Legislative Update

September 2020





Urge Congress to Improve Support for Military Special Needs Families

TRICARE’s Extended Health Care Option (ECHO) program falls short compared with state Medicaid services for individuals who would otherwise require care in an institutional setting. Please act now to urge your elected officials to support Section 706 - Expansion of Benefits Available Under TRICARE Extended Care Health Option Program - in the House version of the FY 2021 National Defense Authorization Act (NDAA). This provision improves ECHO coverage to better align with state Medicaid programs. 

Urge Your Elected Officials to Support Legislation to Stop Cuts to Military Medicine

Act now to urge your elected officials to support FY21 NDAA legislation that will halt MTF restructuring as well as cuts to uniformed medical personnel billets.

Commit to Full Government Funding for FY 2021

The ongoing pandemic makes the annual budgeting process even more likely to result in harmful continuing resolutions. Urge your lawmaker to pass yearlong funding measures that will eliminate uncertainty for servicemembers past and present, and their families, who too often bear unfair burdens as these negotiations stretch out.

Repeal the ‘180-Day Rule’ for Military Retirees Seeking GS-13 and Below DoD Positions

Military members seeking to continue national service through DoD civilian positions must wait 180 days before taking those jobs – a substantial barrier both to their employment prospects and to DoD’s efforts to grow its civilian talent pool. Ask your lawmaker to remove this provision for General Schedule (GS) positions GS-13 and below as part of the annual National Defense Authorization Act.


Service Chiefs to SecDef: Stop the Handover of Military Hospitals to Defense Health Agency

August 12, 2020 | by Patricia Kime, Military.com

Note from MOAA: As we monitor this effort by service leaders, our immediate health care priority remains urging the Senate to support House NDAA language that will halt military treatment facility restructuring and DoD medical billet cuts. Visit MOAA.org/summerstorm for more information and ways to help our lobbying efforts.


The heads of the U.S. military branches are calling on the Defense Department to stop the transfer of all medical facilities to the Defense Health Agency, saying the novel coronavirus pandemic has shown that the plan to convey the services' hospitals and clinics to the agency is "not viable."


In a memo sent to Defense Secretary Mark Esper on Aug. 5, the secretaries of the Army, Navy and Air Force, along with the branch chiefs of the Army, Navy, Air Force, Marine Corps and Space Force, called for the return of all military hospitals and clinics already transferred to the DHA and suspension of any planned moves of personnel or resources.


They said that the COVID-19 outbreak has demonstrated that the reform, which was proposed by Congress in the fiscal 2017 National Defense Authorization Act, "introduces barriers, creates unnecessary complexity and increases inefficiency and cost."


"The proposed DHA end-state represents unsustainable growth with a disparate intermediate structure that hinders coordination of service medical response to contingencies such as a pandemic," they wrote in the memo, first obtained by a reporter for Synopsis, a Capitol Hill newsletter that focuses on military and veterans health care.


The DoD launched major reforms of its health system in 2013 with the creation of the Defense Health Agency, an organization initially established to improve the quality of health care available to military personnel and family members and reduce services such as administration, IT, logistics and training that existed in triplicate across the three service medical commands.


But the initiatives ballooned in 2016, with Congress passing legislation that placed the DHA in charge of military hospitals and clinics worldwide, as well as research and development, public health agencies, medical logistics and other operations run by the service medical commands.


On Oct. 1, 2019, all military hospitals and clinics in the continental United States were transferred to the DHA, with those overseas expected to move over by October 2021.


But in December, Army Secretary Ryan McCarthy asked for a temporary halt of the transfers of Army facilities and requested that the Army Public Health Center and Army Medical Research and Development Command remain permanently under the service's control.


Ryan said he had concerns with what he viewed as a "lack of performance and planning with respect to the transition" by the DHA and Defense Department Health Affairs, according to a memo he sent Deputy Defense Secretary David Norquist.


McCarthy's comments were the first public statements by a military service in opposition to the transformation, which also calls for cutting roughly 18,000 military medical personnel.


In early March, the Air Force and Army surgeons general weighed in, telling the House Appropriations defense subcommittee that the reorganization is an "extremely difficult" and "complicated merger of four cultures." They suggested that the Defense Health Agency isn't ready for some of the coming changes.


The DHA assumed management of all domestic military treatment facilities without the staff or management capabilities to actually run them. As part of the plan, the services were to provide support and guidance for the DHA to run the hospitals and clinics in the interim, until its personnel were ready to operate them.


But then the pandemic struck. And according to a source familiar with operations at several medical treatment facilities in the Washington, D.C., region, tensions that had been bubbling since the initial facility transfer erupted.


At one facility, commanders and DHA leadership argued over who was responsible for the COVID-19 screening tents in the parking lot.


"There are definitely turf battles going on," said the source, a DoD civilian employee. "[The services] are making it very hard."


The COVID-19 pandemic has delayed several elements of the military health system reform effort. In March, the DoD placed a 60-day hold on a step to establish administrative markets responsible for military treatment facilities in five regions in the U.S.


In April, the department paused the rollout of its Military Health Systems Genesis electronic medical records program to several new medical facilities, although it continued to modernize the IT infrastructure needed to support the system.


And in June, the Pentagon's top health official announced that the DoD would delay some of the changes planned for this year, including an effort to begin closing or restructuring 48 hospitals and clinics and sending at least 200,000 patients to private care.


But Assistant Secretary of Defense for Health Affairs Thomas McCaffery, a former health industry executive who took office last August, has said he remains committed to reform, which he believes will improve quality of care while also saving taxpayer dollars.


"There's been at least 12 times since World War II where there has been efforts to change our system," McCaffery said during a visit to military health facilities in Washington last week. "All focused on the best way to organize and manage for the mission, have a ready medical force and a medically ready force. The mission is still the same, and having a more integrated system is the way to do it."


In their letter to Esper, the service heads said the DHA has been helpful during the pandemic in developing standardized clinical practices for the coronavirus response.


But they still asked him to suspend any transfer activity and appoint a working group to explore different options for management of the hospitals.


They also asked that all military hospitals, including two that have operated under the DHA and the National Capital Region since 2013 -- Walter Reed National Military Medical Center in Maryland and Fort Belvoir Community Hospital -- be returned to their respective services.


They did not say which service Walter Reed would fall under; the medical center was created after a merger between the Army's Walter Reed Medical Center in Washington, D.C., and the Navy's National Naval Medical Center in Bethesda, Maryland. It remains housed at Bethesda, a Navy installation.


"We look forward to working together to achieve successful reform of the military health system," they wrote.


Lisa Lawrence, a public affairs officer at the Pentagon, said the department plans to continue pursuing reforms as spelled out in the fiscal 2017 defense policy bill.


"The Department remains focused on ensuring the Services maintain a medically ready force and a ready medical force, as well as [ensuring] all eligible beneficiaries have continued access to quality health care," Lawrence said.


A spokeswoman for the National Military Family Association said that it "makes sense" the pandemic would lead to a reevaluation of the military health system reforms, adding that the organization hopes the DoD, DHA and military services will continue focusing on accountability, transparency and standardization across the system.


"Whatever the outcome, our priority is that service members and families have access to high-quality health care, wherever they happen to be stationed," said Eileen Huck, deputy director for health care at NMFA.


VA Grants $583.8 Million in Retroactive Payments for Blue Water Navy Claims

On Jan. 1, 2020, the VA began processing disability compensation and dependency and indemnity (DIC) claims for Vietnam-era Navy veterans and their survivors exposed to the defoliating toxin commonly known as Agent Orange, or AO.


This veteran group, familiarly known as Blue Water Navy (BWN) veterans, had long contended that their ships, having steamed within 12 nautical miles of the coast of Vietnam, had ingested the toxic AO runoff into their watering producing systems. Drinking and bathing from the water produced on those vessels thus exposed those veterans to Agent Orange.


The Blue Water Navy Vietnam Veterans Act of 2019, signed into law June 25, 2019, gave the VA the remainder of 2019 to prepare for the implementation of BWN veterans’ claims into the Agent Orange presumptive program.


Over the summer of 2020, the VA received deck logs from every surface vessel active during the Vietnam era and used a geographic locator tool to determine when each vessel “crossed the line.” The VA cross-references each claimant’s DD-214 or personnel record to determine presumption – in other words, to find out whether the veteran was assigned to that vessel on a day it operated within the 12-nautical-mile zone.


To date, BWN submariners from the Vietnam era are excluded from presumption, as their sensitive deck logs were not included in the original grouping from the archives. There is no official estimate of when, or if, this last group will be included.


The Senate draft version of the FY 2021 National Defense Authorization Act (NDAA) would add three long-awaited conditions to the AO presumptive list: bladder cancer, hypothyroidism, and Parkinson’s-like symptoms. A fourth condition, hypertension, was removed pending a study expected in late 2020. The House’s draft NDAA does not include language adding these conditions to the list.


TAKE ACTION: Write Your Lawmaker at https://takeaction.moaa.org/moaa/app/write-a-letter?0&engagementId=508560 In Support of Adding These Conditions


Ask Your Lawmakers to Support House NDAA Reforms to TRICARE ECHO Program

By: Karen Ruedisueli

House passage of the TRICARE ECHO Improvement Act as part of the chamber’s FY 2021 National Defense Authorization Act (NDAA) marks the next step in a long effort to secure better benefits for the most severely impacted military special needs families.


Reps. Tom Cole (R-Okla.) and Elaine Luria (D-Va.) secured House passage of the bill, which is now Section 706 – Expansion of Benefits Available Under TRICARE Extended Care Health Option Program – in the House-engrossed version of the NDAA. MOAA needs your support to ensure lawmakers maintain the language in the final NDAA as the legislation moves through the conference process.


MOAA has been fighting for improvements to the TRICARE Extended Care Health Option (ECHO) program since the Military Compensation and Retirement Modernization Commission highlighted ECHO shortcomings in its 2015 report. Most recently, MOAA included ECHO improvement recommendations in testimony at the House Armed Services Personnel subcommittee hearing in February.


ECHO serves a relatively small population of military special needs families, including individuals with intellectual disabilities, serious physical disabilities, and autism spectrum disorder.


Congress established ECHO as a substitute for Medicaid Waiver services that are often unavailable to mobile military families. Medicaid Waiver programs provide in-home services and supports to those who would otherwise require care in an institutional setting. Many states have lengthy waitlists for their Medicaid Waiver programs, leaving military families unable to access services when they PCS from one state to another, moving from waitlist to waitlist.


Section 706 of the House NDAA version would align ECHO coverage with Medicaid, including increased respite care levels as well as coverage for vehicle and residence adaptions – services covered by most state Medicaid programs.


Because the Senate did not include a provision to improve ECHO in its NDAA version, it is important to generate support for House Section 706 as the NDAA moves into conference, where differences between the House and Senate versions will be resolved.


Join MOAA in this effort by asking your lawmaker to support H.R. 6395 Section 706 – Expansion of Benefits Available Under TRICARE Extended Care Health Option Program – as the NDAA process moves forward.  https://takeaction.moaa.org/moaa/app/write-a-letter?4&engagementId=508973


TRICARE Select Enrollment Fees: What You Need to Know, and What You’ll Need to Do

New TRICARE Select enrollment fees take effect in 2021 – a first for retirees who joined the military prior to 2018 and their families. Here’s what you should know about the new fees, and how you can ensure your medical benefit continues without interruption.

Q. Does this apply to TRICARE for Life or TRICARE Prime beneficiaries?

 A. No. Only TRICARE Select retiree beneficiaries in Group A – those whose sponsor entered service before Jan. 1, 2018 – must pay the new fees beginning Jan. 1, 2021.

Q. How much are the fees?

 A. Annual enrollment fees are $150 for an individual or $300 for a family. The Select enrollment fee will be billed monthly at $12.50/month for individual and $25/month for family coverage.

Q. Are any TRICARE Select Group A beneficiaries exempt from the fees?

 A. Yes. Members of following groups won’t pay the new fees:

  • Active duty family members

  • Survivors

  • Medically retired beneficiaries, or their family members


Q. Is anything else changing about TRICARE Select?

 A. Yes. As of Jan. 1, 2021, the catastrophic cap for TRICARE Select retiree Group A beneficiaries will increase from $3,000 to $3,500. Learn more about how TRICARE catastrophic caps work at https://tricare.mil/CoveredServices/BenefitUpdates/Archives/12_30_19_TRICARE_Deductibles_and_Catastrophic_Caps_Reset_Jan_1.

Q. I don’t remember any debate or legislation regarding new fees. Why are these fees being charged now?

 A. The debate took place in 2016, with MOAA and other groups successfully fighting proposals during the FY 2017 National Defense Authorization Act (NDAA) process that would’ve resulted in massive upticks in fees and beneficiary cost shares. Plans called for enrollment fees up to $900 for some beneficiaries, and even an annual TRICARE for Life enrollment fee of up to $632.


Instead, the NDAA included the more modest fees that are now being implemented. MOAA has continued to fight further fee increases, proposals for which began in rapid fashion after the 2017 NDAA took effect.

Q. How do I pay the fees?

 A. If you receive retirement or other pay from a military pay center, you’ll have the fees taken out of that payment. If not, you’ll be asked to set up a recurring payment from a credit or debit card, or via an electronic funds transfer (EFT) from your U.S. bank account. You should receive notification regarding the fees from TRICARE later this summer, per the TRICARE website.

Q. What if I don’t pay the fees?

 A. You’ll be disenrolled from TRICARE, and you’ll have 90 days from your paid-through date to contact your regional contractor and request reinstatement. Any care you receive would have to come at a military treatment facility on a space-available basis.


 Q. What is MOAA doing to help beneficiaries?

  A. Along with getting the word out on the new fee structure, MOAA is pushing Congress and DoD to establish a longer grace period so that no beneficiary will lose coverage in 2021 because they don’t pay their fees.

Q. What about TRICARE Select Group B members?

 A. Group B sponsors entered service on or after Jan. 1, 2018. Group B retirees are currently a small group of medical retirees (and their family members). These beneficiaries will continue to pay annual enrollment fees – for 2020, Group B retiree enrollment fees for Select are $471 for an individual or $942 for a family. Group B enrollment fees are increased every year by the military retirement cost of living adjustment. Unlike Group A, Group B medical retirees and their families are not exempt from enrollment fees.

Q. Where can I get more information?
A. TRICARE’s TRICARE Select Enrollment Fees website (https://tricare.mil/Plans/Enroll/Select/EnrollmentFees) includes a breakdown of the new fee structure, as well as links to other plan features and ways you can reach out for further guidance.

Q. How can I keep up with updates to this issue, or other TRICARE benefits?

A. Bookmark MOAA’s health care news page (https://www.moaa.org/content/publications-and-media/news-articles/news-listing/?cat=2292) for the latest information.


Why Isn’t MOAA Fighting This Fee?

Congress passed this new Select enrollment fee as part of comprehensive MHS Reform legislation in the FY 2017 National Defense Authorization Act (NDAA), but it is just now being implemented.


During the FY 2017 NDAA process, MOAA opposed and defeated several proposals for even higher beneficiary cost sharing, including enrollment fees up to $900 and a proposed TRICARE for Life enrollment fee that would have charged Medicare-eligible retirees an annual enrollment fee equal to 2% of gross retirement pay (capped to $632) for TFL participation.


Because the TRICARE Select enrollment fee has been in law for several years and represents a compromise relative to higher fee increases proposed by Congress and the administration budget during the FY 2017 NDAA process, MOAA is focused on ensuring there is an effective communications plan and adequate grace period so beneficiaries do not lose coverage for the 2021 calendar year if they fail to pay the enrollment fee.


MOAA will continue to update its members and others in the military community as TRICARE announces details of the fee-collection process. Access the latest news from MOAA at https://www.moaa.org/news.


Top VA Medical Officer Reminds Veterans, Staff to Get Flu Shot

By: René Campos

The top medical official in the Veterans Health Administration (VHA) used a recent message to warn veterans and VA health care employees of the impending influenza (flu) season and urging individuals to get their annual flu vaccination before November 30.


The move comes as VA continues battling the coronavirus pandemic, and as talk of the development of COVID-19 vaccines may lead to concern or confusion about the annual flu shot.


“Vaccination of both Veterans and health care personnel is the cornerstone of our efforts to prevent flu transmission,” noted Dr. Richard Stone in his message to veterans and VHA staff. “This will be especially important this year due to the coronavirus pandemic. Vaccination of health care personnel reduces their risk of becoming infected with the flu and transmitting it to susceptible patients and coworkers.”


The message also included a policy and guidance directive requiring flu vaccinations for all health care workers in VA, calling for few exceptions to the policy. This is a departure from earlier directives strongly recommending, but not mandating, flu shots for health care personnel.


Flu Shot Details

Veterans enrolled in the VA health care system should contact their primary care provider about vaccine availability. As of Aug. 12, VA had not updated its online influenza materials to reflect the 2020-21 flu season.


According to Centers for Disease Control and Prevention (CDC) guidance, “Getting vaccinated in July or August is too early, especially for older people, because of the likelihood of reduced protection against flu infection later in the flu season. September and October are good times to get vaccinated. However, as long as flu viruses are circulating, vaccination should continue, even in January or later.”


TRICARE beneficiaries are covered for the flu shot; they can learn more at the TRICARE website (https://www.tricare.mil/CoveredServices/IsItCovered/FluVaccine). More information on the vaccine via Health.mil is available at https://www.health.mil/Military-Health-Topics/Health-Readiness/Immunization-Healthcare/Vaccine-Preventable-Diseases/Influenza-Seasonal/Influenza-Vaccine-Availability.


Why Get the Shot?

More than 490,000 people nationwide were hospitalized with influenza during the 2018-2019 flu season, according to CDC estimates.  More than 4,600 veterans were hospitalized last year, per the VA, with more than 600 requiring intensive care. Another 27,000 veterans sought outpatient care related to the flu, and VA triaged more than 13,000 calls for similar conditions. 


Stone wants to prevent a repeat of these same numbers, especially during the pandemic.


“From both a human and an operation perspective, we need you to get your flu vaccine,” he said in his message.


The pandemic crisis certainly complicates communication, especially when the nation is still battling COVID-19 and fear surrounding it. Veterans are concerned about how to access health care in general, and being asked to get a flu shot, amid all this chaos and recent reports of a potential COVID-19 vaccine that might be available by year’s end, adds additional stress an uncertainty.


Vulnerable veterans need trusted and reliable information. MOAA has reached out to the VHA to share veterans’ concerns, asking the department to work with MOAA and other veterans groups to convey important information (like details on getting a flu vaccination).


MOAA also has asked for details on VA’s plans to combat likely misinformation and fear as COVID-19 vaccinations become available, so veterans can make informed decisions. Stay tuned for future information as it becomes available.



COLA Watch

The July 2020 CPI is 252.636, 1.0 percent above the FY 2020 COLA baseline.
 The Consumer Price Index for August is scheduled to be released Sept. 11. The CPI baseline for FY 2020 is 250.200.


Illinois Legislative Issues


SB 110

 As you know Illinois Senate Bill 110 was introduced to extend the disabled servicemen's Illinois property tax exemption to his / her surviving spouse since the current legislation doesn't do that.  That means when the servicemember dies the surviving spouse suffers a loss of income AND an increase of tax liability. If a veteran with a service-related condition dies in one of Illinois' veterans’ homes from a COVID-19 infection the death certificate will show the cause of death as COVID-19 (not the established service related condition).  Since the death is recorded as something other than service related, the surviving spouse will have a more difficult time in obtaining the DIC payment as well as being able to continue the tax exemption proposed in SB-110.

SB110 is now out of the rules committee and back in the house finance committee, please contact your representatives we need all the sponsors we can get this bill the amendment to the standard homestead exemption for disabled veterans needs to be passed, we have too many surviving spouses who need this exemption to survive remember when the veteran dies their income is cut in half, please help.