TITLE:  , B-287619, July 5, 2001
BNUMBER:  B-287619
DATE:  July 5, 2001
**********************************************************************
, B-287619, July 5, 2001

B-287619

July 5, 2001

The Honorable Jerry Lewis

Chairman, Subcommittee on Defense

Committee on Appropriations

House of Representatives

Dear Mr. Chairman:

This responds to your inquiry of April 4, 2001, concerning the legal
requirements for recognizing and recording obligations under the Defense
Health Program (DHP). You asked us to examine the legal basis for
obligations incurred by TRICARE Management Activity for, among other
services, medical services provided directly by DOD to beneficiaries as well
as medical services provided by civilian contractors who subsequently bill
DHP for those services. You also asked us to examine the legal basis for
obligations for costs of change orders or other negotiated settlements.
Finally, you asked whether the Antideficiency Act applies to DHP obligations
and expenditures.

By letter dated May 3, 2001, we asked the Acting Assistant Secretary of
Defense for Health Affairs for information on DHP's obligations and DHP's
views on the legal issues presented. On June 22, 2001 the Acting Assistant
Secretary of Defense for Health Affairs responded to our request. (DOD
response). We have incorporated information provided by DOD's response as
appropriate throughout this opinion.

In the discussion that follows we have set out the general rules for
obligating funds for the medical services provided to beneficiaries and
contractor provided services, and we conclude that DOD's practices in
obligating funds are consistent with our holdings. For the reasons explained
below, we conclude that due to DOD's legal liability for providing medical
services to eligible beneficiaries, DOD may enter into obligations in excess
of available budgetary resources without violating the Antideficiency Act.
While DOD may enter into obligations in excess of available budgetary
resources, it must obtain appropriations sufficient to liquidate those
obligations.

BACKGROUND

Defense Health Program

The Department of Defense's (DOD) primary medical mission is to maintain the
health of active duty service members in peacetime and during military
operations. DOD also provides health care to other individuals, including
dependents of active duty members, military retirees and their dependents.
[1] DOD's health program, known as TRICARE, provides medical care to
eligible beneficiaries through a combination of direct care and civilian
provided care. DOD provides direct medical care through its military
hospitals and clinics, known as military treatment facilities (MTFs).
Medical services provided at MTFs include outpatient and inpatient care for
medical and surgical conditions, pharmacy services, physical examinations,
dental care, and diagnostic, laboratory and radiological tests and services.

DOD supplements direct care with contracted civilian medical care. The
TRICARE program provides beneficiaries with a choice among a health
maintenance organization (TRICARE Prime), a preferred provider network
(TRICARE Extra), and a fee-for-service benefit (TRICARE Standard). DOD
contracts with managed care support contractors to administer its TRICARE
program on a regional basis, which presently consists of seven contracts
covering eleven geographic TRICARE regions. The TRICARE contracts consist of
a base period and five option years. [2] The TRICARE contractors perform
administrative services, such as developing civilian provider networks,
verifying provider credentials, negotiating reimbursement discounts,
enrolling beneficiaries, referring and authorizing beneficiaries for health
care, and processing health care claims. DOD awarded the TRICARE contracts
as fixed-price, at-risk contracts in which the contractor assumes liability
for payment of medical services subject to the requirements of the contract.
The at-risk care refers to the civilian health care services provided under
a fixed price arrangement in which the contractor approves and makes payment
to the provider or beneficiary. The other arrangement is referred to as
not-at-risk care or pass through costs. For payment of pass through costs,
the contractor provides information to DOD to seek approval for payment. If
DOD approves payment, the contractor is notified to pay the claim.

TRICARE is managed at multiple levels. Congress appropriates funds for the
Defense Health Program's operation and maintenance (O&M), procurement, and
research, development, test and evaluation (RDTE) expenses. [3] See
Department of Defense Appropriations Act, 2000, Pub. L. No. 106-79, 113
Stat. 1212, 1228 (1999). DHP appropriations are used to pay the costs of
providing medical care in the MTFs, purchasing care from civilian medical
providers and paying TMA contractors for administrative services. The Office
of the Assistant Secretary of Defense for Health Affairs sets policy for
MTFs and civilian provided medical care and establishes regulations in
coordination with the Army, Navy and Air Force. The TRICARE Management
Activity (TMA) is delegated responsibility for policy execution, shared with
the military Surgeons General who are responsible for implementing TRICARE
policy within their respective services. TMA performs program-wide support
functions, such as managing TRICARE's information technology and data
systems, preparing the budget and managing the accounts. TMA selects,
directs and pays managed care support contractors, who maintain the civilian
provider network and perform services assisting beneficiaries and management
of the program. In each TRICARE region within the United States, a lead
agent coordinates MTF and contractor activities; usually the commander of
the region's largest MTF. The MTF commanders report to the Surgeon General
of their respective service who allocates part of the service's appropriated
funds to each MTF. MTF officials have input into private provider network
size and composition but lack direct authority over the providers or the
network, which is managed by the managed care support contractor.

Active duty military members are automatically enrolled in TRICARE Prime and
their dependents also may enroll in TRICARE Prime without paying an
enrollment fee. Military retirees and their dependents must pay an
enrollment fee to join TRICARE Prime. Enrollees do not have to meet an
annual deductible. An enrollee chooses a Primary Care Manager who is the
primary physician that provides or coordinates all healthcare for that
enrollee. When an enrollee receives medical care directly from an MTF, there
is no copayment and the costs of providing care are part of the costs of
operating the MTF. Medical care under TRICARE Prime is usually provided in
MTFs, but civilian provided care is used when a Primary Care Manager refers
an enrollee for such care.

Participating civilian medical providers join a network managed by the
TRICARE contractors where they are paid for services provided in accordance
with a negotiated reimbursement rate. If enrollees go to a Prime civilian
provider, the provider submits the claim for reimbursement to the TMA
contractor. Active duty military members and their dependents do not pay a
copayment for civilian provided services except for pharmacy services and
services under the Program for Persons with Disabilities. Military retirees
and their dependents, on the other hand, pay a fixed dollar amount as
copayment for civilian provided services. A TRICARE Prime enrollee may also
use civilian provided care without requesting a referral from their Primary
Care Manager under the Point of Service Option. Under the Point of Service
Option, the requirements of TRICARE Standard described below, such as
deductibles and cost sharing, apply.

TRICARE Extra functions as a preferred provider option in which
participating civilian medical providers join a network managed by the
TRICARE contractors. The participating civilian medical providers are paid
for services provided in accordance with a negotiated reimbursement rate.
Under TRICARE Extra, beneficiaries pay less than they would if using
non-network providers. Medical providers who do not join the network may
provide care under TRICARE Standard, a fee for service option, for which
they are reimbursed up to a maximum rate established for the service
provided. [4] Under TRICARE Standard medical providers can bill the
beneficiary for up to an additional 15 percent above the established rate.
Under TRICARE Extra and TRICARE Standard, beneficiaries do not have to
enroll or pay enrollment fees, but they must pay a deductible each year and
are responsible for cost sharing, that is, the copayment or amount of money
for which the beneficiary is responsible.

The reimbursement process for civilian provided care is essentially the same
under the three TRICARE options. When a beneficiary receives medical care
from a civilian medical provider, the provider submits a claim for
reimbursement to the TRICARE contractor for adjudication in accordance with
DOD regulations. 32 C.F.R. Part 199. A beneficiary, who has paid the health
care provider directly for medical services, may submit a claim for
reimbursement for services provided. For the payment of care that is
at-risk, the TRICARE contractor reviews the claim to verify the eligibility
of the beneficiary, determine whether the medical services provided are
allowable, and determine the amount to be paid. Once the TRICARE contractor
adjudicates and settles a claim, the contractor issues a check to the
claimant. For payment of care that is not at-risk, referred to as "pass
through", the contractor transfers information electronically to seek
approval from DOD for payment. If DOD approves payment, the contractor is
notified to release payment. If a claim is denied, medical providers and
beneficiaries may appeal the determination. 32 C.F.R. sect. 199.10.

ANALYSIS

Recognition and Recording of Obligations for Medical Services and Related
Contractor Provided Administrative Services

Medical Services

Under 31 U.S.C. sect. 1501(a), an amount should be recorded as an obligation
against an available appropriation when supported by documentary evidence of
a legal liability of the government. As explained below, we believe that
DOD's practices in obligating funds are consistent with our holdings. With
respect to direct care, DOD determines a beneficiary's eligibility for
treatment, the type of treatment to be provided and incurs the costs of
treatment. For direct care, DOD's costs are the expenses of operating the
MTFs, such as paying the costs of acquiring supplies, paying employees and
other related expenses of operating the facilities. The rules for
recognizing obligations for these costs are the same as those applicable to
typical internal agency operations. As a general rule, supplies acquired for
use during the current fiscal year are a bona fide need of that year and are
chargeable to the current fiscal year's appropriation. 60 Comp. Gen. 361
(1981). Costs such as paying employees are obligations at the time the
salaries are earned, that is, when the services are rendered, generally on a
pay period basis. 24 Comp. Gen. 676, 678 (1945). Other costs of operating
facilities, such as paying utilities or maintenance services, are generally
obligations at the time the services are performed. B-259274, May 22, 1996;
34 Comp. Gen. 459, 462 (1955). Thus, DOD should record those costs as
obligations chargeable to the appropriation current at the time the services
are provided. [5]

In contrast to the cost of care provided beneficiaries directly through
MTFs, both the TRICARE contractors and DOD determine the liability for
payment of costs of civilian provided care through the adjudicative process
after the medical services are provided in accordance with applicable laws,
regulations and DOD policy. For the at-risk payment portion, which is fixed,
DOD informed us that it records an obligation when the contracting officer
enters into the option period. Where the obligation is fixed, an agency may
record the obligation in an amount equal to the least quantifiable amount of
the government's liability. See 62 Comp. Gen. 143, 146-147 (1983); 48 Comp.
Gen. 497, 502 (1969).

For pass through care, DOD informed us that it records an obligation when
DOD approves the payment and notifies the contractor to make such payment.
Where an agency has an adjudicative administrative process of review and
approval for medical services, the presumption is that the agency is not
liable for the costs until a qualified employee has approved and accepted
the invoice. 46 Comp. Gen. 895 (1967). The approval of the services
constitutes the agency's agreement or legal liability to pay and is the
documentary evidence required by 31 U.S.C. sect. 1501(a). Id. The claims process
for payment of civilian provided services does not establish DOD's liability
for payment until the TRICARE contractor processes the claim and DOD has
determined that the beneficiary is eligible to receive treatment, that the
services provided are allowable, and the amount billed is proper. 32 C.F.R.
Parts 199.3, 199.4 and 199.7. DOD regulations [6] make medical providers and
beneficiaries aware that such adjudication establishes liability for payment
of their claims. Thus, in accordance with 46 Comp. Gen. 895, DOD should
record the obligation at the time, and in the amount, of the approved claim.
See also, B-133944, January 31, 1958 (Fiscal year appropriation properly
charged on monthly basis to cover amounts of bills approved for the costs of
prescriptions filled for veterans); B-92679, July 24, 1950 (Cost of
emergency hospitalization or medical and dental treatment without prior
authorization chargeable to the appropriation current at time the claim for
reimbursement is approved).

TRICARE Contractor Services

The services performed by TRICARE contractors in administering the TRICARE
program include developing civilian provider networks, verifying provider
credentials, negotiating reimbursement discounts, enrolling beneficiaries,
referring and authorizing beneficiaries for health care, and processing
health care claims. With respect to service contracts, for obligational
purposes, the issue is whether a service is severable or nonseverable.
B-277165, January 10, 2000. The nature of the services performed determines
whether a service is severable or nonseverable. Id. Nonseverable services
involve services that represent a single undertaking, or, in other words,
provide value when the entire project is complete. Id. Severable services
generally involve continuing or recurring services often reflecting the day
to day operational needs of an agency. Id. For obligational purposes,
agencies should charge the costs of severable services to the appropriation
current at the time the services are rendered. Id. The types of services
provided by TRICARE contractors, such as ensuring provider credentials,
enrolling beneficiaries, referring and authorizing care, and adjudicating
claims are severable into components that independently provide value to DOD
as performed and meet a separate and ongoing need. See 60 Comp. Gen. 219
(1981) (Technical and management assistance tasks are severable and should
be charged to appropriation current at time services are rendered). Thus,
DOD should record obligations against the appropriation current at the time
the services are rendered.

TRICARE Contracts and Change Orders

Although the TRICARE contracts were awarded as fixed-price at-risk
contracts, DOD may make several types of contract adjustments that affect
the contract performance and price, namely bid price adjustments, equitable
adjustments, and change orders. DOD designed the contracts to include
adjustments for health care cost increases beyond the contractors' control,
with other costs, such as administrative costs, remaining fixed. These bid
price adjustments (BPAs) are based on conditions such as shifts in workload
between the MTFs and civilian providers, or changes in the number of
beneficiaries due to geographic transfers of active duty members and their
dependents. To calculate such adjustments, DOD uses a formula that includes
cost, population shifts, inflation and utilization. TRICARE contractors also
initiate requests for equitable adjustments (REAs) to cover unforeseen
changes in contract conditions, such as higher than anticipated claim
submissions that increase administrative expenses.

Since you asked us to address the obligational requirements for change
orders, we will focus on that process. Generally, government contracts
contain a Changes clause that permits the contracting officer to make
unilateral changes within the general scope of the contract. 48 C.F.R. sect.
43.201. Change orders are a type of contract modification defined by the
Federal Acquisition Regulation (FAR) as " a written order, signed by the
contracting officer, directing the contractor to make a change that the
Changes clause authorizes the contracting officer to order without the
contractor's consent." 48 C.F.R. sect. 43.101. [7] If a change causes an
increase or decrease in the contractor's cost of, or time required for, the
performance of work under the contract, the contracting officer must make an
equitable adjustment and modify the contract in writing. 48 C.F.R. sect.sect.
52.243-1 (fixed price contract) and 52.243-2 (cost reimbursement contract).

Change orders may result from new laws or regulations, or from DOD
initiatives. [8] The TRICARE change orders range in scope from
administrative changes, such as changes to billing procedures, to
significant benefit expansions, such as addition of a hospice benefit or
elimination of copayments for active duty dependents, which could
significantly add to program costs. By June 30, 2000, DOD had made a total
of over 1,000 change orders to the TRICARE contracts. While DOD had
independent government estimates of the cost of the change orders, DOD
implemented many of these change orders prior to negotiation of the final
terms of the modification including payment terms. Between December 2000 and
February 2001, DOD eliminated most of its large backlog of outstanding
change orders under a short-term effort using global settlements to settle
all outstanding contract adjustments. [9]

The issue of the proper obligation of the costs of change orders cannot be
separated from the underlying events triggering the government's liability
for medical services provided to beneficiaries and administrative services
provided to DOD. The change orders to the TRICARE contracts relate to the
nature and amount of medical services provided beneficiaries and to the
management of the TRICARE program. For medical services provided to
beneficiaries directly from the MTFs, DOD's liability consists of the costs
incurred in operating the MTFs and providing medical services to the
beneficiaries and those costs should be recorded as discussed above. For
medical services provided through civilian contracted care, DOD's liability
for at-risk payment is determined by the fixed price established by the
contract and should be recorded at the time DOD executes the contract or
option. For medical services provided through civilian contracted care,
DOD's liability for pass through payment is determined through the
adjudicative process after the medical services are rendered. As discussed
above, those costs should be recorded at the time of the claim approval.
Similarly, for the costs of contractor provided administrative services in
carrying out the TRICARE program, DOD should record obligations as those
services are rendered. To the extent change orders affect services to be
provided in the future, DOD should obligate in accordance with the above
rules.

The resolution of the change orders by negotiation or settlement goes to the
price of the change orders, i.e., the amount of DOD's liability. 48 C.F.R. sect.
52.243-4. The negotiated global settlements totaled about $900 million for
current and prior fiscal years. We have not audited the amounts related to
change orders, BPAs or REAs for services provided during each fiscal year
covered by the global settlements nor has DOD advised us as to those
amounts.

Prior to DOD finalizing the global settlements, Congress, in July 2000,
provided supplemental appropriations of $615,600,000 for the Defense Health
Program in amounts not to exceed:

"$90,300,000 . . . for obligations and adjustments to obligations required
to cover unanticipated increases in TRICARE contract costs that (but for
insufficient funds) would have been properly chargeable to the Defense
Health Program account for fiscal year 1998 or fiscal year 1999; and . . .
$525,300,000 . . . for obligations and adjustments to obligations required
to cover unanticipated increases in TRICARE contract costs that are properly
chargeable . . . for fiscal year 2000 or fiscal year 2001"

Military Construction Appropriations Act, 2001, Pub. L. No. 106-246, sect.
105-106, 114 Stat. 511, 529 (2000). To the extent the amounts appropriated
and otherwise available cover the costs allocable to those years, DOD should
so obligate. [10] DOD informed us that when final settlements were reached,
contract modifications were issued to incorporate the settlement price and
obligations were recorded against the applicable appropriations. To the
extent that the amounts appropriated in the supplemental are inadequate to
cover those costs, DOD would require additional appropriations from
Congress.

Applicability of the Antideficiency Act

The purpose of the Antideficiency Act is to prevent the officers of the
government from making or authorizing obligations or expenditures in excess
of or in advance of available appropriations. The Antideficiency Act's
prohibitions are directed at discretionary obligations incurred by
government officers. 65 Comp. Gen. 4, 9 (1985); 39 Comp. Gen. 422, 425
(1959); B-225801, March 2, 1988. The Antideficiency Act specifically
provides an exception for obligations authorized by law to be made in excess
of or in advance of appropriations. 65 Comp. Gen. at 9.

We have previously identified situations where Congress has expressly
mandated an agency to incur obligations without regard to the availability
of budgetary resources to cover the obligations. Id. For example, in
B-225801, March 2, 1988, we pointed out that the Veterans Administration
(VA) becomes legally liable for compensation and pension benefit payments to
a veteran on the date it administratively adjudicates a veteran's claim as
due and payable. Since no further congressional action is needed to
establish a right to payment, the obligation for these benefits occurs by
operation of law, and should be recorded under 31 U.S.C. sect. 1501 regardless
of the amount of available budgetary resources at such time. Id. In
obligating amounts in excess of available budgetary resources, the agency
does not violate the Antideficiency Act. Id. In 65 Comp. Gen. 4 (1985), we
held that where Congress authorized the Department of Education to extend
loan guarantees in amounts which could at any time far exceed available
funding, [11] and then required the Department to promptly pay beneficiaries
of those guarantees upon the borrower's default, it expressly authorized the
Department to incur obligations in excess of or in advance of
appropriations. We noted that the Department's administrative officers did
not have any control over

the amount the Department would be required to pay under applicable
statutory provisions. Id. Thus, the obligation to make payments on the loan
guarantees were not discretionary expenses covered by the Antideficiency Act
but rather fell within the Antideficiency Act's "unless authorized by law"
exception. Id. Similarly, in

39 Comp. Gen. 422 (1959), we held that the administrative action granting
pay increases to wage board employees effective on a specified date not only
imposed a legal liability on the government to pay additional compensation,
but created an obligation against the appropriation current at the time the
liability arose regardless of whether the applicable appropriation had
sufficient funds. [12]

We think that DHP obligations for medical services fall into the category of
obligations mandated by law. Medical services at MTFs are available to
beneficiaries according to a statutorily established priority. Active duty
members of the armed forces are "entitled to medical and dental care in any
facility of any uniformed service." 10 U.S.C. sect. 1074(a). Dependents of
active duty members are "entitled, upon request, to the medical and dental
care . . . in facilities of the uniformed services, subject to the
availability of space and facilities and the capabilities of the medical and
dental staff." 10 U.S.C. sect. 1076(a)(1). Military retirees "may, upon request,
be given medical and dental care in any facility of any uniformed service,
subject to the availability of space and facilities and the capabilities of
medical and dental staff."

10 U.S.C. sect. 1074(b). [13] Dependents of military retirees "may, upon
request, be given the medical and dental care . . . in facilities of the
uniformed services, subject to the capabilities of the medical and dental
staff." 10 U.S.C. sect. 1076(b). However, apart from the medical services
available at MTFs, dependents of active duty members, military retirees and
their dependents are entitled to receive medical care from civilian
providers. 10 U.S.C. sect.sect. 1079 and 1086. In this regard, sections 1079 and
1086 direct the Secretary of Defense to assure by contract that medical care
is available for these beneficiaries subject to deductibles and copayments
prescribed by law.

While the order of priority for, and the provider of, medical services
varies according to the status of a beneficiary, DOD is required to provide
medical care to beneficiaries as provided by law. The statutes authorizing
the DHP services set forth the beneficiaries' entitlement to medical
services, the medical services available, and the limitations on the amounts
of deductibles and copayments required for such services. Under these
statutory provisions, a beneficiary need only present himself for medical
treatment subject to applicable deductibles and copayments; if the statutory
requirements are met, DOD must pay for or reimburse the beneficiary or
medical provider for those medical services. Thus, we conclude that DHP
actions are "authorized by law" regardless of the amount of available
budgetary resources and do not violate the Antideficiency Act. [14] To the
extent DOD incurs obligations in excess of available budget authority to
cover the costs of services required, DOD would need to obtain additional
appropriations to cover payments for these obligations.

This opinion does not address DOD's management of the defense health
program. For a discussion of some of the challenges DOD faces in managing
the defense health program, see Defense Health Care: Lessons Learned From
TRICARE Contracts and Implications for the Future (GAO-01-742T, May 17,
2001) and products listed therein.

CONCLUSION

DOD should obligate for the medical services provided to beneficiaries and
contractor provided services in accordance with the rules described above.
Given DOD's legal liability for providing medical services to eligible
beneficiaries, we conclude that such actions are "authorized by law"
regardless of the amount of available budgetary resources and do not violate
the Antideficiency Act. We trust that this responds to your request. Should
you have any questions, please contact

Mr. Jeffrey Jacobson (202) 512-8261 or Ms. Edda Emmanuelli Perez of my staff
at (202) 512-2853.

/signed/

Anthony H. Gamboa

General Counsel

Notes

1. For ease of reference and consistent with DOD regulations, we refer to
active duty members and their dependents, military retirees and their
dependents as beneficiaries of DOD's health program. See 32 C.F.R. sect.
199.2(b).

2. The base period, which varies by contract, consists of a transition
period, ranging from 6-9 months, and the early months of health care
delivery.

3. In addition to the DHP appropriations, Congress appropriates military
personnel and military construction funds to cover those costs of the
military health program. Civilian personnel costs are paid from the DHP O&M
appropriation.

4. Prior to TRICARE, DHP implemented the Civilian Health and Medical Program
of the Uniformed Services (CHAMPUS), which like TRICARE Standard, was the
equivalent of a health insurance plan that reimbursed beneficiaries for
portions of the costs of health care received from civilian providers.

5. An exception to this rule is provided in 10 U.S.C. sect. 2410a, which
authorizes DOD to use current fiscal year appropriations to finance a
severable service contract that continues into the next fiscal year.

6. DOD regulations for the CHAMPUS and TRICARE programs are found at 32
C.F.R. Part 199. Parts 199.1 through 199.16 contain provisions established
for the CHAMPUS program, while Parts 199.17 through 199.22 apply to the
TRICARE program. However, the CHAMPUS provisions are also applicable to the
TRICARE program, including claims submission and approval requirements,
except where TRICARE provisions specifically take precedence over CHAMPUS
provisions. See e.g., Part 199.4(a)(ii).

7. This section was amended by FAC 97-22, May 11, 2001 to include this
definition in 48 C.F.R. sect. 2.101.

8. As reported in 1997, the most recent data available to GAO showed that
one-third of all TRICARE change orders resulted from new laws or regulations
while the remaining two-thirds were self-initiated. Defense Health Care:
Actions Underway to Address Many TRICARE Contract Change Order Problems
(GAO/HEHS-97-141, July 14, 1997).

9. Defense Health Care: Continued Management Focus Key to Settling TRICARE
Change Orders Quickly (GAO-01-513, April 30, 2001).

10. In addition, Congress appropriated $695,900,000 for DHP to remain
available for obligation until the end of fiscal year 2002. Pub. L. No.
106-246, sect. 107, 114 Stat. at 530.

11. Subsequent to the decision in 65 Comp. Gen. 4 (1985), Congress enacted
the Federal Credit Reform Act of 1990, as amended, which provides that
beginning with fiscal year 1991, for covered loans and loan guarantees, an
agency must cover the cost of loan and loan guarantee programs with budget
authority. Pub. L. No. 101-508, Title XIII, 104 Stat. 1388-610 (1990).

12. In the cases noted above, we also held that the agencies would have to
request supplemental appropriations to liquidate those obligations if there
were insufficient funds to cover those payments.

13. While not in effect during the period relevant to this opinion, Medicare
eligible military retirees and dependents will be eligible, under TRICARE
for Life, for the same benefits as retirees under age 65. National Defense
Authorization Act for Fiscal Year 2001, Pub. L. No. 106-398, 114 Stat. 1654
(2000). However, these changes do not affect our analysis.

14. While recognizing that the DHP is "essentially an entitlement program",
DOD informed us that it is managed in accordance with the Antideficiency Act
requirements.