MOAA’s work to ensure TRICARE beneficiaries will see greater access to high-quality care under the new provider contract is set to take a major step forward, with congressional oversight of the process included in both House and Senate committee reports on the must-pass defense authorization bill.

Both the Senate and House Armed Services committee (SASC and HASC) reports on the National Defense Authorization Act (NDAA) require assessments of the so-called “T-5” contract and how it will enhance access to network care.

“The committee is concerned about the ability of the TRICARE purchased care network to meet the health care needs of TRICARE beneficiaries,” the SASC report notes. “In a November 2023 Management Advisory, the Department of Defense (DoD) Inspector General reported that, in some locations, the TRICARE network is not robust or adequate enough to meet beneficiaries’ needs.”

The SASC report also notes that military health system reforms in the FY 2017 NDAA established TRICARE Select and required DoD to develop an implementation plan to improve access to care for TRICARE beneficiaries.

SASC FY 2025 NDAA report language directs the Comptroller General to submit a review of DoD’s oversight and enforcement of contractors’ network adequacy requirements in T-5, including an assessment of the reliability of the contractors’ data used in the metrics, as well as T-5 network adequacy requirements related to pediatric primary care and obstetrics care.

[RELATED: How DoD Must Protect Patients During the TRICARE Contract Changeover]

While MOAA understands the COVID-19 pandemic led to workforce volatility and capacity constraints across the U.S. health care system, military family feedback suggests some access problems are due to providers leaving the TRICARE network – not overall capacity shortages.

Preventing an ‘Undue Burden’

The HASC also addressed TRICARE network concerns in its report accompanying its version of the FY 2025 NDAA.

“The committee believes that our servicemembers and their families should have access to medical care that does not cause an undue burden,” the HASC report states. “Recent reports of provider shortages on bases around the country are of particular concern to the committee as servicemembers and their families are traveling greater distances to access the care they need without a sufficient TRICARE network.”

The HASC report directs DoD to provide a congressional briefing on T-5 by Dec. 1 to include how T-5 will ensure access to pediatric primary care and obstetrics care within the direct care system or as part of the managed care support contracts.

[TAKE ACTION:  Support Military Family Access to Children’s Hospitals]

An evaluation of T-5 requirements by the Comptroller General’s Government Accountability Office (GAO) will help determine whether T-5 will address network adequacy issues or if further action will be necessary to ensure beneficiary access to care for servicemembers, retirees, their families and survivors.

MOAA looks forward to leveraging report findings in future TRICARE advocacy efforts. Keep up with the latest on T-5 and other health care news at MOAA.org.