[Federal Register Volume 75, Number 60 (Tuesday, March 30, 2010)]
[Notices]
[Pages 15693-15694]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-7009]


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DEPARTMENT OF DEFENSE

Office of the Secretary


Extension of Web-Based TRICARE Assistance Program Demonstration 
Project

AGENCY: Department of Defense (DoD).

ACTION: Notice of a Web-Based TRICARE Assistance Program demonstration 
project extension.

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SUMMARY: This notice is to advise interested parties of an extension to 
the Military Health System (MHS) demonstration project, under authority 
of Title 10, United States Code, Section 1092, entitled Web-Based 
TRICARE Assistance Program. This demonstration was effective August 1, 
2009, as referenced in the original Federal Register (FR) Notice, 74 FR 
3667, dated July 24, 2009. The demonstration project uses existing 
managed care support contracts (MCSC) to allow Web-based behavioral 
health and related services, including non-medical counseling and 
advice services to Active Duty Service members (ADSM), their families, 
and members and their dependents enrolled in TRICARE Reserve Select, 
and those eligible for the Transitional Assistance Management Program 
(TAMP) who reside in the continental United States. The extension is 
necessary to allow more time to measure the effectiveness of the 
demonstration in meeting its goal of improving beneficiary access to 
behavioral health care by incorporating Web-based technology.

DATES: This extension will be effective April 1, 2010. The 
demonstration project will continue until March 31, 2011.

ADDRESSES: TRICARE Management Activity (TMA), TRICARE Policy and 
Operations, 5111 Leesburg Pike, Suite 810, Falls Church, VA 22041.

FOR FURTHER INFORMATION CONTACT: For questions pertaining to this 
demonstration project contact Mr. Richard Hart at (703) 681-0047.

SUPPLEMENTARY INFORMATION:

Background

    On page 405 of House Report 2638, the Department of Defense 
Appropriations Act for Fiscal Year (FY) 2009 Joint Explanatory 
Statement, Congress stated: ``The Department of Defense Appropriations 
Act for Fiscal Year 2009 stated: ``An area of particular interest is 
the provision of appropriate and accessible counseling to Service 
members and their families who live in locations that are not close to 
Military Treatment Facilities (MTFs), other MHS facilities, or TRICARE 
providers. Web-based delivery of counseling has significant potential 
to offer counseling to personnel who otherwise might not be able to 
access it. Therefore, the Department is directed to establish and use a 
Web-based Clinical Mental Health Services Program as a way to deliver 
critical clinical mental health services to Service members and 
families in rural areas.''
    The TRICARE Assistance Program (TRIAP) demonstration as outlined in 
74 FR 3667 of July 24, 2009, launched August 1, 2009, to provide the 
capability for short-term, problem solving counseling between eligible 
beneficiaries and licensed counselors utilizing video technology and 
software such as Skype or iChat. Regional contractors were tasked with 
formulating and initiating the programs. TRIAP services are available 
24/7. Active Duty Service members, their spouses of any age, and other 
family members 18 years of age or older, who reside in the United 
States are eligible to participate. Enrollees in Reserve Select and 
TAMP also may use the program. TRIAP provides assistance to 
beneficiaries dealing with personal problems that might adversely 
impact their work performance, health, and well-being. It includes 
assessment, short-term counseling, and referrals to more comprehensive 
levels of care if needed. TRIAP is based on commercial employee 
assistance models and provides counseling in a virtual face-to-face 
environment. There is no diagnosis made, are no limits to usage, and no 
notification about those seeking counseling will be made to their 
primary care managers or others, unless required by the counselor's 
licensure (spouse abuse, etc.). Participant confidentiality is 
protected, as no medical record entry is made.
    There were initial challenges in making beneficiaries aware of the 
program when implemented in August 2009. These challenges included:
     Short turnaround with behavioral health (BH) programs 
launching on the same day, both using video, but with distinct 
differences--one a demonstration (TRIAP), the other a permanent benefit 
(Telemental Health).
     Significant program changes days prior to launch: Age and 
confidentiality.
     The regional contractors implemented the program in 
admirably short time, but have varying accessibility and visibility.
     Primary means of communication with Prime beneficiaries 
(newsletter) has significant lead time (4 months).
     Dozens of ``competing'' programs already geared to 
assisting Service members in a similar forum (employee assistance/
counseling format) with BH issues, notably Defense Center of Excellence 
(Psychological Health) and Military OneSource.
     Limited research on Service members' willingness to use 
video as a means of counseling or their belief in confidentiality.
    Despite concerted media and outreach effort on the part of regional 
contractors and extensive media coverage, usage remains very low. In an 
effort to increase awareness and encourage beneficiary use of TRIAP and 
Tele-Behavioral Health Care Services, TRICARE has launched aggressive 
external communications initiatives, to include but not limited to:
     Article in Prime newsletter (December) delivered to 
beneficiaries via direct mail. Advance copy sent to 30,000 subscribers.
     In production: Leadership video broadening the message to 
motivate beneficiaries to get help. Includes messages by line 
spokespersons. Wide distribution to MTFs, installations, and service 
leadership.
     Senior leader talking points.

[[Page 15694]]

     Updated briefings slide library.
     Fact sheet on TRIAP.
     Behavioral health flyer updated for 2010: Orders for 
several hundred thousand in the queue now for distribution by 
approximately 2,000 points of contact, including the TRICARE Service 
Centers, Family Support Offices, Wounded Warrior case managers, and 
nearly 700 Reserve and Guard unit representatives.
     Behavioral Resources Guide updated for 2010: Orders for 
several hundred thousand in the queue now for distribution by 
approximately 2,000 points of contact including the TRICARE Service 
Centers, Family Support Offices, Wounded Warrior case managers, and 
nearly 700 Reserve and Guard unit representatives.
     Partnering with Chaplain Corps, all services--new effort.
     MHS conference (January 2010)--three breakouts on mental 
health.
     Additional partnering efforts with TMA regions/
contractors--MHS conference.
    In order to allow enough time for marketing efforts to take effect 
and provide enough time to gather adequate data on the feasibility of 
utilizing audio and visual technologies, including Web-based services, 
to our Active Duty Service members, their families and other 
beneficiaries on a permanent basis, an extension of the demonstration 
is necessary.

Implementation

    This demonstration extension will be effective April 1, 2010.

Evaluation

    As noted in the original FR Notice, 74 FR 3667, July 24, 2009, an 
independent evaluation of the demonstration will be conducted. It will 
be performed retrospectively and use a combination of administrative 
measures of behavioral health care access to provide analysis and 
comment on the effectiveness of the demonstration in meeting its goal 
of improving beneficiary access to behavioral health care by 
incorporating Web-based technology.

    Dated: March 25, 2010.
Mitchell S. Bryman,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2010-7009 Filed 3-29-10; 8:45 am]
BILLING CODE 5001-06-P