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Text of Department of Defense Interim Final Rule: TRICARE Pharmacy Benefits Program Reforms

17 pages. "This interim final rule implements Section 702 of the National Defense Authorization Act for Fiscal Year 2018 [which] makes significant changes to the TRICARE Pharmacy Benefits Program, specifically it: [1] updates co-payment requirements; [2] authorizes a new process for encouraging use of pharmaceutical agents that provide the best clinical effectiveness by excluding coverage for particular pharmaceutical agents that provide very little or no clinical effectiveness relative to similar agents and for giving preferential status to agents that provide enhanced clinical effectiveness; and [3] authorizes special reimbursement methods, amounts, and procedures to encourage use or high-value products and discourage use of low-value products with respect to pharmaceutical agents provided as part of medical services from authorized providers."

GAO Report: Health Benefits Cost Comparison at Department of Defense Had Minimal Impact, but Needs Uniform Implementation Process

45 pages. "GAO, in response to a mandate, determined [1] how DOD implemented the [health benefit cost comparability provision in the 2005 Defense Appropriations Act], and [2] what impact the provision had on DOD's fiscal year 2005 competitive sourcing program." [GAO-06-72, published Dec. 5, 2005, released Dec. 9, 2005]

GAO Report: Cost Impact of Health Care Reform at the Department of Defense and the Extension of Dependent Coverage

15 pages. "Overall, DOD expects to incur minimal costs to implement the 21 [ACA] and [ Health Care and Education Reconciliation Act of 2010 (HCERA)] provisions with which department officials have determined it is required to comply. In particular, DOD officials estimated that 11 of the provisions could be implemented at no cost, and the estimated costs of complying with another third of the provisions are minimal because no new staff or significant additional resources will be required to implement them." [GAO-11-873R, Sept. 26, 2011]

Department of Defense Stresses Reserve Component Troops' Re-Employment Rights Under USERRA

Excerpt: National Guard troops, reservists and active duty military people can rest easy that their jobs will be waiting for them when they return from deployment. That is the message the U.S. Office of Special Counsel conveyed ... Passed in October 1994, the Uniformed Services Employment and Re-employment Rights Act is the tool the Office of Special Counsel wields to back up that statement.

Proposed Dept. of Defense Regs on Relationship between TRICARE and Employer-Sponsored Group Health Plans (PDF)

3 pages. Excerpt: This proposed rule implements Section 1097c of Title 10, United States Code. This law prohibits employers from offering incentives to TRICARE-eligible employees to not enroll, or to terminate enrollment, in an employer-offered Group Health Plan (GHP) that is or would be primary to TRICARE. Cafeteria plans that comport with section 125 of the Internal Revenue Code will be permissible so long as the plan treats all employees the same and does not illegally take TRICARE eligibility into account.

Defense Department to Extend Benefits to Same-Sex Spouses of Military Personnel (PDF)

"The Department will construe the words 'spouse' and 'marriage' to include same-sex spouses and marriages, and the Department will work to make the same benefits available to all military spouses ... [A]ll spousal and family benefits, including identification cards, will be made available to same-sex spouses no later than September 3, 2013."

Text of DOL Amicus Brief Asserting ERISA 404(c) Was Not Sufficient Defense in Suit Asserting Fiduciary Breach

Excerpt: The district court erred in applying ERISA section 404(c) as a defense to the Plaintiffs' claims that the fiduciaries breached their ERISA duties in maintaining the Motorola Fund as an investment option in the Plan. The statute and its regulations make clear that ERISA section 404(c) provides a limited exception from liability for losses 'which result from' a participant's or beneficiary's exercise of control over his individual account in an individual account plan.

Text of DOD Final Regs: TRICARE Pharmacy Benefits Program Reforms

"Section 702 of the National Defense Authorization Act for Fiscal Year 2018 ... made significant changes to the TRICARE Pharmacy Benefits Program; specifically it: [1] Updated co-payment requirements; [2] authorized a new process for encouraging use of pharmaceutical agents that provide the best clinical effectiveness ... and [3] authorized special reimbursement methods, amounts, and procedures to encourage use of high-value products and discourage use of low-value products with respect to pharmaceutical agents provided as part of medical services from authorized providers. This rule finalizes the changes made to the TRICARE Pharmacy Benefit Program[.]"

Audit of TRICARE Telehealth Payments (PDF)

32 pages. "The [Defense Health Agency (DHA)] improperly paid claims for FY 2020 telehealth services.... These improper payments occurred because the DHA did not have controls in place to prevent payment when the claims for originating site and distant site services were performed by the same provider, or when the beneficiary was not present at the originating site.... As a result of improperly paid telehealth claims, ... the DHA potentially overpaid health care providers for originating site fees by $620,162 from October 2019 through June 2020."

GAO Testimony: Observations on the Concurrent Receipt of Military Retirement and VA Disability Compensation

15 pages. "Three factors are important to weigh in deliberations on the merits of modifying the military offset provision. First, many benefit programs use offset provisions when individuals qualify for benefits from more than one program.... Second, the proposed modifications to the concurrent receipt provisions in the military retirement system would have implications not only for the Department of Defense's retirement costs but would also increase the demand placed on the Department of Veterans Affairs' (VA) claim processing system.... Third, such increased demand would come at a time when the VA disability program compensation, along with other federal disability programs, is facing the need for more fundamental reform." [GAO-03-575T, published Mar. 27, 2003, released Mar. 27, 2003]