'I can be a bad ass,’ top health official says, when it comes to making sure Tricare patients get good service
Some Tricare beneficiaries still have problems trying to get medical care, and officials have taken actions to try to improve the performance of contractors, said Navy Vice Adm. Raquel Bono, director of the Defense Health Agency.
Officials are closely monitoring the performance of the two U.S. Tricare contractors, Humana Military in the East region, and Health Net Federal Services in the West region, said Bono, speaking at a family forum Monday at the 2018 AUSA annual meeting.
She said she recently was impressing upon some senior spouses that “it’s extremely important to me that we get the type of performance we need” from the contractors.
And, she told them, “While I may not look like it, I can be a bad ass.”
Defense health officials have issued several corrective action plans to the contractors, among other things. Through August, the contractors were meeting contract requirements at a level of about 80 percent.
She said there are still challenges with the accuracy of the contractors' provider directories. Defense health officials have issued corrective action plans to both contractors regarding these issues. Families have had trouble finding area doctors and other medical providers who are in the Tricare network.
Officials also issued a corrective action plan to Health Net regarding its customer call centers. Humana has corrective action plans regarding claims processing, correspondence, autism care/Applied Behavior Analysis therapy.
Tricare underwent massive changes in January, as three regions were reduced to two, and Tricare Select replaced Tricare Standard and Extra. There have also been increases in some co-pays and some pharmacy costs.
Help spread the word
Bono asked for the help of those in the audience – which included many military spouses – in getting the word out about important changes coming up.
There are new requirements for those who are retiring. To keep Tricare with no break in coverage, the service member must re-enroll within 90 days of retirement.
There are new open enrollment seasons affecting three benefits, all of which will be held Nov. 12 to Dec. 10:
- Those in Tricare Prime or Select who like their plan don’t need to do anything. But anyone wishing to switch from Prime to Select, or vice versa, must do so during that open season. Until now, families could switch at any time. But once the open season is over, a switch can be made only for a qualifying life event. A few examples of those are moving, retiring, separating from active duty, getting married, having children, and getting divorced. (Tricare.mil/openseason)
- The Tricare Retiree Dental Program ends Dec. 31. To have dental coverage for themselves and their family members through the government in 2019, retirees must enroll in the FEDVIP plan during that open enrollment season which starts Nov. 12. (Tricare.benefeds.com)
- Retirees and their family members and active duty family members (not active duty) will also have access to new vision coverage under the FEDVIP, during that open enrollment season which starts Nov. 12. (Tricare.benefeds.com)
Results of a recent survey of Tricare users show most are now worried about how to afford their medications after a dramatic cost increase Feb. 1.
A House-Senate conference committee tasked with ironing out differences in separate versions of the defense authorization bill has rejected Senate-passed provisions that would have sharply increased Tricare fees, deductibles and co-pays for a million retirees under age 65.
The Military Coalition, a consortium of almost three dozen associations and Veterans groups, is urging House-Senate conferees, as they negotiate a final defense policy bill, to reject Senate-passed language that would impose higher Tricare enrollment fees and deductibles on more than a million retirees under age 65.
More than 4,000 retired Tricare Prime users in the northern U.S. may not have paid their January enrollment fees due to a glitch caused during a contractor change this month.
Today the U.S. Department of Veterans Affairs (VA) announced it is inviting training providers to participate in a new pilot program to prepare Veterans for careers in the high-tech workforce.
The Veteran Employment Through Technology Education Courses (VET TEC) program, for which Veterans can apply beginning in April, is designed to give Veterans more options and access to nontraditional training to acquire skills in information technology, computer software, information science, media application, data processing and computer programming fields.
“We are invested in ensuring Veterans make successful transitions into their post-military career,” said VA Secretary Robert Wilkie. “We are excited to partner with successful training providers who will help pave the way for Veterans seeking meaningful employment in their field of study.”
VET TEC training providers will have access to student Veterans who are motivated, hard-working team players. They will operate under an incentivized payment structure designed to ensure Veterans complete their training and land good jobs. The structure includes the following:
- When Veterans begin their courses, VA will pay the training provider 25 percent of tuition and mandatory fees.
- When a Veteran graduates, VA will pay another 25 percent of the tuition and mandatory fees.
- When a Veteran lands a job in his or her area of study and training, VA will pay the last 50 percent of tuition and mandatory fees.
Veterans will receive a monthly housing stipend while in training. This benefit will be modeled after the Post-9/11 GI Bill housing rate.
The VET TEC webpage provides additional requirements and application instructions. VA will review applications from training providers to ensure proposed programs meet VET TEC criteria. Selected training providers will be notified in early spring.
VET TEC is part of the Harry W. Colmery Veterans Educational Assistance Act of 2017, commonly referred to as the Forever GI Bill. The Forever GI Bill was signed into law Aug. 16, 2017, and further expands GI Bill benefits. For more information on VA education benefits, visit www.benefits.va.gov/gibill/.
For Veterans who have military experience in commercial truck and vehicle operation, it seems natural to want to apply these skills to a civilian career. Yet to transition from a military truck driving job to a commercial truck driver has historically not been simple.
Fortunately, the Federal Motor Carrier Safety Administration is changing that for military Veterans. The FMCSA has recently passed the Military Licensing and State Commercial Driver’s License Reciprocity rule. Find out what this rule means for military Veterans.
Becoming a Military Truck Driver
If you have experience driving a truck for the military, you might have the skills you need to operate the vehicle. To be a commercial truck driver, you also need to get a commercial driver’s license or CDL.
The most common path for getting a CDL is to attend truck driving school. Trucking school ranges from one day to two months in length, and it provides you with the skills needed to pass the CDL exams. These exams include a written test and a road skills test.
Once you get your CDL, you have the option of adding endorsements for hauling passengers, hazardous materials, and tank vehicles to your license. These endorsements allow you to increase your job opportunities by picking up more specialized freight.
Waiver of CDL Exams
As a military truck driver who has the experience, you want to be able to get a civilian job as soon as possible. Yet previously, military Vets had to start from the basics, which is a time-consuming process that has the potential to dissuade Vets from getting their CDL.
At the same time, the trucking industry is in dire straits to be able to fill trucking jobs. Therefore, the FMCSA has published the Military Licensing and State Commercial Driver’s License Reciprocity rule in the Federal Register on Sept. 28, 2018.
This rule allows military Vets who were employed as a truck driver in the last 12 months to forgo taking the CDL skills test. This means that experienced military Vet truck drivers no longer have to take the written portion of the exam.
All that these drivers need to do is be able to pass the road test. If you have experience as a truck driver in the military, you should be fully equipped to operate a commercial vehicle. As such, you will only have to take the driving test to be able to get your CDL.
Benefits of Waivers
You can avoid going to trucking school in order to get your CDL as a Veteran, which saves you time and money on getting your civilian job going.
In addition, the FMCSA rule states that military Veterans who have proven experience in similar skills, such as transporting hazardous materials or tanker loads, can also be exempt from these exams. While the endorsements are not mandatory for commercial truck drivers, they do enhance a driver’s CDL and work history for potential employers.
Along with the fact that you must have applicable experience within the last year, take note of a few highlights from the ruling. The FMCSA had already provided the skills text exemption for military drivers back in 2011.
However, the old rule was that Vets had to have at least two years of safe driving experience in service. The new ruling cuts that required time in half. Therefore, if you did not qualify for the waiver exemption prior, you may be eligible now.
Also, military Veteran truck drivers must be able to pass the vision, hearing, and certified medical examiner physical exam in order to qualify to be a commercial driver. There are exemption waivers for the vision and hearing portions of the exam.
In addition, certain physical issues, such a high blood pressure or diabetes, that are manageable do not automatically disqualify you from a truck driving career. In other words, it is becoming easier than ever for Veterans to get trucking jobs when they return to civilian life.
The Department of Veterans Affairs has begun hiring more job counselors to reduce caseloads in the Vocational Rehabilitation and Employment (VR&E) Program for disabled Veterans.
The aim of the hiring effort is to get the counselor-to-caseload ratio down to one counselor for every 125 Veterans seeking employment, the VA said in a release Wednesday.
According to the numbers provided by the VA in its release, the current ratio is roughly 1 counselor to 148 Veteran job-seekers.
"The VR&E program is much more than a benefits program," VA Secretary Robert Wilkie said in a statement. "It's a vital support network, where VA's expert counselors work closely with Veterans on their personalized vocational rehabilitation goals."
Funding from Congress allowed the VA "to expand our team of counselors who are on the ground across the country working tirelessly for Veterans, and we appreciate their support," he added.
Currently, there are about 940 counselors working across VA's 56 regional offices and other satellite offices to advise Veterans with service-connected disabilities on transitions to the civilian workforce, the VA said.
The plan is to hire an additional 172 vocational rehabilitation counselors (VRCs) to bring caseloads down to more manageable levels "and [provide] the resources needed to ensure Veterans are receiving thorough, quality services," the VA said.
About 900 of the VRCs will work out of regional and satellite offices; others will work out of military installations and college campuses.
The VA estimates that more than 56,000 Veterans have either completed a rehabilitation plan, found jobs or "achieved a greater independence in living through VR&E assistance" since 2014.
The announcement of the job counselor expansion comes amid frequent charges by the American Federation of Government Employees and congressional Democrats of widespread staff shortages at the VA's more than 1,200 facilities.
The AFGE, representing more than 230,000 VA employees, has cited figures from former VA Secretary Dr. David Shulkin that there are more than 33,000 unfilled positions at the VA.
The Veterans Affairs Department may soon have to reinstate many of the employees it fired over the last year, following a ruling from a third-party arbitrator that said the agency has violated a collective bargaining agreement in enforcing one of the key reforms signed into law by President Trump.
The ruling, if upheld, would impact employees represented by the American Federation of Government Employees who faced adverse action under the 2017 VA Accountability and Whistleblower Protection Act. Trump, VA and lawmakers in both parties have heralded the law as a significant step in cracking down on malfeasant and poorly performing employees, but its enforcement has been mired in controversy since its passage.
AFGE brought the case for mediation after VA issued a series of memoranda that said VA was no longer required to give employees 90 days to improve and performance improvement plans would not be used. The union said that violated specific clauses in its collective bargaining agreement requiring those steps for employees identified for poor performance.
VA argued the memos do not affect performance improvement plans, and even if they did, the accountability law supersedes the requirements of the collective bargaining agreement.
The arbitrator rejected that argument, saying the memos did affect performance improvement plans and the accountability law speaks only to the hastened timeline once the department decides to discipline an employee. It does not address what VA must do prior to firing someone, said Jerome Ross, the arbitrator, and therefore it cannot supersede the collective bargaining agreement. Ross noted that federal law requires that federal employees be afforded a “reasonable opportunity to demonstrate acceptable performance.”
VA also tried to dismiss the grievance on the grounds that AFGE has filed another grievance demanding the department bargain over implementation of the accountability law, but Ross said the two claims were sufficiently distinct.
The arbitrator ruled that VA must resume compliance with its CBA, rescind any adverse action against AFGE-represented employees who did not first receive a performance improvement plan and reinstate them at the department, including back pay, restored leave and other benefits. VA must also pay AFGE’s attorney fees.
VA has 30 days to challenge the ruling before the Federal Labor Relations Authority. A spokesman said the department would review the decision and “determine an appropriate response.”
AFGE originally brought the case to mediation on behalf of its employees at the Veterans Benefits Administration, but a spokesman said the union expects the ruling to apply across the department. He did not immediately have available a count of how many employees may now have their jobs reinstated and/or receive back pay, but public data posted by VA shows about 1,400 employees were fired outside of their probationary periods between the time the department issued the memos last August and June 30, 2018. It is unclear how many of those employees were denied opportunities to improve their performance and are represented by AFGE. The union represents more than two-thirds of the departments 383,000 workers.
Lawmakers have for months accused VA of flouting congressional intent in implementing the accountability law. Earlier this year, a group of senators wrote a letter voicing concerns specifically about the elimination of performance improvement plans and lack of progressive discipline.
The senators said new policies have led to employees being fired for “missing deadlines or moving slowly after an injury,” even on first offenses. Such actions “are not the types of offenses that rise to the level of immediate termination,” an authority provided in the 2017 law.
“This is unacceptable and runs counter to congressional intent and your previous comments,” the lawmakers said. They noted then-VA Secretary David Shulkin had previously testified, “Every good manager works with their employees to make them better, to give them feedback,” a practice which the new policies do not allow.
VA has also faced criticism for disproportionately firing low-level employees, such as housekeeping staff. A June letter asked VA’s inspector general to investigate the law’s enforcement, and while no Republican signed onto either letter, Republican leaders on the department’s oversight committee’s have voiced concerns. The IG is currently probing the law’s enforcement.
The department has stood by its actions.
“VA makes absolutely no apology for holding employees accountable when circumstances warrant," Curt Cashour, a department spokesman, said in June. "If former employees feel their removal from federal employment is improper, they have a number of appeal options under federal law."
At a House hearing on the law last month, then-acting VA Secretary Peter O’Rourke defended the department’s policies, but acknowledged it still had work to do to ensure consistent enforcement.
“Right now we’re dealing with the first year of implementation,” he said. “New rules, everyone’s trying to figure that part of it out.”
Number of Vacancies
The VA has reported the vacancies as follows:
- 45,239 overall vacancies at the department, out of a total of 419,353 full-time authorized and budgeted positions. This overall number of vacancies includes: 40,456 vacancies in the Veterans Health Administration, out of a total of 375,953 full-time authorized and budgeted positions
- 1,978 vacancies in the Veterans Benefits Administration, out of a total of 25,560 full-time authorized and budgeted positions
- 233 vacancies in the National Cemetery Administration, out of a total of 2,179 full-time authorized and budgeted positions
- 2,572 vacancies in the department’s Staff Offices, out of a total of 15,661 full-time authorized and budgeted positions
“President Trump has made it clear that achieving the optimal workforce at VA is a top priority as we look to provide the best care and benefits to our nation’s heroes,” according to VA Secretary Robert Wilkie. “My priority has been to have a clear and accurate picture of our vacancies, and getting this information out publicly is an important step in transparency to Veterans and taxpayers.”
With approximately 374,000 current employees, the VA is the second largest federal organization in government. From the start of fiscal year (FY) 2014 to the end of FY 2017, the VA has had a growth rate of 12.5%. The average annual turnover rate is 9.2%. The VA turnover rates compare favorably with other large cabinet-level agencies, which averaged 11% in FY 2017.
The agency also notes there is a national shortage of healthcare professionals, especially for physicians and nurses and this shortage impacts the VA as well as other health care organizations.
Veterans Health Administration Vacancies
The Veterans Health Administration (VHA) is the largest administration within VA, accounting for approximately 335,000 of VA’s 374,000 employees. VHA turnover rates compare favorably with the healthcare industry, including for those occupations identified as mission critical. In FY 2017, VHA’s annual turnover rate for full-time and part-time employees was 9.1%, compared to the healthcare industry turnover rate of 20-30%.
Vacancies are current unencumbered positions due to turnover and new positions planned anticipated growth in services. VHA has approximately 40,000 vacancies, which is consistent with the historical annual 9% turnover rate and a 2-3% growth rate.
Staffing plans consider normal rates of workforce turnover, retirement, and growth, and the expectation that there will always be vacant positions. Each year, VHA hires more employees than it loses to replace turnover and keep up with the growth in demand for services.
The agency emphasizes that the best indicators of adequate staffing levels include Veteran access to care and health care outcomes and not the number of vacant positions.
In support of its job performance, the agency cited the following:
- The VA now provides same-day services for care needs right away at all primary care and mental health clinics.
- In FY18 to date, 21% of all appointments have been completed the same day that the appointment was requested.
- The average time to complete an urgent referral to a specialist has decreased from 19.3 days in FY14 to 3.2 days in FY17 and 2.0 days in FY18. The performance is continuing to improve and was down to 1.3 days in July 2018.
- VA completed 95% of follow-up appointments no later than the provider recommended date for time sensitive appointments in FY to date.
- According to a recent RAND Corp. study, Veterans receive the same or better care at VA medical centers as patients at non-VA hospitals.
- For inpatient care specifically, VA hospitals performed on average the same or significantly better than non-VA hospitals on 21 of 26 measures.
- VA performed significantly better than commercial and Medicaid Health Maintenance Organizations on 28 of 30 measures, with no difference on the other two.
- Although there was variation in performance across VA, the variation was even wider among non-VA hospitals.
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