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FrontMatter -- Reviewers -- Acknowledgments -- Contents -- Summary -- 1 Introduction -- 2 TRICARE Beneficiaries and Mental Health Issues in Military Families -- 3 Requirements Related to the Practice of Counseling -- 4 Independent and Supervised Practice of Counselors in Other Health-Care Systems -- 5 Research Regarding the Determinants of High-Quality Mental Health Care -- 6 Findings, Conclusions, and Recommendations -- Appendixes -- Appendix A: Public Meeting Agendas -- Appendix B: Additional Demographic Information on the TRICARE Beneficiary Population -- Appendix C: Definition of Terms Used in This Report -- Appendix D: Excerpts from 32 CFR 199.6: Selected Subsections Regarding the Practice of Authorized Mental Health Providers Under TRICARE -- Appendix E: Excerpts from Army Regulation 40-68: Selected Subsections Regarding the Scope of Practice and Supervision of Licensed Counselors -- Appendix F: Case Summary Illustrating the Complexity of Mental Health Issues in the Military Population -- Appendix G: State Laws and Regulations Regarding the Practice of Counselors as of November 2009 -- Appendix H: Biographic Sketches of Committee Members, Consultant, and Staff.

Other written product issued by the General Accounting Office with an abstract that begins "This report provides information on the legal requirements for recognizing and recording obligations under the Defense Health Program (DHP), specifically focusing on (1) the legal basis for obligations incurred by TRICARE Management Activity for, among other services, medical services provided directly by the Department of Defense (DOD) to beneficiaries as well as medical services provided by civilian contractors who subsequently bill DHP for those services, (2) the legal basis for obligations for costs of change orders or other negotiated settlements, and (3) whether the Antideficiency Act applies to DHP obligations and expenditures. GAO held that (1) DOD 's practices in obligating funds are consistent with federal regulations, (2) DOD should record obligations for change orders against the appropriation current at the time the services are rendered, and (3) DOD may enter into obligations in excess of available resources, but it must obtain appropriations sufficient to liquidate those obligations."

A letter report issued by the General Accounting Office with an abstract that begins "Testifying before Congress in 2002, military beneficiary groups and civilian managed care support contractors described problems with the processing of TRICARE claims for civilian-provided care. These problems included slow payments and procedures that made claims processing inefficient. The Bob Stump National Defense Authorization Act of 2003 required GAO to review improvements to TRICARE claims processing and continuing impediments to claims processing efficiency. Specifically, GAO describes (1) efforts to improve claims processing and changes in processing timeliness and (2) Department of Defense (DOD) procedures and data that continue to affect claims processing efficiency. To identify improvements to claims processing and impediments to processing efficiency, GAO analyzed 1999 and 2002 claims data for changes in processing timeliness. GAO also interviewed and analyzed claims processing documentation from DOD officials, managed care support contractors, and claims processors."

Testimony issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO discussed opportunities to reduce claims processing and other costs of the Department of Defense's (DOD) managed health care program--TRICARE, focusing on: (1) the cost of processing TRICARE claims; (2) opportunities that potentially can reduce costs and improve service to beneficiaries, namely increased anti-fraud efforts and more joint procurement of pharmaceuticals and medical supplies with the Department of Veterans Affairs (VA); and (3) the process beneficiaries use to make medical appointments."

Testimony issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO discussed proposed changes and improvements to the military health system (MHS), focusing on: (1) the various proposals to expand the military health care benefit, especially those for older retirees, including describing the nature of the enhancement, the present or potential challenges in implementing these proposals, and overall cost implications; (2) the broader perspective of the appropriate size and structure of the military health system; and (3) the obstacles that impede improvements in the TRICARE program, particularly in terms of accessing appointments and claims processing."

TRICARE provides health care benefits to nearly two million children of active duty, retired, National Guard, and reserve service members. Child health advocates and congressional reports have raised questions regarding the adequacy access to care for children with military health benefits, particularly children with special health care needs (CSHCN). The objective of this study was to compare the health care experiences of CSHCN in TRICARE with those of CSHCN with other sources of health insurance. A cross‐sectional analysis comparing unmet health care needs among CSHCN with TRICARE versus CSHCN with other sources of health insurance using nationally representative data from three years of the National Survey of Children's Health (NSCH), 2016‐2018. The NSCH includes a broad range of questions related to child health and health care to provide national level estimates, and the data allow for comparisons between insurance coverage groups and TRICARE. The survey data contain responses from over 100,000 parents or primary caregivers (parents) of children, representative of over 73 million children annually. This includes 804 children who were representative of approximately 367,000 CSHCN covered by TRICARE annually. Children with special health care needs. Overall, 21 percent (95% CI 19‐24 percent) of parents of children covered by TRICARE reported their child had a special health care need, compared to 16 percent of children with commercial insurance (95% CI 15‐16 percent) and 24 percent of children with public insurance (95% CI 23‐25 percent). Eight percent of parents of CSHCN covered by TRICARE (95% CI 4‐16 percent) reported any unmet health care needs in the prior 12 months, compared to 4 percent of CSHCN with private insurance (95% CI 4‐5 percent) and 9 percent of CSHCN with public insurance (95% CI 8‐11 percent). Among specific needs, 3 percent or fewer CSHCN covered by TRICARE had unmet needs for medical, dental, vision, hearing, or mental health care. Similarly, 5 percent or fewer reported difficulty or ...

A letter report issued by the General Accounting Office with an abstract that begins "Testifying before Congress in 2002, military beneficiary groups described problems accessing care from TRICARE's civilian medical providers. Providers also testified on their dissatisfaction with the TRICARE program, specifying low reimbursement rates and administrative burdens. The Bob Stump National Defense Authorization Act of 2003 required GAO to review the oversight of the TRICARE network of civilian providers. Specifically, GAO describes how the Department of Defense (DOD) oversees the adequacy of the civilian provider network, evaluates DOD's oversight of the civilian provider network, and describes the factors that have been reported to contribute to network inadequacy. GAO analyzed TRICARE Prime--the managed care component of TRICARE. To describe and evaluate DOD's oversight, GAO reviewed and analyzed information from reports on network adequacy and interviewed DOD and contractor officials in 5 of 11 TRICARE regions."

Testimony issued by the General Accounting Office with an abstract that begins "This testimony discusses lessons learned from the Department of Defense's (DOD) TRICARE contracts and their implications for the future. TRICARE's successes and maturity reflect the ability of the DOD and its contractors to work within the current contract structure. However, it has not been easy, and there are important lessons from current contract shortcomings that need to be addressed in designing future TRICARE contracts. Most, including DOD, believe that the current contracts are too large, complex, and prescriptive in nature, limiting innovation and competition. Also, numerous adjustments to these contracts have created an unstable program, and program costs have been difficult to predict, contributing to annual funding shortfalls. Additionally, financial incentives, accountability, and data quality need to be strengthened to achieve greater efficiencies. To address these weaknesses, DOD redesigned its solicitation for the next round of TRICARE contracts; however, the initial issuance was withdrawn because of internal concerns and reservations about its costs and specifications. DOD is now reassessing how to structure the TRICARE contracts and is considering the views and recommendations of the Defense Medical Oversight Committee, a group formed to oversee TRICARE."

A letter report issued by the General Accounting Office with an abstract that begins "Under TRICARE, the Department of Defense's (DOD) managed care program, military-operated hospitals and clinics are supplemented by contracted civilian services. Since the inception of TRICARE, DOD has made many changes to these contracts via contract change orders. Since July 1997, when GAO reported that DOD was trying to improve its change order process, the backlog of change orders has continued to grow. This report evaluates (1) the status of the change order backlog and how DOD addressed it, (2) factors that contributed to the growth of the backlog, and (3) DOD's new initiative to improve the change order process. GAO found that as of June, 2000, the number of change orders issued had almost tripled, while the number of unsettled change orders had more than doubled since July 1997. Despite recommendations to devote high-level attention to managing improvements to the change order process, this was not done. Until recently, none of TRICARE Management Activity's (TMA) many initiatives significantly improved the process or reduced the backlog. The current small backlog is the result of recent concerted effort, not better management over time. TMA's new Change Management Process (CMP) appears to address many of TMA's problems with change orders. However, past initiatives have made similar promises and delivered little when they were abandoned or eclipsed by higher priorities. The high volume of change orders now or soon to enter the new CMP makes it imperative that TMA management closely monitor the process to prevent future backlogs."