Within the Office of the Under Secretary of Defense for Personnel and  Readiness, the Office of the Assistant Secretary of Defense for Reserve  Affairs works with the seven reserve components to determine whether  members of the Selected Reserve are eligible for TRS and to ensure that  members have information about TRICARE, including TRS. TMA works with contractors to manage civilian health care and other  services in each TRICARE region (North, South, and West). DOD Does Not Have Reasonable Assurance That Selected Reserve Members Are Informed about TRS

DOD does not have reasonable assurance that members of the Selected  Reserve are informed about TRS for several reasons. Second, the contractors are  challenged in their ability to educate the reserve component units in their  respective regions because they do not have comprehensive information  about the units in their areas of responsibility. And, finally, DOD cannot  say with certainty whether Selected Reserve members are knowledgeable  about TRS because the results of two surveys that gauged members’  awareness of the program may not be representative of the Selected  Reserve population because of low response rates. Reserve Components Are Responsible for Providing Information about TRS to Selected Reserve Members, but Most Components Have Not Established Centralized Accountability for TRS Education

A 2007 policy from the Under Secretary of Defense for Personnel and  Readiness designated the reserve components as having responsibility for  providing information about TRS to members of the Selected Reserve at  least once a year. Furthermore, officials from three  of the seven components told us that they were not aware of this policy. Additionally, while most of the components had someone designated to  answer TRICARE benefit questions, only one of the reserve components  had an official at the headquarters level designated as a central point of  contact for TRICARE education, including TRS. Despite the challenges contractors face, officials with TMA’s Warrior  Support Branch told us that they are satisfied with the contractors’ efforts  to provide TRS briefings to the reserve component units in their regions. In  addition, during the course of our review, TMA initiated additional efforts  that specifically examine access to civilian providers for TRS beneficiaries  and the Selected Reserve population, including mapping the locations of  Selected Reserve members in relation to areas with TRICARE provider  networks. DOD Monitors Access to Civilian Providers for TRS Beneficiaries along with TRICARE Standard and Extra Beneficiaries

Because TRS is the same benefit as the TRICARE Standard and Extra  options, DOD monitors TRS beneficiaries’ access to civilian providers as a  part of monitoring access to civilian providers for beneficiaries who use  TRICARE Standard and Extra. As we have recently reported, in the  absence of access-to-care standards for these options, TMA has mainly  used feedback mechanisms to gauge access to civilian providers for these  beneficiaries. Recommendation for Executive Action

We recommend that the Secretary of Defense direct the Assistant  Secretary of Defense for Reserve Affairs to develop a policy that requires  each reserve component to designate a centralized point of contact for  TRS education, who will be accountable for ensuring that the reserve  components are providing information about TRS to their Selected  Reserve members annually. Agency Comments and Our Evaluation

In commenting on a draft of this report, DOD partially concurred with our  recommendation. Appendix I: TRICARE Management Activity Analysis of Claims

We asked the TRICARE Management Activity (TMA) to conduct an  analysis of claims filed for TRICARE Reserve Select (TRS) beneficiaries  and TRICARE Standard and Extra beneficiaries.
Why GAO Did This Study

TRICARE Reserve Select (TRS) provides certain members of the Selected Reserve--reservists considered essential to wartime missions--with the ability to purchase health care coverage under the Department of Defense's (DOD) TRICARE program after their active duty coverage expires. TRS is similar to TRICARE Standard, a fee-forservice option, and TRICARE Extra, a preferred provider option. The National Defense Authorization Act for Fiscal Year 2008 directed GAO to review TRS education and access to care for TRS beneficiaries. This report examines (1) how DOD ensures that members of the Selected Reserve are informed about TRS and (2) how DOD monitors and evaluates access to civilian providers for TRS beneficiaries. GAO reviewed and analyzed documents and evaluated an analysis of claims conducted by DOD. GAO also interviewed officials with the TRICARE Management Activity (TMA), the DOD entity responsible for managing TRICARE; the regional TRICARE contractors; the Office of Reserve Affairs; and the seven reserve components.

What GAO Found

DOD does not have reasonable assurance that Selected Reserve members are informed about TRS. A 2007 policy designated the reserve components as having responsibility for providing information about TRS to Selected Reserve members on an annual basis; however, officials from three of the seven components told GAO that they were unaware of this policy. Additionally, only one of the reserve components had a designated official at the headquarters level acting as a central point of contact for TRICARE education, including TRS. Without centralized responsibility for TRS education, the reserve components cannot ensure that all eligible Selected Reserve members are receiving information about the TRS program. Compounding this, the managed care support contractors that manage civilian health care are limited in their ability to educate all reserve component units in their regions as required by their contracts because they do not have access to comprehensive information about these units, and some units choose not to use the contractors to help educate their members about TRS. Nonetheless, DOD officials stated that they were satisfied with the contractors' efforts to educate units upon request and to conduct outreach. Lastly, it is difficult to determine whether Selected Reserve members are knowledgeable about TRS because the results of two DOD surveys that gauged members' awareness of the program may not be representative because of low response rates. Because TRS is the same benefit as the TRICARE Standard and Extra options, DOD monitors access to civilian providers for TRS beneficiaries in conjunction with TRICARE Standard and Extra beneficiaries. DOD has mainly used feedback mechanisms, such as surveys, to gauge access to civilian providers for these beneficiaries in the absence of access standards for these options. GAO found that jointly monitoring access for these two beneficiary groups is reasonable because a claims analysis showed that TRS beneficiaries and TRICARE Standard and Extra beneficiaries had similar health care utilization. Also, during the course of GAO's review, TMA initiated other efforts that specifically evaluated access to civilian providers for the Selected Reserve population and TRS beneficiaries, including mapping the locations of Selected Reserve members in relation to areas with TRICARE provider networks.

What GAO Recommends

GAO recommends that the Secretary of Defense direct the Assistant Secretary of Defense for Reserve Affairs to develop a policy requiring each reserve component to designate a centralized point of contact for TRS education. DOD partially concurred with this recommendation, citing a concern about regional coordination. GAO modified the recommendation.