This afternoon, President Clinton announced the Medicare
Demonstration of Military Managed Care, a demonstration that
will give military retirees improved access to military treatment
facilities.
DoD and the Department of Health and Human Services have
reached agreement on implementation details for this new
initiative that has the potential for multiple benefits. Such
benefits include: expanded health care options for military
Medicare-eligibles, an improved way for DoD to care for older
retirees and their family members, continued medical readiness
support, and savings for the Medicare Trust Fund by providing
health care to military Medicare-eligibles at a lower cost in the
Military Health Services System.
The demonstration's goal is to implement a cost-effective
alternative for delivering accessible and quality care to these
beneficiaries while not increasing the total federal cost for
either agency. Our Medicare and DoD dual-eligible beneficiaries
have long asked that they be able to use the Military Health
Services System as their Medicare provider. This demonstration
will help to establish whether this is a workable, affordable
option, stated Stephen C. Joseph, the assistant secretary of
Defense for Health Affairs.
Under the demonstration, the Medicare program will consider
the Military Health Services System similarly to a risk-type
health maintenance organization (HMO) for dual-eligible Medicare
and DoD beneficiaries. Medicare will pay for dual-eligibles
enrolled in DoD's managed care program, TRICARE Prime, after DoD
meets its current level of effort. That level of effort is
measured in terms of health care expenditures for the dual-
eligible population. Medicare will reimburse DoD at a discounted
Average Adjusted Per Capita Cost (AAPCC) rate, and the maximum
total Medicare reimbursement to DoD for any year will not exceed
$65 million.
This demonstration will cover four sites (San Antonio,
Texas, because of its two medical centers, plus three other
sites) in DoD TRICARE Region 6 and the Tacoma-Bremerton,
Washington, area in DoD TRICARE Region 11. Three additional
sites in Region 6 will be identified to serve as comparison
sites.
Eligibility for participation in this demonstration will
include people who meet all of the following criteria:
-- are eligible both for care from DoD and through
Medicare's aged program,
-- enroll in TRICARE Prime,
-- are covered by Medicare Part B,
-- agree to receive covered services only through
TRICARE,
-- are residents of the geographic areas covered by the
demonstration and where enrollment in the demonstration is
offered,
-- as dual-eligibles, used a military treatment
facility before July 1, 1996, or became dual-eligible
starting after June 30, 1996.
Enabling legislation is expected from the Congress this
year; and the demonstration will begin either 60 days following
enactment or January 1, 1997, whichever is later. Joseph
remarked that This is a giant step in the right direction for us
to be able to care for our older beneficiaries. It is a great
day for military medicine.
