By Patricia Kime
June 29, 2015

Link: http://www.militarytimes.com/story/military/benefits/health-care/2015/06/29/military-health-care-access-mental-health-in-defense-bills/29229503/

House and Senate lawmakers hashing out a compromise on their respective defense policy bills will mull over several military health provisions as they finalize the legislation.

Discrepancies to be addressed include access to urgent care and other medical appointments, mental health services for troops, family members and veterans, pharmacy fees and birth control.

The Senate bill would allow Tricare beneficiaries up to four visits a year for urgent care without referrals, a move designed to reduce the number of emergency room visits for nonemergency treatment.

Earlier this year, the Defense Department proposed fining beneficiaries who frequently seek care at emergency rooms rather than make a physician's appointment or wait until normal office hours.

Service members and their families use ERs both at military and civilian hospitals at rates that exceed the national average, costing the government millions each year, according to reports from advocacy groups.

The average cost of an ER visit is $531, while the average urgent care visit costs $131, according to the Senate report on the legislation.

The House bill does not include the urgent care benefit but also seeks to address ER overuse by requiring DoD to provide appointments for beneficiaries within the time standards and wait time goals set by the department.

Under the legislation, DoD would be required to provide beneficiaries appointments at a Tricare-approved provider if it can't meet the standards.

The provisions have been hailed by military advocates. "We appear to be making headway in our efforts to improve access to acute care for military families," National Military Family Association officials said in a statement.

The Senate draft bill aims to improve mental health services both within the military and in local communities through a requirement that all DoD primary care physicians and mental health providers be trained to assess for suicide risk and manage patients at high risk for suicide.

The bill also includes a proposal from Sen. Joe Donnelly, D-Ind., that would require DoD to develop a system that would encourage civilian mental health providers to receive training to treat service-related behavioral health conditions in troops, veterans and their families and be listed in a registry accessible to patients.

Donnelly said June 24 that many private psychiatrists, psychologists and social workers are unfamiliar with the unique stressors facing troops, families and veterans, and programs that train cultural sensitivity, awareness and proven treatments for service-related conditions would help by broadening access to care.

"When you look at what a service member goes through when they are on deployment or when they are home ... what we wanted to do with this bill is make sure our care providers have an understanding as well as knowledge of evidence-based practices for treating military personnel," Donnelly said.

A provision that would affect the largest number of Tricare beneficiaries is a Senate proposal to increase prescription drug co-payments starting next year. Under the legislation, fees would rise substantially by 2025 for nearly all types of medications, including generics.

That has caught the eye of beneficiary advocates. "The Senate's proposal shifts a disproportionate share onto beneficiaries who are already doing their part to lower health care costs," the Military Officers Association of America said in a statement.

The House version rejects any proposals to raise Tricare fees, including pharmacy co-payments.

Both versions contain provisions on birth control, with proposals in the House expanding birth control options available at military treatment facilities to include all methods approved by the Food and Drug Administration.

Lawmakers say the unavailability of long-term birth control methods, or the standard practice of dissuading troops from using methods such as IUDs if they have not had children, represent an obstacle to care that can negatively affect their health and careers.

Lawmakers from both chambers are expected to reach a compromise on the final legislation "probably in early July," according to Senate Armed Services Committee Chairman Sen. John McCain, R-Ariz.

Military advocacy groups have praised the decision by both committees to postpone major health care reforms as proposed by the Military Compensation and Retirement Modernization Commission earlier this year.