VA/DOD Health Care

More Guidance Needed to Implement CHAMPUS-Funded Sharing Agreements Gao ID: HEHS-95-15 October 28, 1994

Congress has encouraged the Defense Department (DOD) and the Department of Veterans Affairs (VA) to enter into resource-sharing agreements to exchange hospital and other services. At the end of fiscal year 1993, 332 military and VA hospitals, using hospital operating funds, have entered into about 600 agreements representing 3,500 shared services. To improve efficiency and access to care in the DOD and VA health care system, Congress passed legislation in 1989 and 1992 authorizing the use of Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) funds to reimburse VA for providing health care services to CHAMPUS beneficiaries. It also authorizes VA to treat all categories of CHAMPUS beneficiaries. This report determines the extent to which CHAMPUS funds are being used for health care resource-sharing agreements both inside and outside catchment areas--generally a 40-mile radius around a military treatment facility.

GAO found that: (1) in February 1994, after nearly 3 years of negotiation, VA and DOD agreed on a framework for VA to treat CHAMPUS-eligible beneficiaries and receive reimbursement from CHAMPUS funds; (2) implementation of CHAMPUS/VA sharing agreements has been delayed because of disagreements between DOD and VA over VA hospital requirements; (3) neither DOD nor VA has conducted a systemwide search to identify additional opportunities for sharing agreements; (4) potential sharing opportunities have been missed because DOD hospital commanders have not used CHAMPUS funds for sharing agreements between their hospitals and VA hospitals and are unclear about their authority to do so; and (5) DOD needs to clarify the authority of DOD hospital commanders to propose sharing agreements using CHAMPUS funds, and it needs to provide instructions on developing and implementing such agreements.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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