Three of six recommendations from a House Armed Services Committee (HASC) panel that are designed to help tackle the “long-standing problem” of “timely access to quality care” will be part of the base text of the House version of the FY 2025 National Defense Authorization Act (NDAA).

The report, released April 11 by the committee’s Quality of Life Panel, looks at widespread quality of life issues faced by servicemembers and their families. MOAA has been an active supporter and resource for the panel since its creation; panel leaders Reps. Don Bacon (R-Neb.) and Chrissy Houlahan (D-Pa.) have spoken at MOAA’s 2023 and 2024 Advocacy in Action events, respectively, and MOAA President and CEO Brian T. Kelly, USAF (Ret) has testified before the panel and was among those credited with supporting the panel’s work on its report.  

[RELATED: MOAA President Outlines Key Priorities for New House Quality of Life Panel]

The report’s findings were used to draft the Servicemember Quality of Life Improvement Act, legislation that will serve as the base for the HASC chairman’s mark of the FY 2025 NDAA. The three health care recommendations in the bill would:

• Direct DoD to waive the TRICARE Prime referral requirement for active duty servicemembers to access nutritional, audiological, optometric, or podiatric care in a military treatment facility (MTF), or to access MTF primary and preventive health care services for women.
  
  
• Create an urgent mental health care access standard – if urgent mental health care services cannot be provided within three days, the beneficiary must be referred to the TRICARE network for care.
  
  
• Direct the services to conduct an annual survey of medical providers to find out why they remain in, or separate from, active service. The report must include retention efforts from the services.

[RELATED: MOAA's TRICARE Guide]

The panel also recommends a full Defense Health Agency (DHA) evaluation of access-to-care standards; a DHA report providing access-to-care data from each inpatient MTF; and a Government Accountability Office (GAO) report on how addressing MTF staff shortages could improve provider productivity. These recommendations were not part of the new legislation.

MOAA appreciates the QoL panel’s work to highlight access-to-care issues within the military health system. The referral waiver will allow servicemembers to more quickly and easily access specialty care related to well-being and readiness, while the proposed access standard will ensure beneficiaries in need of urgent mental health care are not retained in an MTF system that lacks capacity for urgent appointments.

Provider Problems

The report notes medical provider shortages are largely to blame for access-to-care problems; it cites June 2023 GAO data indicating 2,107 MTF behavioral health contractor positions are unfilled.

Other factors contributing to access delays, according to the report, include the lack of standardization for MTF patient-to-provider ratios and the effects of collateral duties on MTF provider capacity.

MOAA’s concerns about provider shortages, magnified by post-COVID health care system capacity constraints, led us to prioritize efforts to halt proposed medical billet cuts. We achieved three consecutive one-year delays with the FY 2020-2022 defense authorization bills. The FY 2023 bill included a five-year halt to medical billet cuts and requires extensive analysis and mitigation planning before DoD can proceed with medical billet reductions.

[RELATED: TRICARE For Life Under Threat: How MOAA Works to Protect Your Benefit]

The QoL report also notes, “…because the Department currently evaluates access to care data aggregately and not by location or specialty, it could fail to identify problems within a specific network or detect shifting health care landscapes in a particular region, thereby exacerbating problems by not directing resources where they are needed.”

It cites numerous findings related to access-to-care problems, including:

• A 2018 report by the DoD Inspector General (DOD IG) which found DoD did not consistently meet access to care standards for urgent and routine appointments at select MTFs.
  
  
• A 2020 DOD IG report which found a lack of access was more acute as it related to mental health care.
  
  
• A recently published GAO report which indicated DHA has not established access standards for urgent behavioral health referrals. Wait times for urgent appointments ranged from more than two weeks to more than three weeks, depending on region.
  
  
• A November 2023 DOD IG Management Advisory which found access to care and wait time challenges are not limited to behavioral health, nor to locations outside the continental U.S.

MOAA, the NDAA, and Your Health Care

MOAA’s FY 2025 NDAA health care priorities have also focused on addressing access issues. Recognizing capacity constraints in both MTFs and the TRICARE network, MOAA has advocated for TRICARE plan flexibility to allow beneficiaries to access care where it is available – either in the MTF or TRICARE network – through more expansive TRICARE Qualifying Life Events (QLEs), including a QLE for pregnancy.

We have also advocated for greater oversight of TRICARE networks, including a GAO evaluation of network adequacy requirements in the next-generation TRICARE contracts (T-5) to address reports of network erosion in certain geographic areas.

Please watch for opportunities to support FY 2025 NDAA provisions to improve access to care for TRICARE beneficiaries as the bill moves forward. You can find the latest on the NDAA and other MOAA legislative priorities at MOAA’s Advocacy News page, and the latest on how you can support those priorities at MOAA’s Legislative Action Center.