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TITLE VII--HEALTH CARE PROVISIONS

Subtitle C--Planning, Programming, and Management

JWNDAA Section

House Conference Report 109-702

(a) Annual Integrated Regional Requirements on Support- The Regional Director of each region under the TRICARE program shall develop each year integrated, comprehensive requirements for the support of military treatment facilities in such region that is provided by contract civilian health care and administrative personnel under the TRICARE program.

(b) Purposes- The purposes of the requirements established under subsection (a) shall be as follows:

(1) To ensure consistent standards of quality in the support of military treatment facilities by contract civilian health care personnel under the TRICARE program.

(2) To identify targeted, actionable opportunities throughout each region of the TRICARE program for the most efficient and cost effective delivery of health care and support of military treatment facilities.

(3) To ensure the most effective use of various available contracting methods in securing support of military treatment facilities by civilian health care personnel under the TRICARE program, including resource-sharing and clinical support agreements, direct contracting, and venture capital investments.

(c) Facilitation and Enhancement of Contractor Support-

(1) IN GENERAL- The Secretary of Defense shall take appropriate actions to facilitate and enhance the support of military treatment facilities under the TRICARE program in order to assure maximum quality and productivity.

(2) ACTIONS- In taking actions under paragraph (1), the Secretary shall--

(A) require consistent standards of quality for contract civilian health care personnel providing support of military treatment facilities under the TRICARE program, including--

(i) consistent credentialing requirements among military treatment facilities;

(ii) consistent performance standards for private sector companies providing health care staffing services to military treatment facilities and clinics, including, at a minimum, those standards established for accreditation of health care staffing firms by the Joint Commission on the Accreditation of Health Care Organizations Health Care Staffing Standards; and

(iii) additional standards covering--

(I) financial stability;

(II) medical management;

(III) continuity of operations;

(IV) training;

(V) employee retention;

(VI) access to contractor data; and

(VII) fraud prevention;

(B) ensure the availability of adequate and sustainable funding support for projects which produce a return on investment to the military treatment facilities;

(C) ensure that a portion of any return on investment is returned to the military treatment facility to which such savings are attributable;

(D) remove financial disincentives for military treatment facilities and civilian contractors to initiate and sustain agreements for the support of military treatment facilities by such contractors under the TRICARE program;

(E) provide for a consistent methodology across all regions of the TRICARE program for developing cost benefit analyses of agreements for the support of military treatment facilities by civilian contractors under the TRICARE program based on actual cost and utilization data within each region of the TRICARE program; and

(F) provide for a system for monitoring the performance of significant projects for support of military treatment facilities by a civilian contractor under the TRICARE program.

(d) Reports to Congress-

(1) ANNUAL REPORTS REQUIRED- Not later than February 1, 2008, and each year thereafter, the Secretary, in coordination with the military departments, shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report on the support of military treatment facilities by civilian contractors under the TRICARE program during the preceding fiscal year.

(2) ELEMENTS- Each report shall set forth, for the fiscal year covered by such report, the following:

(A) The level of support of military health treatment facilities that is provided by contract civilian health care personnel under the TRICARE program in each region of the TRICARE program.

(B) An assessment of the compliance of such support with regional requirements under subsection (a).

(C) The number and type of agreements for the support of military treatment facilities by contract civilian health care personnel.

(D) The standards of quality in effect under the requirements under subsection (a).

(E) The savings anticipated, and any savings achieved, as a result of the implementation of the requirements under subsection (a).

(F) An assessment of the compliance of contracts for health care staffing services for Department of Defense facilities with the requirements of subsection (c)(2)(A).

(e) Effective Date- This section shall take effect on October 1, 2006.

The Senate amendment contained a provision (sec. 726) that would require each TRICARE Regional Director to develop an annual comprehensive plan for support of military treatment facilities in the region provided by contracted civilian health care and administrative personnel. The provision would require approval by the TRICARE Regional Director of each contract within the region, and require consistent standards of quality within the region. The provision would also require removal of financial disincentives for military treatment facilities and civilian contractors to initiate and sustain cost-effective health care staffing support agreements.

The House bill contained no similar provision.

The House recedes with an amendment that would remove the requirement that the Regional Director approve each support contract within the region, and require the Secretary of Defense to establish additional quality and performance standards for health staffing support contractors.

Senate Armed Services Committee Report 109-254

The committee recommends a provision that would require each TRICARE Regional Office Director to develop an integrated plan for support of military treatment facilities by contracted civilian health care and administrative personnel. The provision would require approval by the TRICARE Regional Office Director of all such contracts, in accordance with a consistent process for developing cost benefit analyses of such agreements prescribed by the Secretary of Defense. The provision would also require consistent standards of quality for contracted support personnel, including accreditation of health care staffing in accordance with the Joint Commission on Accreditation of Health Care Organization Health Care Staffing Standards.

The committee is concerned that contracting for support services has become fragmented and inefficient in the TRICARE program. Based on information obtained from beneficiaries and contractors alike, it appears to lack rigor in terms of performance outcomes, providing incentives for achieving efficiencies, and consistent quality standards for contracted personnel. In light of the Department's intent to continue conversion of military medical personnel to civilians, either as federal employees or contracted support, it is crucial that the Department reexamine the effectiveness of all of its contracting approaches in order to achieve maximum efficiency in the military health care system.