provider “opts out” of Medicare, Medicare will not make any payment to the provider or the beneficiary except for services provided in an emergency/urgent care situation. A private contract must be signed by both parties prior to delivery of services, and must include the following statements:

• The beneficiary (or legal representative) agrees not to bill Medicare or to ask the provider to bill Medicare for services.
• The beneficiary (or legal representative) agrees to give up any Medicare coverage and payment for services furnished by the opt-out provider, even though the services may have otherwise been covered by Medicare.
• The beneficiary (or legal representative) agrees to be liable for the full billed amount without regard to any limits that would otherwise apply under Medicare.
• The beneficiary acknowledges that Medigap plans will not make payments to opt-out providers, and other supplemental plans may elect not to make payment.

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VA DISABILITY & SSDI
In a recent statement made to the Veterans’ Disability Benefits Commission, Allison Percy, principal analyst at the Congressional Budget Office (CBO), reported only 15% of veterans who are receiving VA disability compensation also receive Social Security Disability (SSDI). Federal law grants disability payments through the Social Security Act on top of veterans disability benefits. Disabled veterans are the only group of individuals who are permitted to receive SSA disability in addition to Veterans Administration disability benefits. Ms. Percy invited the Veterans Disability Benefits Commission to provide the answers on the following since there is no data available:

• The extent to which SSDI payments are received by veterans with service-connected disabilities rated at 100% or by those with lower-rated service-connected disabilities who also have additional disabilities unrelated to their military service
  
• The likelihood that veterans will receive both types of payments depending on the type of disability.

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TRICARE RESERVE SELECT UPDATE 05:
On October 1 TRS will begin Tiers 2 and 3 coverage of this three their program. The tiers will cover all members of the National Guard and reserves at different levels of premiums depending on the member’s status and their access to other health insurance.  These are:

• Tier 1 for those who deploy for a contingency operation and are entitled to participate at a cost share of 28/72 (those previously eligible for TRS);
• Tier 2 for those who are unemployed or are not offered employer sponsored health care, are now eligible to participate at a cost share of of 50/50; and
  
• Tier 3 for all others at a cost share of 15/85.

Full activation of the program now makes nearly all members of the Selected Reserve eligible for military Tricare coverage. TRS features are:

1. Comprehensive health care benefits with covered benefits of Tricare Standard and Tricare Extra cost sharing, deductibles, and catastrophic caps that apply to active-duty family members (including the TRS member, him/herself)
   
2. Two types of coverage - TRS member-only coverage & TRS member and family coverage
   
3. Worldwide availability (as long as you continue in the SelRes under a TRS Service Agreement)

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VA MENTAL HEALTH FUNDING:
The Department of Veterans Affairs (VA) provides mental health services to veterans with conditions such as post-traumatic stress disorder (PTSD) and substance abuse disorders. To address gaps in services needed by veterans, VA approved a mental health strategic plan in 2004. VA planned to increase its fiscal year 2005 allocations for plan initiatives by $100 million above fiscal year 2004 levels. VA also planned to increase its fiscal year 2006 allocations for plan initiatives by $200 million above fiscal year 2004 levels---composed of $100 million for continuation of fiscal year 2005 initiatives and an additional $100 million identified in the President’s fiscal year 2006 budget request. GAO was asked by Rep. Michael Michaud (D-ME) and Rep. Lane Evans (D-IL), to provide preliminary information on VA’s allocation and use of funding for mental health strategic plan initiatives in fiscal years 2005 and 2006. GAO reviewed VA reports and documents on mental health strategic plan initiatives and conducted interviews with VA officials from headquarters, 4 of 21 health care networks, and 7 medical centers. VA delegates decision making to its health care networks for most budget and management responsibilities regarding medical center operations, and medical centers receive most of their resources from the networks.

     According to Government Accountability Office (GAO) findings delivered to a House committee 28 SEP the Bush Administration failed to fully fund its promised $300 million to address gaps in access and quality of mental health services for veterans over the last two years.  Preliminary findings of the GAO study show that the VA actually budgeted only half (approximately $53 million) of the $100 million it had committed to mental health care initiatives in fiscal year 2005.  VA also claimed to allocate another $35 million in FY 2005 through a general fund, but GAO found VA did not notify networks that these funds were to be used for [mental health] plan initiatives and that medical center officials were unaware that any portion of their general allocation was to be specifically used for mental health strategic plan initiatives.  GAO said VA did not distribute the remaining $12 million of the promised $100 million because VA officials claimed there was not enough time to distribute the monies.  For fiscal year 2006, GAO found that VA failed to distribute all of the promised $200 million for additional mental health care staff, allocating only $92 million for new initiatives and $66 million to continue efforts from FY 2005.  GAO reported that it is unclear whether VA medical centers will actually spend all of the FY 2006 mental health care strategic plan funds.

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FEHBP PREMIUMS 2007
In JAN 07 federal employees will see their health insurance premiums rise an average of 2.3% -- a much smaller increase than in years past. Individual enrollees in the Federal Employees Health Benefits Program (FEHBP)will pay an extra $1.45 every two weeks for a total of $58.45. Those with family plans will pay $3.13 more for a total of $131.64, on average. And in the biggest plan, Blue Cross Blue Shield, premiums won't go up at all. They will even decrease under certain options. More than 50% of the 8 million FEHBP participants belong to Blue Cross Blue Shield. Local plans, such as those operated by health maintenance organizations, will get more expensive. Officials at the Office of Personnel Management (OPM), which oversees the FEHBP, said the primary reason for a lower premium hike this year is a more liberal use of reserve funds. Those are taken from participants' premiums each year and hoarded to cover unexpected medical costs.

     OPM Director Linda Springer said at a press briefing 26 SEP that the insurance companies themselves first floated the idea of dipping into reserves this year, and her financial team found the circumstances were right. OPM will use $500 million from an $11 billion pot of reserves -- less than 5%.  Springer said Performance was good enough, and OPM did not have to build the reserve.  However, Jacqueline Simon, public policy director for the American Federation of Government Employees said, “ The reserves are being used improperly. What we know is true is that enrollees' premiums will go up by more than the government's premiums. And the reason for that is that OPM manipulated the allocation of the so-called excess reserves to give themselves a greater subsidy." According to Nancy Kichak, OPM's associate director for strategic human resources policy, the government's contributions will go up 1.6% next year. That's smaller than the enrollee increase because of a technical matter involving timing differences in calculating the two portions.  Last year, enrollees had a 10% average premium increase, while the government's hike was 5.2%. Premium increases peaked in fiscal 2002, when they reached 12.7% between employees and the government. The last time they were this low was in 1997, when there was a 1.6% hike divided between enrollees and the government.  Federal employees and retirees will be able to pick their insurance plan for 2007 during open season, which starts 13 NOV.  About a week before that, OPM will post brochures on its Web site detailing costs and coverage in each plan. For the first time, current and retired federal employees will be able to choose supplemental vision and dental insurance during the open season. Biweekly premiums for family dental plans range from around $20 to $55 and feature 100% coverage for preventative dental work and varying coverage for other procedures. Family vision insurance will range from about $8 to $16 every two weeks. There is no government subsidy for the dental and vision insurance. Also for the first time, OPM is publicizing specific insurance plans that meet its standards for cost transparency. The 18 companies will let enrollees get cost information for certain procedures including cataract repair, caesarean birth and knee replacement to allow participants to shop for the best deal. OPM will feature the companies during open season.  [Source: GOVEXEC.com Daily Briefing 20 Sep 06]

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GI BILL INEQUITIES:
On 27 SEP MOAA President VADM Norb Ryan, Jr. (USN-Ret) represented MOAA and The Partnership for Veterans Education - a broad-based group of military, veterans and higher education associations at a Montgomery GI Bill (MGIB) hearing before two House Armed Services and Veterans Affairs subcommittees.  He recommended that Congress combine the reserve and active duty MGIB programs, which are now separately overseen, respectively, by the Armed Services and Veterans Affairs Committees.  Ryan highlighted that today's Reserve benefit is only 27% of the active duty benefit - down from 50% when it was first enacted.  He noted that Guard-Reserve members can only use their benefits while in service - which can negate much of the benefit in a high-mobilization environment. He likened the situation to a car out of alignment that might run the All-Volunteer Force into a ditch if not fixed.  Ryan proposed a total force GI Bill to better support recruiting, retention, and readjustment for all servicemembers.  The first witness, Sen. Blanche Lincoln (D-AR), promoted her bill to let activated reservists use their GI Bill benefits for 10 years following completion of service, just as active duty veterans already can.  Her measure was adopted in the Senate version of the defense authorization bill for fiscal year 2007 but it was dropped in final negotiations with the House.       Principal Deputy Assistant Secretary of Defense for Personnel and Readiness Mike Dominguez said DoD opposes any changes, saying education benefits aren't that important to reservists, and that he would rather spend money on equipment.  He took the position of dismissing any inequity, saying Guard/Reserve GI Bill upgrades are not a cost-effective way to support recruiting and retention. That did not go down well with the legislators, who expressed frustration that a year-long DoD study of consolidating the GI Bill was still not completed. Rep. Vic Snyder (D-AR), Ranking Minority Member of the Military Personnel Subcommittee, said he felt strongly about the Guard and Reserve inequity.  Many Guard and Reserve members have served two tours in Iraq, and he contrasted their relatively skimpy education benefit with the 45 months of GI Bill benefits he earned in the Vietnam era in return for 21 months of active service (including a 13-month deployment).  Snyder said he will introduce total force MGIB legislation and work to get it passed next year.  [Source: MOAA Leg Up 29 Sep 06 ++]

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TRICARE UNIFORM FORMULARY UPDATE 14:
A panel of beneficiary advisors has concurred with a DoD pharmacy panel's recommendation to move Crestor and Caduet, which lower so-called "bad cholesterol" (LDL), to Tricare’s "third tier" of medications. The change could affect about 44,000 beneficiaries.  Tricare will continue to cover 12 other cholesterol-lowering drugs, including the popular Lipitor and Zocor, at the lower $3 (generic) or $9 (brand name) copay. The proposed plan is to implement the change within 90 days. MOAA believes 90 days is not enough time to notify beneficiaries and allow them to discuss alternative options with their doctors. DoD provides beneficiaries no notice at all of such changes, but depends on military associations to spread the word.  But associations typically have 60-to-90-day lead times for their magazines, which makes timely notification impossible for most beneficiaries, even if they belong to an association.  The practical reality is that this prevents most affected beneficiaries from finding out about the change until they get charged $22.       Third-tier drugs can still be obtained at the regular $9 copay if the doctor specifies the drug is medically necessary for the patient (e.g., works better or avoids side effects associated with other drugs) and the medical necessity determination is approved by DoD. Dr. William Winkenwerder, Assistant Secretary of Defense for Health Affairs, will make the final decision on moving the drugs to the third tier. For more information, contact the Tricare Retail Pharmacy (TRRx) customer service line at 1(866) 363-8779. For the TRICARE mail order pharmacy (TMOP) call 1(866) 363-8667.  Information on both programs can be found at www.express-scripts.com/TRICARE. [Source: MOAA Leg Up 29 Sep 06 ++]

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TRICARE CATASTROPHIC CAP UPDATE 03
The Tricare Catastrophic Cap Resets on 1 OCT 06.  The catastrophic cap limits the amount of out-of-pocket expenses a family will have to pay for Tricare-covered medical services.  The cap applies to all covered services—annual deductibles, pharmacy copays, Tricare Prime enrollment fees and other cost shares based on Tricare-allowable charges. The cap applies to the fiscal/enrollment year (1 OCT to 30 SEP) and is a total amount per family.  The cap is $1,000 for active duty families and $3,000 per family for all other beneficiaries.  After you meet the catastrophic cap, Tricare will pay your portion of the Tricare-allowable amount for all covered services for the rest of the fiscal/enrollment year.  The cap does not apply to services not covered by Tricare or to any amount that nonparticipating providers may charge above the Tricare maximum allowable charge for services.  Tricare will not apply out-of-pocket expenses paid under the Prime point-of-service option (deductibles and cost shares) to the annual fiscal/enrollment year catastrophic cap.  The beneficiary is responsible for any point-of-service charges incurred both before and after meeting the catastrophic cap. For more information about the Tricare catastrophic cap, you may call your regional contractor, visit or call or visit a local beneficiary counseling assistance coordinator (BCAC) or Tricare service center.  A BCAC directory is available online at www.tricare.osd.mil/BCACDirectory.htm.  [Source: NAUS Weekly Update 22 Sep 06 ++]  

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GENERIC DRUG PRICES UPDATE 01:
Wal-Mart announced it is selling nearly 300 generic drugs for $4 per prescription, whether or not a customer has insurance.  The new pricing began 22 SEP 06 at Wal-Mart’s 65 stores in Tampa, Florida, and will be in place in all Florida stores in JAN 07, expanding to many more states by the end of 2007.  The $4 price is for a 30-day supply of many generic versions of popular prescription medications.  Insured customers will be allowed to pay the $4 per prescription price even if that is less than the co-payment required by their plan. The administrator of the federal Centers for Medicare and Medicaid Services, does not expect beneficiaries of the Medicare drug benefit (Part D) to switch because of the coverage for generics provided already by Part D plans.  He said that the Wal-Mart plan does provide a way for Medicare recipients to save money after they reach the "doughnut hole," the gap in annual drug costs at which Medicare does not subsidize these costs.  According to Wal-Mart, it started the program to help families and retirees, especially those on Medicare.  It is likely, however, that Wal-Mart is also banking on increased traffic in its stores to offset the substantially lower prices on some of the generic drugs on its list.  Stock prices for competitors CVS and Walgreen fell 7 and 8 percent respectively the day after Wal-Mart’s announcement.  Generic drugs continue to be available under Tricare for $3 per 30-day supply. However, a proposal under consideration at the conference committee on the 2007 National Defense Authorization Act would increase the price of generics to $6.  [Source: NAUS Weekly Update 22 Sep 06 ++]    

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HURRICANE SAFETY:
Have a good plan prepared when hurricanes threaten your area. Don't wait until your radio blares out a hurricane warning. There's a lot you can do to protect yourself, your family, your pets, and your home -- if you act in time. Last year’s devastation from Hurricane Katrina and Hurricane Rita has made more Americans appreciate the wrath of Mother Nature. The effects of that disaster brought home the message that these storms touch everyone's lives. One in six Americans live in a county on the Atlantic or Gulf coasts where hurricanes pose yearly threats. Even if we don't live in these areas, many of us vacation in areas of the U.S., the Caribbean, or Mexico where hurricanes habitually hit. Unfortunately, it may have taken the impact of Katrina and Rita to make people realize that riding out a hurricane is always a big mistake. In case of an emergency, TRICARE will provide you with up-to-date, critical information on TRICARE and DoD related matters that may affect your health benefits. Updates will include information gathered from a variety of sources, including other federal agencies and departments, state and local government, and the news and media. For tips on protecting your family and property visit: www.fema.gov/plan/index.shtm.  U.S. hurricane season runs from June through November. Mid-August to late October is peak season. 

Before Hurricane Season:

• Put together a disaster supplies kit. It should contain: 1) A first-aid kit. 2) Canned food & a can opener. 3) Three gallons of water per person. 4). Clothing, rain gear, and bedding or sleeping bags. 5) One flashlight per person, with extra batteries. 6) Any special items or medicines needed for infants or people with disabilities.
  
• Learn whether you live in a flood zone. Call your local emergency management or planning/zoning office to find out. If you are in a flood zone, it's a good idea to buy flood insurance -- normal homeowners' policies don't cover floods. Remember, most policies don't take effect for 30 days.
  Learn how to turn off your home's water, electricity, and gas. Don't turn the gas back on without professional help.
  
• If you live in a county near the coast, make sure your house is hurricane resistant. If you're not sure, have a licensed engineer check it.

During Hurrican Season Stay Informed:

• Get a weather radio and keep its batteries fresh. The National Weather Service suggests that people have a weather radio equipped with a Specific Area Message Encoder (SAME) feature. This automatically broadcasts an alert when there's hurricane information for your area.
  
• People with hearing or visual impairments can get weather radios that connect to strobe lights, pagers, bed-shakers, home computers, and printers.
  
• If you don't have a special weather radio, keep a battery-operated radio handy. Know how to tune it to a local station that broadcasts severe-weather warnings.
  
• Know what to listen for: A hurricane WATCH means that conditions are right for a hurricane to hit. It's time to check your hurricane preparations and review your evacuation plan.  A hurricane WARNING means a hurricane is expected to hit your area within 24 hours. Leave the area if local officials say to do so.

What to Expect:

• Hurricanes pack sustained high winds of 74 mph or more. Gusts can be much faster. Hurricane Camille in 1969 set the record for the highest wind speed ever to hit the Western hemisphere. It had sustained winds of 190 mph at landfall. Items such as toys left in the yard, signs, and construction materials become deadly missiles in hurricane-force gales.
  
• When a hurricane hits expect a storm surge (i.e. a dome of water topped by battering waves) to sweep the coastline the shore. At the water's edge, it's the greatest threat to life and property. Storm surges can be 50 or even 100 miles wide. A 15-foot storm surge is not unusual for a major storm.
  
• If it's high tide when a hurricane hits, the storm surge adds to the water's height. In 1989, Hurricane Hugo caused a 20-foot storm tide in South Carolina.
  
• Hurricanes carry lots of rain. These rains often cause flash floods, landslides, and mud slides hundreds of miles from the coast.  In 1969, Hurricane Camille dropped 27 inches of rain on Virginia causing severe flash floods that killed 150 people. Slow-moving hurricanes cause the most flooding.
  
• Hurricanes often spawn tornadoes far from the center of the storm.

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SOLE SURVIVING CHILD (ENLISTMENT):
Contrary to popular belief only sons, the last son to carry the family name, and sole surviving sons must register for the draft, they can be drafted, and they can serve in combat. However, they may be entitled to a peacetime deferment if there is a military death in the immediate family. Provisions regarding the survivors of veterans were written into Selective Service law after World War II. Details have varied over the years, but the basic premise remains the same; where a family member has been lost as a result of military service, the remaining family members should be protected insofar as possible.  It is important to keep in mind that the provisions are directly related to service-connected deaths. The mere fact that a man is the only child or only son does not qualify him for consideration - he must be the survivor of one who died as a result of military service.  The present law provides a peacetime exemption for anyone whose:

• Parent or sibling was killed in action, died in line of duty, or died later as a result of disease or injury incurred in line of duty while serving in the armed forces of the United States; or
  
• Parent or sibling is in a captured or missing status as a result of service in the armed forces during any period of time. This is known as the "surviving son or brother" provision. A man does not have to be the only surviving son in order to qualify; if there are four sons in a family and one dies in the line of duty, the remaining three would qualify for surviving son or brother status under the present law.  The surviving son or brother provision is applicable only in peacetime. It does not apply in time of war or national emergency declared by the Congress.

     The original law, passed in 1948, exempted the sole surviving son of a family where one or more sons or daughters died as a result of military service. No restriction existed at that time to limit the exemption to peacetime. The provision was intended to protect families which had lost a member in World War II.
In 1964, recognizing that sons of World War II veterans were reaching draft age, Congress changed the law to include the sole surviving son of a family where the father, or one or more sons or daughters, died as a result of military service. At this time the peacetime-only restriction was also added to the law.  A further change was made in 1971, expanding the exemption to any son, not necessarily the sole surviving son, of a family where the father, brother or sister died as a result of military service. This provision was recently expanded to include mothers.

     In addition to peace-time draft deferrment, DoD authorizes discharges for any son or daughter in a family in which the father or mother or one or more sons or daughters:

1. Have been killed in action or have died when serving in the U.S. Armed Forces from wounds, accident, or disease, or
2. Are in a captured or missing-in-action status, or
3.  Have a permanent 100% Service-related disability (including 100% mental disability), as determined by the Veterans' Administration or one of the Military Services, and are not gainfully employed because of the disability.

[Source: About U.S. Military Rod Powers article 26 Sep 06 ++]

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