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5. The dependent medical care program, which provides care by civilian hospitals and physicians to dependents of military personnel, is known as the Civilian Health and Medical Program of the Uniformed Services and referred to by the acronym CHAMPUS. The subcommittee considers the choice of this acronym unfortunate, as its meaning is not immediately apparent to the uninitiated beneficiary as is the case with such terms as medicare. The subcommittee recommends the Department of Defense commence a vigorous program to make military personnel and their families better acquainted with the meaning of CHAMPUS.
6. The CHAMPUS benefits were greatly expanded by the Congress in 1966. The program, however, has not been of as much benefit to military families as Congress intended because of serious shortcomings in the administration of the program.
7. All evidence available to the subcommittee indicates that the quality of care provided to military dependents from civilian sources is excellent. Spokesmen for various military groups who represent more than 200,000 personnel, active and retired, officer and enlisted, all reported that they received virtually no complaints about the quality of care under CHAMPUS.
8. The subcommittee believes that the impact of the administrative problems associated with the expansion of CHAMPUS since 1966 could have been greatly lessened by more adequate advance planning. The subcommittee found planning to be inadequate, although 5 months before the expanded program became law the Assistant Secretary of Defense for Manpower specifically requested the Department of the Army, which is responsible for the dependent medical care program, to prepare appropriate plans for the implementation of the expanded program. Similarly, the subcommittee found that some worthwhile solutions recommended in the studies undertaken since 1966 have not been instituted and the problems to which they address themselves remain unsolved.
9. The physical location of the Office of the Civilian Health and Medical Program (OCHAMPUS) in Denver makes it difficult, timeconsuming, and expensive for that office to deal with the seven uniformed services, all of which are headquartered in Washington. OCHAMPUS' organizational location in the Surgeon General of the Army's office hampers its effective relationship with various organizations, private and governmental, with which it has to deal and leaves it five echelons removed from the office principally responsible for formulating the policies under which it operates that is, the Office of the Assistant Secretary of Defense for Health Affairs and Environment. The subcommittee recommends that OCA AMPUS be redes. ignated as a DOD agency and be relocated to a suitable location within a 100-mile radius of Washington. The subcommittee also recommends that personnel staffing in adequate numbers be provided for CH.LVPI'S in the Office of the Deputy Assistant Secretary of Defense for Health Affairs and, while CHÁMPUS remains an Army agency, in the office of the Army Surgeon General.
10. Contributing to the administrative problems of OCHAMPI'S and fiscal agents and the anguish of potential beneficiaries is the unduly complicated claims form. Some 22 percent of all claims are still being returned to the beneficiaries for correction or additional infor
mation. The subcommittee believes the CHAMPUS claims form can be simplified and recommends that such a restructuring be undertaken, together with the provision of a more lucid instruction sheet.
11. The single most important reason why military dependents are not getting the benefits they are entitled to under CHAMPUS is the lack of a proper information program. Many young enlisted families, who need the program most, are entirely unaware of the benefits Congress has voted for them. The subcommittee found inexcusable delays in publishing information, a lack of understanding as to who was responsible for the information program at all, inadequate distribution of the material published, and the failure of the material published to provide completely authoritative and clearly written explanations.
The subcommittee found that the Head of the Office of Information for the Armed Forces, the principal Defense official responsible for disseminating troop information, was unaware until it was brought to his attention by the subcommittee of Army surveys which indicated as many as 40 percent of the enlisted personnel did not know about the CHAMPUS program.
The lack of an adequate information program on CHAMPUS handicaps the providers as well as the users of care.
T'he subcommittee recommends that the Department of Defense issue directives clearly setting out the responsibility by agency for the various functions associated with the CHAMPUS information program and providing authority for one official to make sure these functions are carried out. The subcommittee further recommends that a vigorous information program be pursued on a continuing basis with improved written material and use of all available media, including Armed Forces radio and TV facilities, troop newspapers, and the public press, with distribution of material sufficient to make an authoritatire pamphlet available to each military family as well as to those engaged in providing care.
12. Inquiry into the appropriateness of physicians' fees disclosed that one physician, a psychiatrist in San Diego, Calif., received $176,000 in 1 year (1968) under the CHAMPUS program. The subcommittee found that 1 year later OCHAMPUS standard review procedures had failed to produce any report on the appropriateness of the physician's charges. Under prodding by the subcommittee, the Department of Defense pursued an investigation which eventually resulted in the psychiatrist being required to refund $11,121.75 to the Government. The subcommittee recommends that the Department of Defense revise its procedures to assure more current review of the propriety of physicians' charges.
13. It is the conclusion of the subcommittee that the time has come for establishment of a civilian-sources dental care program for dependents of active duty personnel. The position of the Department of Defense in opposing such a program is indefensible and untenable. The subcommittee is particularly disturbed that in arriving at its position, the Department of Defense ignored the advice of its health professionals who are responsible for policies concerning the health care of its personnel.
A dental care survey by the Department of Defense supports the findings of an earlier Armed Services Subcommittee that dental
care is the one big remaining gap in the medical care program for dependents of service personnel.
The American Dental Association, which took a neutral position on the dependent dental care program during the 90th Congress, has now adopted a policy of positive support for such a program.
The subcommittee recommends in the strongest possible terms that dental care legislation be considered by the Committee on Armed Services at the earliest practicable time.
14. The subcommittee found incredible inconsistencies in the staffing policies of the various services for optometry officers. The subcommittee believes that the ratio of optometry officers in the Army, Navy, and Air Force is inadequate. The subcommittee recommends that pending legislation to provide special pay for optometry officers be made the subject of hearings by a legislative subcommittee.
Dependents and retirees have to wait long periods often a matter of months—for eye examinations in military facilities. Eye examinations are presently excluded by law under the CHAMPUS program. The subcommittee believes that the law should be changed to include eye examinations in the CHAMPUS program.
15. An inequity results from a policy now in force which excludes personnel retired for physical disability from receiving care in military facilities for certain chronic conditions. The retiree in such cases is required to use VA hospitals, although a military facility capable of providing the needed care may be located much closer to his home. The subcommittee recommends that the policy spelled out in Erecutive orders be amended so that retired members who are eligible for care in military facilities should be equally eligible for all types of care.
16. The subcommittee commends the Department of Defense for establishing the short-term health insurance program for servicemen being separated from active duty other than by reason of retirement. The insurance during the post-service period covers the discharged man during the period prior to the time he can obtain health care coverage such as might be provided by a new civilian employer. The subcommittee recommends that the Department of Defense take steps to assure better supervision of the program at unit and separation activity levels so the full value of the program will be available to the young families for whom it is intended.
The Subcommittee on Supplemental Service Benefits was created to conduct an inquiry into the supplemental service benefits, other than exchanges and commissaries, in an effort to ascertain the extent of their use by service personnel and their dependents, their value to service personnel, and a comparison of such supplemental service benefits with industry and Government benefits. The subcommittee's mandate was not to consider specific legislation, but to inquire into and make recommendations regarding possible extensions, expansions, restrictions or improvements in the supplemental benefits available to members of the armed service and their dependents, retired personnel, and dependents of retired and deceased personnel. First Area of Inquiry
The subcommittee chose as its first area of inquiry a review of the health benefits program of the Armed Forces. The subcommittee gave first priority to health care for service personnel and their families both because its unquestioned importance makes it the No. 1 supplemental benefit and because it provides the first opportunity for congressional review of the health benefits program since the Congress expanded the program by the passage of Public Law 89–614, which became fully effective on January 1, 1967. Public Law 89-614 increased the range of medical benefits available to dependents, provided principally through the provision of outpatient care for the first time from civilian sources, extended civilian hospital and outpatient care to retirees and their dependents, and established a handicapped care program for dependents of active duty personnel. Magnitude of Programs Reviewed
In approaching a discussion of the problems in the medical programs administered by the Department of Defense, it is necessary to appreciate the size of these endeavors. Some statistics will convey an idea.
The total programs administered by the Department of Defense cover, to a greater or lesser extent, 10 million eligible persons. The Defense Department budget for medical care is $2,700,000,000 a year. The military departments run 240 hospitals and 565 dispensaries which in 1969 had an average daily bed occupancy of 43,610 and handled 53.3 million outpatient visits. There were 1.2 million hospital admissions during 1969 and 146,145 live births in military facilities.
During the year there were 7.4 million dental procedures performed. In addition to this, there is the civilian health and medical program of the uniformed services (CHAMPUS), which administers the care provided to military dependents and retirees and their dependents by civilian hospitals and civilian doctors. In 1969 the CHAMPUS program handled claims for 600,000 people at a cost of
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approximately $200 million. As indicated further in this report, the claims would have been higher if more people had been made aware of their rights under CHAMPUS. Background of Committee Interest
The Committee on Armed Services has long shown a special concern for the medical care of military personnel and of their families. In this regard, the work of two prior subcommittees should be mentioned.
In 1964 the work of the Special Subcommittee on Construction of Military Hospital Facilities led to significant improvements in the Department of Defense medical construction policies, particularly with respect to the programing of beds in new military hospitals for retired members and their dependents, a type of programing which had been discontinued by the Secretary of Defense in 1962.
In 1967 the Special Subcommittee on Military Dental Care was established for the purpose of inquiring into “the dental care needs of military families, the importance of this type of care to military personnel, the best way to provide care if needed, and the cost of such a program.” While the legislation to authorize a civilian dental care program for the dependents of active duty members, which the subcommittee recommended, has yet to be submitted to the Congress by the Department of Defense, significant improvements in the military dental care program for dependents did result from the subcommittee's work. Moreover, much valuable information on this subject was developed by the subcommittee which will materially assist both the Committee on Armed Services and the Department of Defense in eventually developing a solution to the dependent dental care problem. Hearings and Witnesses
The subcommittee held 3 days of hearings in Washington, D.C., and, in addition, had the benefit of several other studies of the Defense Department medical programs.
Of the six principal departmental witnesses requested by the subcommittee, only two-the Surgeon General of the Air Force and the Director of OČHAMPUS—appeared. The other four, however, were represented by high-level members of their respective staffs who assured the subcommittee that they were authorized to speak for their principals and their respective departments on all matters before the subcommittee.
Testifying on behalf of the Office of the Secretary of Defense were Brig. Gen. George J. Hayes, USA, Staff Director, Office of the Deputy Assistant Secretary of Defense for Health Affairs; Brig. Gen. Leo E. Benade, USA, Deputy Assistant Secretary of Defense for Military Personnel Policy; Mr. John C. Broger, Director, Office of Information for the Armed Forces; and Mr. Vernon McKenzie, Health Administrator, Office of the Deputy Assistant Secretary of Defense for Health Affairs.
Other Department of Defense witnesses were: Lt. Gen. Kenneth E. Pletcher, USAF, Surgeon General of the Air Force; Rear Adm. John W. Albrittain, USN, Deputy Surgeon General of the Navy; Brig. Gen. Thomas J. Whelan, Jr., USA, Acting Surgeon General of the Army, and Brig. Gen. Louis J. Hackett, Jr., USA, Director of OCHAMPUS.