1. Health Budgets & Financial Policy Financial Statements & Accounting Data TMA Office of the Chief Financial Officer (OCFO) Management Control & Financial Studies Division

2. Health Budgets & Financial Policy 2 Outline Financial Statement Reporting Requirements Legacy Accounting Systems Medical Accounts Receivable (A/R)

3. Health Budgets & Financial Policy 3 CFO Act of 1990: Integrated Financial Management (FM) systems supporting DoD accounting needs are key to effective financial management Federal Financial Management Improvement Act (FFMIA) of 1996: ALL Federal agencies to comply –Implement/maintain systems that meet Federal FM system requirements (Joint Financial Management Improvement Program (JFMIP)) –Support Federal accounting standards (Federal Accounting Standards Advisory Board (FASAB)) –Apply US Standard General Ledger (USSGL) at the transaction level Fiscal Management Requirements

4. Health Budgets & Financial Policy 4 Since passage of CFO Act of 1990, DoD has expressed its intentions to achieve auditable financial statements Nineteen of 24 government agencies covered by the CFO Act received “clean” audit opinions for FY 2010 DoD is the largest agency still without a “clean” or “Unqualified” Audit Opinion Congress became impatient and mandated a 30 September 2017 deadline for DoD’s financial statements to be validated as ready for audit –National Defense Authorization Act (NDAA) for FY 2010 (Public Law 111-84), Section 1003, describes the mandated requirements Congressional Deadline

5. Health Budgets & Financial Policy 5 “I’ve directed the Department to cut in half the time it will take to achieve audit readiness for the Statement of Budgetary Resources so that by 2014 we will have the ability to conduct a full- budget audit.” Secretary Leon E. Panetta, Oct. 13, 2011 Testimony before the House Armed Services Committee Call to Action

6. Health Budgets & Financial Policy Within 60 days, the USD(C) must submit a revised plan to: Achieve audit readiness of the Statement of Budgetary Resources (SBR) by the end of FY 2014 Increase emphasis on accountability of assets Review all financial controls over the next two years Establish course-based certification program for financial managers Resource efforts to meet these goals Achieve full audit readiness by FY 2017 6 The Directive

7. Health Budgets & Financial Policy Important Dates in 2014: ● 30 June: Components assert SBR audit readiness ● 30 September: USD(C) validates audit readiness of Component SBRs ● By 31 December: Begin Auditing SBRs 7 Important Dates

8. Health Budgets & Financial Policy 8 Financial Statements MHS Financial Statement Reporting Entities (FSREs) MHS MERHCF 1 DHP 3 TRICARE Mgmt. Activity (TMA) Service Medical Activity (SMA) TMA - FODTMA – CRM 1 TMA-USUHS 2 SMA – Army (MEDCOM) 4 (USACE) 5 SMA – Navy (BUMED) 4 (NAVFAC) 5 SMA – Air Force (AFMS) 4 (USAFE) 5 (1 ) Under Audit (2) All Proprietary Statements Validation Through Examination In Process (3) Includes American Recovery and Reinvestment Act (ARRA) Funding (4) Executes DHP Funds (5) Executes MILCON Funds MERHCF: Medicare-Eligible Retiree Health Care Fund DHP: Defense Health Program Appropriation MILCON: Military Construction Appropriation FOD: Financial Operations Division CRM: Contract Resource Management USUHS: Uniformed Services University MEDCOM: Army Medical Command BUMED: Navy Bureau of Medicine and Surgery AFMS: Air Force Medical Service USACE: U.S. Army Corps of Engineers NAVFAC: Naval Facilities Engineering Command USAFE: U.S. Air Forces in Europe MILCON 3

9. Health Budgets & Financial Policy 9 Accounting Data FSRELegacyEnterpriseBusiness Rules Command Control TMAWAASDAITMA USUHSCUFSDAIUSUHS ArmySTANFINSGFEBSArmy NavySTARS-FLNavy ERPNavy Air ForceGAFS-RDEAMSAir Force

10. Health Budgets & Financial Policy 10 Accounting System Acronyms CUFS – College and University Financial System DAI – Defense Agency Initiative DEAMS – Defense Enterprise Accounting and Management System FSRE – Financial Statement Reporting Entities GAFS-R – General Accounting Financial System - Revised GFEBS – General Fund Enterprise Business System STANFINS – Standard Army Finance Information System STARS-FL – Standard Accounting and Reporting System - Field Level TMA – TRICARE Management Activity USUHS – Uniformed Services University of the Health Sciences WAAS – Washington Headquarters Services (WHS) Allotment Accounting System

11. Health Budgets & Financial Policy 11 Office of Management & Budget (OMB) –Use commercial off-the-shelf (COTS) JFMIP- certified software for replacement of core FM systems (OMB Circular A-127) New Service FM COTS are JFMIP-certified –Army – General Fund Enterprise Business System (GFEBS) SAP COTS –Navy – Navy Enterprise Resource Planning (ERP) Oracle COTS –Air Force – Defense Enterprise Accounting and Management System (DEAMS) Oracle COTS Fiscal Management Requirements

12. Health Budgets & Financial Policy 12 Standard Financial Information Structure (SFIS) –A comprehensive, standard “business language” that defines financial information that supports all DoD-wide budget, cost/performance management, and external reporting requirements –SFIS is NOT an IT system –http://comptroller.defense.gov/fmr/01/01_04.pdf What is SFIS?

13. Health Budgets & Financial Policy 13 Financial Statements FSRE Structure Challenges –TMA has a clear chain of command and organizational structure –MERHCF has actuarial and accounting information –SMA components have two lines of authority (command and control, and finance business rules) vs. dollar flow. Face issues related to MILDEP priorities vs. fund flow priorities: financial impact, accounting system, financial business rules

14. Health Budgets & Financial Policy 14 Financial Statements FSRE Structure Challenges (continued) –Solution: single accounting system with common business rules and chain of command simplifies, streamlines the financial statement, financial reporting, and financial performance reporting

15. Health Budgets & Financial Policy 15 Budget Execution – O&M As of 30 September 2010

16. Health Budgets & Financial Policy 16 Budget Execution – O&M As of 30 September 2010

17. Health Budgets & Financial Policy 17 Budget Execution – O&M As of 30 September 2010

18. Health Budgets & Financial Policy 18 Budget Execution – RDT&E As of 30 September 2010

19. Health Budgets & Financial Policy 19 Budget Execution – RDT&E As of 30 September 2010

20. Health Budgets & Financial Policy 20 Budget Execution – RDT&E As of 30 September 2010

21. Health Budgets & Financial Policy 21 Budget Execution – Procurement As of 30 September 2010

22. Health Budgets & Financial Policy 22 Budget Execution – Procurement As of 30 September 2010

23. Health Budgets & Financial Policy 23 Budget Execution – Procurement As of 30 September 2010

24. Health Budgets & Financial Policy 24 Two types of A/R in governmental accounting –Intra-governmental (e.g., Coast Guard, VA) Expect to get paid 100% of Billed Amount Disputes regarding claims against other federal agencies (e.g., Coast Guard, VA) are to be resolved per Code of Federal Regulations 4 CFR 101 –Public (civilian emergencies, Third Party Collections) Need to establish an allowance for bad debt MTFs may be reporting collections to higher headquarters but what data is reported regarding outstanding and aged (e.g., >30 days, >120 days) Medical A/R? Accounts Receivable (A/R)

25. Health Budgets & Financial Policy 25 DoD Financial Management Regulation (FMR), Volume 4, Chapter 3, “Receivables” dated November 2009 DoD Financial Management Regulation (FMR), Volume 6B, Chapter 10, “Notes to Financial Statements” dated September 2008 Located at OSD (Comptroller) Web site: –http://www.defenselink.mil/comptroller/fmr/ DoD References

26. Health Budgets & Financial Policy 26 A/R are reported on the annual audited financial statements Service Financial Statements located at OSD(Comptroller) Web site: –http://comptroller.defense.gov/cfs/fy2010.html Medical A/R was NOT being reported by the SMA activities Service Financial Statements

27. Health Budgets & Financial Policy 27 MHS Accounts Receivable Policy Accounts Receivable Policy Memorandum (with attachment) –Policy signed on 8 May 2008 Purpose –Establish policy for the recognition (“as rendered”), classification, recording, aging, collection, disposition and reporting of accounts receivable in order to improve the accuracy of financial statements –Compliance with DoD’s Financial Management Regulation (FMR) and Generally Accepted Accounting Principles (GAAP)

28. Health Budgets & Financial Policy 28 Accounts Receivable Policy (con’t) Implementation Date –1 October 2009 (for FY 2010 reporting purposes) Title 10 United States Code, Chapter 55, Section 1095 –This policy does not modify the ability of the Services to use monies collected in the fiscal year collected 10 U.S.C. 1095(g) reads as follows: "Amounts collected under this section from a third-party payer or under any other provision of law from any other payer for health care services provided at or through a facility of the uniformed services shall be credited to the appropriation supporting the maintenance and operation of the facility and shall not be taken into consideration in establishing the operating budget of the facility."

29. Health Budgets & Financial Policy 29 Third Party Collections (TPC) Total Third Party Collections (TPC) Billings in FY 2011 were $388.9 million Total TPC Collections from insurers in FY 2011 were $190.5 million How much is really being written off as uncollectible, and how much is still on the books as Medical A/R?

30. Health Budgets & Financial Policy 30 Medical Services Account (MSA) Combination of both Intra-governmental A/R (e.g., Coast Guard, VA) and Public A/R (e.g., civilian emergencies) Total MSA amount collected for medical care provided in MTFs for FY 2011 was $281.2 million

31. Health Budgets & Financial Policy 31 Medical Affirmative Claims (MAC) Medical Affirmative Claims (MAC) A/R is all Public A/R (e.g., insurance companies, liable individuals) Total amount collected for medical care provided in MTFs for FY 2011 was $15.1 million

32. Health Budgets & Financial Policy 32 Financial Metrics Monthly Reporting, History and Measures –Accounts Receivable (A/R) Public debt > 30 days at Sep 30, 2010 (Red Metric) SMA-Army ($260 million) SMA-Navy ($17 million) SMA- Air Force ($70 million) SMA A/R increased dramatically in 1 st Qtr FY 2010 when A/R recording began

33. Health Budgets & Financial Policy Current Status SMA – Army Net Public Accounts Receivable (Gross Accounts Receivable less Allowance for Doubtful Accounts) Balance as of 4th Quarter, FY 2010, was $260 Million compared to 4th Quarter, FY 2009, in the amount of $112 Million Military Treatment Facilities (MTFs) pull Accounts Receivable data from TPOCS and CHCS. Regional Medical Command consolidates MTFs Accounts Receivable data. MEDCOM Headquarters submits consolidated Accounts Receivable report to DFAS-Indianapolis via the AR Tool. MEDCOM now has visibility of over 520,000 accounts Bad debt write-off procedures and processes under review in FY 2011 Clean up of old debt was addressed in FY 2011 33

34. Health Budgets & Financial Policy Current Status SMA – Navy Net Public Accounts Receivable (Gross Accounts Receivable less Allowance for Doubtful Accounts) Balance as of 4th Quarter, FY 2010, was $17 Million compared to 4th Quarter, FY 2009 in the amount of $9 Million. Implementation of the Medical Accounts Receivable policy was completed in July 2010. MTFs currently recognize receivables and calculate Allowance for Doubtful Accounts. Medical Accounts Receivable is entered into Standard Accounting and Reporting System-Field Level (STARS-FL) on a monthly basis. Successful completion of new processes and procedures to record Net Medical Accounts Receivable Gross Accounts Receivable less Allowance for Doubtful Accounts) in STARS-FL. 34

35. Health Budgets & Financial Policy Current Status SMA – Air Force Net Public Accounts Receivable (Gross Accounts Receivable less Allowance for Doubtful Accounts) Balance as of 4th Quarter, FY 2010, was $70 Million compared to 4th Quarter, FY 2009, in the amount of $36 Million. Third Party Collections (TPC) program is currently executed by two distinct contractors. The two contractors provide the Accounts Receivable reports to Air Force Headquarters. Data for the Accounts Receivable reports is consolidated and a summary report is provided at the end of each quarter in required format. In FY 2011, worked with DFAS-Indianapolis to evaluate and development more accurate methodology for Allowance for Doubtful Accounts successfully. Continuing clean up of old debt and write off of balances. Reporting Accounts Receivable via AR Tool to DFAS-Indianapolis. 35

36. Health Budgets & Financial Policy 36 Write Off of Aged A/R Due from the Public On 22 December 2011, TMA issued to the Services a memorandum with the subject “Write Off of Aged Accounts Receivable Due From the Public” Requires Services to write off delinquent public A/R over 2 years old IAW OMB Circular A-129 Write off of delinquent public A/R must be completed by the Services within 90 days of the issuance of the memorandum Waiver of requirement can be requested if collection efforts are still continuing on the delinquent public A/R Waived public A/R accounts over 2 years old will be reclassified as Currently not Collectible (CNC)

37. Health Budgets & Financial Policy 37 Accounts Receivable Service Points of Contact Army - Navy – Air Force –

38. Health Budgets & Financial Policy 38 Outline Financial Statement Reporting Requirement Legacy Accounting Systems Medical Accounts Receivable (A/R)

39. Health Budgets & Financial Policy 39 Questions? TMA OCFO/MC&FS