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TREA Legislative Update for August 25, 2006

It is another quiet and slow news week in Washington DC with members of Congress either on vacation or out and about campaigning around the Country. The President is back in town working on Iraq and out of town working on the election (but see below). THERE WILL BE NO UPDATE NEXT WEEK. TREA is having its National Convention in Nashville from August 30 to September 2, 2006 Hope to see many of you there.

President signs Executive Order on Medical Health Records-On Tuesday, August 22, President Bush signed an executive order requiring the federal departments that pay for health care to move towards requiring records to be “transparent” and that all medical records be electronic. The four agencies affected by the order are the following agencies: the Department of Health and Human Services, which oversees Medicare; the Department of Veterans Affairs; the Defense Department; and the Office of Personnel Management, which oversees the Federal Employee Health Benefit Program. The House (HR4157) and the Senate (S1418) have passed different IT medical record bills and there is concern that they will not have a conference to settle final language before the end of this session. This order will, therefore, put the weight of the federal government’s purchasing power behind this push for a fully electronic system and “transparency” of information. The Order is effective January 1, 2007. We believe there will be many meetings in Washington in the near future analyzing exactly what this will mean for DOD and the VA. The full order is below:

Executive Order: Promoting Quality and Efficient Health Care in Federal Government Administered or Sponsored Health Care Programs

By the authority vested in me as President by the Constitution and the laws of the United States, and in order to promote federally led efforts to implement more transparent and high-quality health care, it is hereby ordered as follows:

Section 1. Purpose. It is the purpose of this order to ensure that health care programs administered or sponsored by the Federal Government promote quality and efficient delivery of health care through the use of health information technology, transparency regarding health care quality and price, and better incentives for program beneficiaries, enrollees, and providers. It is the further purpose of this order to make relevant information available to these beneficiaries, enrollees, and providers in a readily useable manner and in collaboration with similar initiatives in the private sector and non-Federal public sector. Consistent with the purpose of improving the quality and efficiency of health care, the actions and steps taken by Federal Government agencies should not incur additional costs for the Federal Government.

Sec. 2. Definitions. For purposes of this order:

(a) "Agency" means an agency of the Federal Government that administers or sponsors a Federal health care program.

(b) "Federal health care program" means the Federal Employees Health Benefit Program, the Medicare program, programs operated directly by the Indian Health Service, the TRICARE program for the Department of Defense and other uniformed services, and the health care program operated by the Department of Veterans Affairs. For purposes of this order, "Federal health care program" does not include State operated or funded federally subsidized programs such as Medicaid, the State Children's Health Insurance Program, or services provided to Department of Veterans' Affairs beneficiaries under 38 U.S.C. 1703.

(c) "Interoperability" means the ability to communicate and exchange data accurately, effectively, securely, and consistently with different information technology systems, software applications, and networks in various settings, and exchange data such that clinical or operational purpose and meaning of the data are preserved and unaltered.

(d) "Recognized interoperability standards" means interoperability standards recognized by the Secretary of Health and Human Services (the "Secretary"), in accordance with guidance developed by the Secretary, as existing on the date of the implementation, acquisition, or upgrade of health information technology systems under subsections (1) or (2) of section 3(a) of this order.

Sec. 3. Directives for Agencies. Agencies shall perform the following functions:

(a) Health Information Technology.

(1) For Federal Agencies. As each agency implements, acquires, or upgrades health information technology systems used for the direct exchange of health information between agencies and with non-Federal entities, it shall utilize, where available, health information technology systems and products that meet recognized interoperability standards.

(2) For Contracting Purposes. Each agency shall require in contracts or agreements with health care providers, health plans, or health insurance issuers that as each provider, plan, or issuer implements, acquires, or upgrades health information technology systems, it shall utilize, where available, health information technology systems and products that meet recognized interoperability standards.

(b) Transparency of Quality Measurements.

(1) In General. Each agency shall implement programs measuring the quality of services supplied by health care providers to the beneficiaries or enrollees of a Federal health care program. Such programs shall be based upon standards established by multi-stakeholder entities identified by the Secretary or by another agency subject to this order. Each agency shall develop its quality measurements in collaboration with similar initiatives in the private and non-Federal public sectors.

(2) Facilitation. An agency satisfies the requirements of this subsection if it participates in the aggregation of claims and other appropriate data for the purposes of quality measurement. Such aggregation shall be based upon standards established by multi-stakeholder entities identified by the Secretary or by another agency subject to this order.

(c) Transparency of Pricing Information. Each agency shall make available (or provide for the availability) to the beneficiaries or enrollees of a Federal health care program (and, at the option of the agency, to the public) the prices that it, its health insurance issuers, or its health insurance plans pay for procedures to providers in the health care program with which the agency, issuer, or plan contracts. Each agency shall also, in collaboration with multi-stakeholder groups such as those described in subsection (b)(1), participate in the development of information regarding the overall costs of services for common episodes of care and the treatment of common chronic diseases.

(d) Promoting Quality and Efficiency of Care. Each agency shall develop and identify, for beneficiaries, enrollees, and providers, approaches that encourage and facilitate the provision and receipt of high-quality and efficient health care. Such approaches may include pay-for-performance models of reimbursement consistent with current law. An agency will satisfy the requirements of this subsection if it makes available to beneficiaries or enrollees consumer-directed health care insurance products.

Sec. 4. Implementation Date. Agencies shall comply with the requirements of this order by January 1, 2007.

Sec. 5. Administration and Judicial Review.

(a) This order does not assume or rely upon additional Federal resources or spending to promote quality and efficient health care. Further, the actions directed by this order shall be carried out subject to the availability of appropriations and to the maximum extent permitted by law.

(b) This order shall be implemented in new contracts or new contract cycles as they may be renewed from time to time. Renegotiation outside of the normal contract cycle processes should be avoided.

(c) This order is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person.

GEORGE W. BUSH

THE WHITE HOUSE,

August 22, 2006.

Latest TRS enrollment numbers

TRICARE Reserve Select enrollment numbers

As of August 18, 2006:  
Step 1–48,886 entered agreements by member
Step 2–28,175 executed agreements on DEERS
Step 3–11,465 Total plans (count by RC v. TRICARE region)
          3,457 Total plans disenrolled 
          14,922 Total plans ever enrolled
          3,638 member-only plan
          1,088 member-only plans disenrolled
          4,726 Total member-only ever enrolled
          7,827 family plans and 2,369 family plans disenrolled 
          10,196 family plans ever enrolled
          32,728 Total beneficiaries entered in DEERS
          9,826 Total beneficiaries disenrolled.
          42,554 Total beneficiaries ever enrolled.

New TRICARE Fact Sheet: “What Happens to My Benefit When I Retire-Today DOD put out the following comprehensive fact sheet on what the military retiree health care benefit is. This should be helpful for anyone to track down what he or she is entitled to. You may wish to print this out to hand out at chapter meetings or just to friends and neighbors.