Community-Based Health Care Initiative

In March 2004, in conjunction with MRP, the Army also implemented  CBHCI. As a result, most reserve component  soldiers who request to be retained on active duty to receive medical  treatment or evaluation, did not experience delays in obtaining MRP  orders and therefore have not experienced significant gaps in pay and  benefits. In response to our prior work in this area, the Army has fully  implemented 17 of the 22 recommendations we made in our previous  report and partially implemented 2 recommendations aimed at improving  training for reserve component soldiers in the MRP program and the Army  personnel responsible for managing these soldiers. Significant Improvements to Processes and Guidance Result in Fewer Pay Problems

In response to our previous work related to ADME, the Army has  implemented a more streamlined, customer-friendly process for requesting  MRP orders, implemented comprehensive guidance intended to effectively  manage injured and ill reserve component soldiers, provided a more  effective means of tracking injured and ill reserve component soldiers in  the MRP program, addressed the issues we identified previously related to  the Army’s capacity to house and manage injured and ill reserve  component soldiers, and developed performance measures to evaluate  MRP. As a result, the  wounded national guardsman stated his family’s medical benefits were  temporarily disrupted for approximately 2 weeks until the MRP order was  processed. Among other things, the guidance now  provides    specific organizational responsibilities for administering MRP;    an order distribution list covering the command and control, pay,  personnel, and medical eligibility functions;    eligibility criteria for being retained on active duty, including guidelines  for extension of orders beyond 1 year;    criteria that clearly establish priorities for where a soldier may be  attached for medical care (i.e., medical facility has the specialties and  the capacity needed to treat the soldier, proximity to soldiers’  residence);    minimum eligibility criteria for soldiers applying for MRP and ADME    avenues through which eligible soldiers may apply for MRP and ADME;    a list and examples of the specific documentation required to retain or  extend active duty orders for the purpose of medical treatment or  evaluation; and    a list of the entitlements available for injured reserve component  soldiers and their dependents. Lack of Integrated Systems Continues to Be a Challenge

The three recommendations from our prior work that the Army has not yet  addressed were all aimed at improving the Army’s order-writing, pay,  personnel, and medical eligibility systems. These actions are part of a  continuing Army-wide systems integration challenge that affects all  soldiers, including those in the MRP program. The lack of integrated pay, personnel, and other systems can also cause  problems when soldiers are released from active duty but still have time  left on their MRP orders. The Army Lacks the Data Needed to Determine Whether It Is Effectively Managing the Additional Risks Associated with CBHCI

Although the Army has identified several factors associated with CBHCI  that put soldiers at greater risk of being retained on active duty longer  than medically necessary, the Army currently lacks the data needed to  determine whether it is effectively managing this risk. According to the  Army’s metrics, soldiers treated by civilian providers through CBHCI are,  on average, retained on active duty 117 days longer than soldiers treated at  MTFs—which could indicate that the Army is not managing the added  risks associated with CBHCI. According to the Army’s CBHCI selection  criteria, soldiers whose injuries are expected to be treated within 60 days  are not eligible to participate in CBHCI, causing the metrics for soldiers  treated at MTFs to be skewed lower than those for soldiers treated  through CBHCI. Appendix I: Objectives, Scope, and Methodology

To determine whether the Army’s Medical Retention Processing (MRP)  program has resolved the issues we identified previously with the Active  Duty Medical Extension (ADME) program, we reviewed applicable  policies, procedures, and program guidance; observed MRP operations;  and interviewed appropriate agency officials. We also relied on the Standards for Internal  Control in the Federal Government to provide a framework for assessing  the Army’s MRP program and its Community-Based Health Care Initiative  (CBHCI).
Why GAO Did This Study

In February 2005, GAO reported that weaknesses in the Army's Active Duty Medical Extension (ADME) process caused injured and ill Army National Guard and Reserve (reserve component) soldiers to experience gaps in pay and benefits. During the course of GAO's previous work, the Army implemented the Medical Retention Processing (MRP) program in May 2004 and Community-Based Health Care Initiative (CBHCI) in March 2004. CBHCI allows reserve component soldiers on MRP orders to return home and receive medical care through a civilian health care provider. As directed by congressional mandate, GAO determined whether (1) MRP has resolved the pay issues previously identified with ADME and (2) the Army has the metrics it needs to determine whether it is effectively managing CBHCI program risks. GAO's scope did not include the medical, facilities, or disability ratings issues recently reported by the media at Walter Reed Army Medical Center.

What GAO Found

The Army's MRP program has largely resolved the widespread delays in order processing that were associated with ADME. As a result, injured and ill reserve component soldiers retained on active duty through MRP have not experienced significant gaps in pay and benefits. The Army has addressed 17 of the 22 recommendations GAO made previously, which include developing comprehensive guidance for retaining injured and ill reserve component soldiers on active duty, providing a more effective means of tracking the location of soldiers in the MRP program, addressing problems related to inadequate administrative support for processing active duty retention orders, and developing performance measures to evaluate MRP. Of the five recommendations the Army has not fully implemented, two are related to providing adequate training to reserve component soldiers in the MRP program and Army personnel responsible for managing the program and three deal with improving the Army's order-writing, pay, personnel, and medical eligibility systems. Although the Army has issued a soldiers' handbook for soldiers in the MRP program and developed a biannual training conference for Army personnel responsible for managing these soldiers, the Army lacks consistent, Army-wide training standards for injured reserve component soldiers in the MRP program and Army personnel responsible for managing the program. Because of an Army-wide system integration challenge that affects all soldiers, not just those in the MRP program, information is not always updated in the order-writing, pay, personnel, and medical eligibility systems as it should be. As a result, 7 of the 25 randomly selected soldiers GAO interviewed reported that their families' medical benefits were temporarily disrupted when they transitioned to MRP orders. The lack of integrated systems also caused overpayment problems when soldiers were released from active duty but still had time left on their MRP orders. Over a nearly 3-year period, GAO estimates that the Army overpaid these soldiers by at least $2.2 million. Although, according to the Army, soldiers participating in CBHCI are at greater risk of being retained on active duty longer than medically necessary, the Army currently lacks the data needed to determine whether it is effectively managing this risk. According to the Army's metrics, soldiers treated by civilian providers through CBHCI are, on average, retained on active duty 117 days longer than soldiers treated at military treatment facilities (MTF). According to the Army, the metrics for soldiers treated at MTFs are skewed lower because of the Army's CBHCI selection criteria-- which exclude soldiers whose injuries or illnesses are expected to be treated within 60 days. However, until the Army obtains more comparable information for the patient populations treated through CBHCI and MTFs, the Army cannot reliably determine whether it is effectively managing the program's risk.