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MEDICARE-ELIGIBLE RETIREE HEALTH CARE FUND (MERHCF) Presented to: DQMC

MEDICARE-ELIGIBLE RETIREE HEALTH CARE FUND (MERHCF) Presented to: DQMC . Medicare-Eligible Retiree Health Care Fund (MERHCF) Defined. Established by Congress (2001 NDAA) to provide mandatory funding for a military retiree health care entitlement

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MEDICARE-ELIGIBLE RETIREE HEALTH CARE FUND (MERHCF) Presented to: DQMC

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  1. MEDICARE-ELIGIBLE RETIREE HEALTH CARE FUND (MERHCF) Presented to: DQMC

  2. Medicare-Eligible Retiree Health Care Fund (MERHCF) Defined • Established by Congress (2001 NDAA) to provide mandatory funding for a military retiree health care entitlement • Covers certain Medicare-eligible DoD beneficiaries(military retirees, retiree family members and survivors - not simply “over-65s”) • Pays for MTF care, purchased care and pharmacy • Recognizes DoD’s accrued and future liability for cost of retiree/survivor health care for military service members and their family members based on actuarial analyses and assumptions, including population characteristics such as: • Rates of retention to retirement eligibility, tendency to remain on active duty beyond retirement eligibility, life expectancy, age-related demand for health care, etc. Implemented 1 October 2002 (FY03)

  3. MERHCF Revenue Sources Annual DoD actuarial “Normal Cost” contribution Total actuarial liability - $534.4B; Treasury Portion amortized over 50 years ($6.7B) FY12 ($10.8B) FY12 Accrual fund investment earnings FY12 Estimated Outlays $9.8B ($1.8B Direct Care; $8.0B Purchased Care)

  4. Normal Cost Contribution Paid by Treasury on behalf of Service MILPERS accounts FY12 per capita rates: • Full time $5,580 annually • Part time $3,260 annually Multiplied by annual budgeted Service end strength FY12 actual total DoD contribution - $10.8B Pays forfuturehealth care costs of current military personnel once they retire and they and their family members/survivors become eligible for Medicare

  5. Simultaneous Reconciliation Purchased Care TRICARE for Life* -Medicare primary payor, TRICARE supplemental (last) payor (must be enrolled in Medicare Part B) plus TRICARE unique benefits (OCONUS purchased care) Managed Care Support (MCS) Contracts* -network at-risk costs (under 65 Medicare eligibles – must be enrolled in Part B) TRICARE Senior Pharmacy* -retail, TMOP costs (must be enrolled in Part B, unless “grandfathered” – age 65 or older as of 1 April 2001) USFHP -enrollees x capitation rate * Includes claims processing and other administrative costs Funds flow: Daily transactions against accrual fund for appropriate charges

  6. Direct (MTF) Care Inpatient Care -Relative Weighted Products (RWPs) x MTF-specific rate (Medical Expense and Performance Reporting System (MEPRS) cost/RWP) Outpatient Care -Ambulatory Patient Group (APG) weights x MTF-specific rate (MEPRS cost/APG weight) Outpatient Pharmacy - “Ingredient cost” - purchase costs from MEPRS; patient-specific workload from Pharmacy Data Transaction Service (PDTS) “Non-ingredient cost” – MTF-specific MEPRS cost/script Move to per capita rate when feasible

  7. MTF Reconciliation The plan… Results used to adjust future prospective payment amount SIDR completion timeliness delays Execution Review to 3d Qtr of following year Execution Review FY03 - Year of Execution FY04 - 1 Year Post Execution FY05 - 2 Years Post Execution Use results of the Execution Review to adjust prospective payment amounts in the next available budget year under the PPBS cycle; do not transfer money to or from the fund based on execution year under/over execution Provides stable business environment for MTFs

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