Briefing: Billing for Foreign Patients in CONUS Date: 20 March 2007 Time: 1110 - 1200

1. Briefing: Billing for Foreign Patients in CONUS Date: 20 March 2007 Time: 1110 - 1200

2. Objectives • Help CONUS-based MTF UBO staff better understand how to bill foreign military members and their dependents • Clarify confusing issues • Provide tools for improved performance • Identify useful references

3. Significant Issues • Unclear visibility to management • True extent of care provided in CONUS to foreign military and their dependents is unknown • Unpredictable management oversight • Issue is “below the radar” with occasional cost or workload data reported upward • Inconsistent performance • Often dismissed as minimal cost and workload

4. Challenges • Multitude of countries involved • Currently some 80 nations • Different levels of benefits authorized, depending on the country • Perceived lack of guidance & training • Invitational Travel Orders (ITOs) not always available or correctly completed • Billing for reimbursement of care provided is not a high priority • Focus on ensuring access to care and avoiding international incidents • Billing often an afterthought

5. Covered Countries • Some 80 countries currently are covered by some sort of health care agreements with DoD • Programs Include: • NATO Status of Forces Agreements (SOFA) • Partnership for Peace (PFP) • Reciprocal Health Care Agreements (RHCAs) • Currently 18 are in effect • Includes several NATO SOFA countries such as Canada, Germany & the UK • A tailored negotiated agreement between the U.S. and the specific foreign country • Each one is slightly different

6. DEERS Improvements • In the past, foreign military were NOT enrolled in DEERS • New ID Card (DD Form 2765) automatically enrolls foreign military member and dependents (when applicable) into DEERS • DEERS assigns them a Foreign Identification Number (FIN) in lieu of an SSN • FIN used for foreign military, foreign nationals and their eligible family members • Numbered 900-00-0001 and up

7. PATCAT Table Issues • Are foreign military & their dependents being assigned to the correct PATCATs? • PATCAT Table has a column indicating “No DEERS Check” for foreign military PATCATs • Assumes they are NOT in DEERS, so why bother checking?

8. No TRICARE Eligibility • Only U.S. military and their families can enroll in TRICARE • Personnel from countries with agreements with the U.S. are entitled to the same access to care in MTFs as are TRICARE Prime enrollees • But their Health Care Delivery Program (HCDP) code shows them as “TRICARE Standard,” which puts them low in priority so they will not get an MTF appointment, unless someone intercedes

9. Success Factors • Having access to the Invitational Travel Order (ITO) is a key • Tells where they are from and what they are authorized to receive • Determines financial responsibility for health care of dependents • May not always be correct as to covered health care services • Verifying eligibility via DEERS

10. Authorities for Care • Invitational Travel Orders (for students and their dependents) • ID card/letter • DEERS • Agreements

11. Invitational Travel Orders

12. Invitational Travel Orders

13. Non-Student Visitor • A foreign national visitor who is not a student will not be issued an ITO • Visitors should have some kind of documentation to identify themselves and their home country • ID card • Letter of Invitation

14. Agreements • Reciprocal Health Care Agreement (RHCA) • Signed by ASD(HA) • Status of Forces Agreement (SOFA) • NATO • Partnership for Peace (PFP) • Counterpart Agreements • Acquisition & Cross Servicing Agreements (ACSA)

15. RHCA Restrictions Example: Ecuador - excludes FMS/IMET & their dependents

16. Web Sites • https://fhp.osd.mil/portal/rhas.jsp sponsored by OASD(Health Affairs), users must have a ".mil" e-mail address to access the site. The reciprocal health care agreements are posted on the site; also has matrices that describe eligibility for care, by country name • http://www.tricare.osd.mil/foreignforces/ sponsored by TRICARE Management Activity (TMA) in Falls Church, Virginia. The site describes eligibility for care by country name, except for Reciprocal Health Care countries. Because it is a public site, the reciprocal agreements are not mentioned

17. Web Sites

18. Web Sites France FFM

19. Web Sites

20. France FFM Dependents Web Sites

21. Web Sites

22. Web Sites Argentina FFM Please note: This website, https://fhp.osd.mil/portal/rhas.jsp is sponsored by OASD(Health Affairs) and you must have a ".mil" email address to access the site. The reciprocal health care agreements are posted on the site, the site also has matrices that describe eligibility for care, by country name.

23. Web Sites

24. Argentina FFM Dependents Please note: This website, https://fhp.osd.mil/portal/rhas.jsp is sponsored by OASD(Health Affairs) and you must have a ".mil" email address to access the site. The reciprocal health care agreements are posted on the site, the site also has matrices that describe eligibility for care, by country name. Web Sites

25. Service References • Army Regulation 40-400, Medical Services Patient Administration, 12 March 2001, see Chapter 3, Section VI, and Appendix B, Table B-1, Section VI • Navy Medical Command Instruction 6320.3B, 14 May 1987, see Sections E.1. through E.4 • Air Force Handbook 41-114, Health Services, Military Health Services System (MHSS) Matrix, 1 March 1997, see Section B, Table 13-16, and Section D, Table 29-32

26. Service References • Joint Instruction (Air Force Handbook 36-3026 (I), Army Regulation 600-8-14, BUPERS Instruction 1750.10B), 20 December 2002, Identification Cards for Members of the Uniformed Services, Their Eligible Family Members and other Eligible Personnel

27. Other References • DoDI 6015.23, 20 October 2002, Subject: Delivery of Health Care at MTFs: Foreign Service Care, Third-Party Collection; Beneficiary Counseling and Assistance Coordinators (New version is in draft) • DoDI 1000.13, 5 December 1997, Subject: ID Cards, Section 6.2.5.12 and Attachment E4.A1.9 relating to foreign force members and their dependents

28. Other References • HA Policy 97-041, 18 March 1997, Subject: Assistant Secretary of Defense Health Affairs PolicyMemorandum on Priority Use of MTFs, see Sections B.2. and B.3. • HA Policy 98-006, 31 December 1997, Subject: Implementation of Supplemental Care Program Policy Changes • DoDI 6000.11, 9 September 1998, Subject: Patient Movement • DoDI 6000.12, 29 April 1996, Subject: Health Services Operations and Readiness

29. Summary • Help CONUS-based MTF UBO staff better understand how to bill foreign military members and their dependents • Clarify confusing issues • Provide tools for improved performance • Identify useful references

30. Quiz • Are Reciprocal Health Care Agreements (RHCA) all the same when it comes to medical services provided to CONUS-based foreign military members and their dependents? • Are foreign military members and their dependents who are stationed in CONUS enrolled in DEERS? • What Web site shows MTFs what medical services foreign military members and their family members are eligible for?