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                                  Next Generation of TRICARE

                                  Provider Contracts Forthcoming

                                  Defense    Health   Agency    n  Minimize Transition Disruptions — TRICARE
                                  (DHA) is in the final process    contractor transitions have a history of issues of
                                  of  development  of  a  Request   delayed referrals, claims processing, and customer
                                  for Proposals (RFP) for the      service. We have urged DHA and Congress to
                                  fifth-generation  of  man-       ensure minimal disruptions due to the changes.
                                  aged-care support contracts for
             Michael P. Hughes,   the TRICARE health services   n  Shield Beneficiaries from Higher TRICARE Costs
                OSC, USNR (ret)   program. This is commonly        — There are concerns that the new T- 5 construct
              NERA Vice President  known as T-5. These contracts   could, at least in the short term, result in signifi-
                                  are particularly important as    cant cost increases for TRICARE. Rising costs are
            legislatively-directed military medical facility restructur-  historically a main reason used to justify TRICARE
            ing and medical billet cuts proposed by the services are   fee increases. NERA and the TMC are adamantly
            likely to move many beneficiaries to the civilian sector for   opposed to shifting health care costs to beneficiaries,
            care through TRICARE.                                  particularly if the increases are a result of contract
            The latest RFP will deliver health care services for military
            personnel, retirees and dependents enrolled in TRICARE   n  Maintain Robust Provider Networks — With each
            in the United States. Healthcare for those overseas will be   contract transition we have already seen reduced
            provided through a separate contract. Separate contracts   provider networks in certain geographic areas as
            will be issued for the East and West TRICARE regions.   contractors have cut provider reimbursements to
            They must be separate and distinct contractors and one   compete. This has resulted in less timely care and
            contractor can not be awarded both contracts. The con-  extreme wait times in some specialty care areas.
            tracts are proposed to be for eight one-year options.  NERA and the TMC have expressed concern that
                                                                   DHA and Congress ensure that the new manage
            The current TRICARE West contract is held by Health    care support networks in TRICARE remain viable
            Net Federal Services, LLC, a subsidiary of Centene     to maintain access to care and provide high qual-
            Corporation. The  TRICARE East contract is held by     ity providers.
            Humana Military Health Services Inc., a subsidiary of
            Humana Inc. Both current contracts are for shorter peri-  n  Improve Access to Mental Health Care — An
            ods than the new eight year contracts.                 August 2020 DoD Inspector General (IG) report,
                                                                   Evaluation of Access to Mental Health in the
            NERA and our partners of The Military Coalition        Department of Defense, confirmed reports from
            (TMC) support the intentions to improve access to care,   TMC member organizations of significant barriers
            health outcomes, the quality of care and patient outcomes   for beneficiaries access to mental health services.
            through these new contracts, but based on previous expe-  We are recommending that DHA and Congress
            rience with TRICARE contract transitions there are con-  ensure the recommendations of the IG report are
            cerns and risks which we have forwarded to the appropri-  carried out.
            ate congressional oversight committee chairs and ranking
            members. Following is a brief synopsis of these concerns:

                If you have concerns or issues you would like NERA to address please let me
               know. My email is [email protected] and my cell is 443-812-9591 or you can send
             mail to my attention at NERA national headquarters. I welcome all suggestions.

                                                                                        The Naval Enlisted Reserve Association 5
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