United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 2001-10-12 monographic deposited born digital 43 p. GA 1.13:GAO-02-73 https://www.govinfo.gov/app/details/GAOREPORTS-GAO-02-73 P0b002ee18039c9b3 f:d0273 DGPO 2010-08-12 2011-03-28 GAOREPORTS-GAO-02-73 machine generated eng fdlp REPORT GAOREPORTS-GAO-02-73 GAO-02-73 Federal Employees Health Benefits Program Program for Persons with Disabilities Individual Case Management Program for Persons with Exraordinary Conditions Managed Care Support Contractor Other Written Product A02228 The Department of Defense (DOD) health program-TRICARE-provides medical care for about 8.3 million active duty service members and retired beneficiaries and their dependents and survivors. As supplements to TRICARE, DOD provides benefits for persons with extraordinary disabling physical or mental disorders through its Individual Case Management Program for Persons with Extraordinary Conditions (ICMP-PEC) and for less severely disabled active duty dependents through its Program for Persons with Disabilities (PFPWD). Recently, military families and advocacy groups have raised concerns about problems accessing ICMP-PEC benefits. Also, the DOD Authorization Act for 2001 entitled military retirees age 65 and older and their dependents and survivors to TRICARE benefits for life (TFL) which may have caseload and cost effects on ICMP-PEC. As of June 2001, there were 38 ICMP-PEC participants whose total services for fiscal year 2001 were projected to cost about $6 million with annual per-case cost projected to range from about $13,000 to $382,000. Currently ICMP-PEC lacks a clearly enunciated purpose, well-defined eligibility criteria and benefits, and an efficient application process. In addition, PFPWD is an established program with well defined criteria and benefits that assist thousands of ADFMs with their special health care service and equipment needs. Also, prior to April 2001, PFPWD provided many services and equipment items at modest cost-shares to ADFMs with severe disabilities that were also available at higher copayments to less seriously disabled ADFMS under TRICARE Basics. Data are not available on how many PFPWD participants are affected by the program's $1,000 monthly benefit limit. A comparison of ICMP-PEC's home care benefit of up to 24 hours of skilled nursing care per day, seven days per week-and unlimited skilled nursing facility (SNF) coverage with Medicare and selected Medicaid programs showed that ICMP-PEC's benefits are more generous. https://www.govinfo.gov/content/pkg/GAOREPORTS-GAO-02-73/html/GAOREPORTS-GAO-02-73.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-GAO-02-73/pdf/GAOREPORTS-GAO-02-73.pdf GAO-02-73 https://www.govinfo.gov/app/details/GAOREPORTS-GAO-02-73 Other Written Product GAO-02-73; Defense Health Care: Disability Programs Need Improvement and Face Challenges; Federal Employees Health Benefits Program Program for Persons with Disabilities Individual Case Management Program for Persons with Exraordinary Conditions Managed Care Support Contractor Public Law 106-65 Public Law 106-398