1. Guard & Reserve Healthcare in the Pacific Territories Issues and Solutions

2. TRICARE Pacific 2 The Setting Guam, Saipan and American Samoa  USARPAC RC Duty Status  Pre-Mob: Pre Mob order date or 90 days before report for active duty  Mobilized: Duration of mobilization  De-Mob: TAMP (Transition Assist Mgm. ’ t Program) 180 days RC Numbers (RC/FM)  Guam/Saipan: 671  A. Samoa:299

3. TRICARE Pacific 3 The Benefit Coverage Options  TRICARE Global Remote Overseas (Prime)  AD/FM, Pre-Mob and Mob RC/FM (not TAMP) No co-pay, No deductible and No premium Covered travel benefit  TRICARE Reserve Select (Standard)  AD/FM non-Mob 20% Co-Pay, Annual premium = $81 Member / $253 Member & Family No deductable No travel benefit  Decline coverage / Island Gov ’ t Health Plan

4. TRICARE Pacific 4 The Issues Real & Perceived TRICARE Access and Payment Health Care Quality TRICARE Coverage for Inactive Reservists Access to Off-Island Care Funding for Medical Travel/Per Diem Adequate TRICARE Staffing

5. Discussion & Recommendations

6. TRICARE Pacific 6 TRICARE Access and Payment “ Providers do not accept TRICARE Standard ” Capabilities  Guam: MTF ’ s & TC participating providers  Saipan: TGRO network & TC participating providers Commonwealth Health Center & most private clinics  A. Samoa: Only LBJ public hosp is TC participating Solutions  Briefs to explain TRICARE programs to beneficiaries  Site visits to providers to accept TRICARE payments and relieve beneficiaries of upfront payments  ?

7. TRICARE Pacific 7 Health Care Quality “ Island care not equivalent to CONUS standard ” Medical infrastructure is limited  Specialty care/Diagnostic testing availability is an issue  Access to available care is not an issue Medical infrastructure is not within TMA purview  Territorial Gov ’ t, & Dept of the Interior Solutions:  TAO-P: MOU between ISOS & VA estab new VA Clinic as TGRO network facility that Reservists can utilize  USARPAC: Drilling medical Reservists/TDY TAMC staff assist  VA has offered space if USARPAC/TAMC will equip  DOI, DVA and DOD(HA): Pacific Insular Health Care Conference  Results yet to be announced

8. TRICARE Pacific 8 TRICARE Coverage for Inactive Reservists Those in TAMP/TRS are not TGRO eligible Prime Areas and OCONUS w/MTF  RC on TAMP can enroll in Prime Remote Areas  RC on TAMP cannot enroll in Prime (TGRO) Solutions  Policy change to allow RC on TAMP in remote area to enroll in TGRO?  Policy change to waive cost share for RC on TAMP?  Policy change to make TRICARE Reserve Select equivalent to Prime vice Standard?  ?

9. TRICARE Pacific 9 Access to Off-Island Care Those in TAMP/TRS do not have Prime or JFTR Travel Benefit Issue is off-island access to locally unavailable med services TRS has air ambulance benefit, but upfront payment and file claim RC wants TGRO Prime benefit for TAMP/TRS for urgent/emergent care so it is “cashless/claimless” Solutions:  Offer TGRO to TAMP/TRS  TMA authorized to guarantee payment for TRS beneficiaries vice beneficiary paying upfront  Change JFTR to permit funding TAMP/TRS med travel  TPMRC capacity to support urgent/emergent movement  ?

10. TRICARE Pacific 10 Funding for Medical Travel/Per Diem Who pays for medical travel? Reserve units currently responsible for funding  Difficult to predict year to year  Impacts on mission accomplishment Solution:  Fund through Defense Health Program (DHP)  USARPAC reprograms RC medical travel funds to DHP  ?

11. TRICARE Pacific 11 Adequate TRICARE Staffing No permanent, full time, culturally sensitive TRICARE reps. Background  Remote Pacific = 30 countries, benes are a few to hundreds  Saipan RC benes 2 to 250, A.Samoa benes 20 to 450 depending on RC activation Remote TRICARE POC’S  Remote commands designate individual(s) to assist beneficiaries  TMA provided training and support  RC request full-time, permanent BCAC for each location Solutions:  NDAA 2004, Section707  “TRICARE will designate one full-time person to serve as a BCAC for each Region for RC beneficiaries and RC will provide eleven (11) assets to support this requirement”  ?