Military Pay
Processes for Retaining Injured Army National Guard and Reserve Soldiers on Active Duty Have Been Improved, but Some Challenges Remain Gao ID: GAO-07-608 May 29, 2007In February 2005, GAO reported that weaknesses in the Army's Active Duty Medical Extension (ADME) process caused injured and ill Army National Guard and Reserve (reserve component) soldiers to experience gaps in pay and benefits. During the course of GAO's previous work, the Army implemented the Medical Retention Processing (MRP) program in May 2004 and Community-Based Health Care Initiative (CBHCI) in March 2004. CBHCI allows reserve component soldiers on MRP orders to return home and receive medical care through a civilian health care provider. As directed by congressional mandate, GAO determined whether (1) MRP has resolved the pay issues previously identified with ADME and (2) the Army has the metrics it needs to determine whether it is effectively managing CBHCI program risks. GAO's scope did not include the medical, facilities, or disability ratings issues recently reported by the media at Walter Reed Army Medical Center.
The Army's MRP program has largely resolved the widespread delays in order processing that were associated with ADME. As a result, injured and ill reserve component soldiers retained on active duty through MRP have not experienced significant gaps in pay and benefits. The Army has addressed 17 of the 22 recommendations GAO made previously, which include developing comprehensive guidance for retaining injured and ill reserve component soldiers on active duty, providing a more effective means of tracking the location of soldiers in the MRP program, addressing problems related to inadequate administrative support for processing active duty retention orders, and developing performance measures to evaluate MRP. Of the five recommendations the Army has not fully implemented, two are related to providing adequate training to reserve component soldiers in the MRP program and Army personnel responsible for managing the program and three deal with improving the Army's order-writing, pay, personnel, and medical eligibility systems. Although the Army has issued a soldiers' handbook for soldiers in the MRP program and developed a biannual training conference for Army personnel responsible for managing these soldiers, the Army lacks consistent, Army-wide training standards for injured reserve component soldiers in the MRP program and Army personnel responsible for managing the program. Because of an Army-wide system integration challenge that affects all soldiers, not just those in the MRP program, information is not always updated in the order-writing, pay, personnel, and medical eligibility systems as it should be. As a result, 7 of the 25 randomly selected soldiers GAO interviewed reported that their families' medical benefits were temporarily disrupted when they transitioned to MRP orders. The lack of integrated systems also caused overpayment problems when soldiers were released from active duty but still had time left on their MRP orders. Over a nearly 3-year period, GAO estimates that the Army overpaid these soldiers by at least $2.2 million. Although, according to the Army, soldiers participating in CBHCI are at greater risk of being retained on active duty longer than medically necessary, the Army currently lacks the data needed to determine whether it is effectively managing this risk. According to the Army's metrics, soldiers treated by civilian providers through CBHCI are, on average, retained on active duty 117 days longer than soldiers treated at military treatment facilities (MTF). According to the Army, the metrics for soldiers treated at MTFs are skewed lower because of the Army's CBHCI selection criteria-- which exclude soldiers whose injuries or illnesses are expected to be treated within 60 days. However, until the Army obtains more comparable information for the patient populations treated through CBHCI and MTFs, the Army cannot reliably determine whether it is effectively managing the program's risk.
RecommendationsOur 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.
Director: Team: Phone:GAO-07-608, Military Pay: Processes for Retaining Injured Army National Guard and Reserve Soldiers on Active Duty Have Been Improved, but Some Challenges Remain
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Challenges Remain' which was released on May 29, 2007.
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GAO:
Report to Congressional Committees:
United States Government Accountability Office:
May 2007:
Military Pay:
Processes for Retaining Injured Army National Guard and Reserve
Soldiers on Active Duty Have Been Improved, but Some Challenges Remain:
GAO-07-608:
GAO Highlights:
Highlights of GAO-07-608, a report to congressional committees
Why GAO Did This Study:
In February 2005, GAO reported that weaknesses in the Army‘s Active
Duty Medical Extension (ADME) process caused injured and ill Army
National Guard and Reserve (reserve component) soldiers to experience
gaps in pay and benefits. During the course of GAO‘s previous work, the
Army implemented the Medical Retention Processing (MRP) program in May
2004 and Community-Based Health Care Initiative (CBHCI) in March 2004.
CBHCI allows reserve component soldiers on MRP orders to return home
and receive medical care through a civilian health care provider. As
directed by congressional mandate, GAO determined whether (1) MRP has
resolved the pay issues previously identified with ADME and (2) the
Army has the metrics it needs to determine whether it is effectively
managing CBHCI program risks. GAO‘s scope did not include the medical,
facilities, or disability ratings issues recently reported by the media
at Walter Reed Army Medical Center.
What GAO Found:
The Army‘s MRP program has largely resolved the widespread delays in
order processing that were associated with ADME. As a result, injured
and ill reserve component soldiers retained on active duty through MRP
have not experienced significant gaps in pay and benefits. The Army has
addressed 17 of the 22 recommendations GAO made previously, which
include developing comprehensive guidance for retaining injured and ill
reserve component soldiers on active duty, providing a more effective
means of tracking the location of soldiers in the MRP program,
addressing problems related to inadequate administrative support for
processing active duty retention orders, and developing performance
measures to evaluate MRP.
Of the five recommendations the Army has not fully implemented, two are
related to providing adequate training to reserve component soldiers in
the MRP program and Army personnel responsible for managing the program
and three deal with improving the Army‘s order-writing, pay, personnel,
and medical eligibility systems.
* Although the Army has issued a soldiers‘ handbook for soldiers in the
MRP program and developed a biannual training conference for Army
personnel responsible for managing these soldiers, the Army lacks
consistent, Army-wide training standards for injured reserve component
soldiers in the MRP program and Army personnel responsible for managing
the program.
* Because of an Army-wide system integration challenge that affects all
soldiers, not just those in the MRP program, information is not always
updated in the order-writing, pay, personnel, and medical eligibility
systems as it should be. As a result, 7 of the 25 randomly selected
soldiers GAO interviewed reported that their families‘ medical benefits
were temporarily disrupted when they transitioned to MRP orders.
* The lack of integrated systems also caused overpayment problems when
soldiers were released from active duty but still had time left on
their MRP orders. Over a nearly 3-year period, GAO estimates that the
Army overpaid these soldiers by at least $2.2 million.
Although, according to the Army, soldiers participating in CBHCI are at
greater risk of being retained on active duty longer than medically
necessary, the Army currently lacks the data needed to determine
whether it is effectively managing this risk. According to the Army‘s
metrics, soldiers treated by civilian providers through CBHCI are, on
average, retained on active duty 117 days longer than soldiers treated
at military treatment facilities (MTF). According to the Army, the
metrics for soldiers treated at MTFs are skewed lower because of the
Army‘s CBHCI selection criteria”which exclude soldiers whose injuries
or illnesses are expected to be treated within 60 days. However, until
the Army obtains more comparable information for the patient
populations treated through CBHCI and MTFs, the Army cannot reliably
determine whether it is effectively managing the program‘s risk.
What GAO Recommends:
GAO recommends six new actions aimed at providing Army-wide training
standards for MRP, developing performance metrics for CBHCI, and
providing short-term solutions to address the Army‘s lack of integrated
systems. In its written comments, the Department of Defense concurred
with five of GAO‘s six recommendations and partially concurred with
one.
[Hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-07-608].
To view the full product, including the scope and methodology, click on
the link above. For more information, contact McCoy Williams at (202)
512-9095 or williamsm1@gao.gov.
[End of section]
Contents:
Letter:
Results in Brief:
Background:
Significant Progress Made in Resolving Previously Identified Pay
Problems, but Some Challenges Remain:
The Army Lacks the Data Needed to Determine Whether It Is Effectively
Managing the Additional Risks Associated with CBHCI:
Conclusion 22:
Recommendations for Executive Action:
Agency Comments and Our Evaluation:
Appendix I: Objectives, Scope, and Methodology:
Appendix II: Status of Prior Recommendations:
Appendix III: Comments from the Department of Defense:
Tables:
Table 1: Installations GAO Visited:
Table 2: Community-Based Health Care Organizations Visited:
Table 3: The Status of the Army's Effort to Implement Prior GAO
Recommendations:
Abbreviations:
ADME: Active Duty Medical Extension:
CBHCI: Community-Based Health Care Initiative:
CBHCO: community-based health care organization:
CONUS: continental United States:
DFAS: Defense Finance and Accounting Service:
DIMHRS: Defense Integrated Military Human Resources System for
Personnel and Pay:
DOD: Department of Defense:
GWOT: Global War on Terrorism:
HRC: Human Resource Command:
HRC-A: Human Resource Command-Alexandria:
IMCOM: Installation Management Command:
MHO: medical holdover:
MODS: Medical Operational Data System:
MRP: Medical Retention Processing:
MRPU: medical retention processing unit:
MTF: military treatment facility:
NDAA: National Defense Authorization Act:
United States Government Accountability Office:
Washington, DC 20548:
May 29, 2007:
Congressional Committees:
Mobilized Army National Guard and Army Reserve soldiers--or reserve
component soldiers--who are injured or become ill in the line of duty
are released from active duty and demobilized when their mobilization
orders expire unless the Army has taken steps, at the soldiers'
request, to extend their active duty service for the purpose of
receiving medical treatment. In February 2005 we reported[Footnote 1]
on weaknesses in the Army's Active Duty Medical Extension (ADME)
process--the process used by the Army at that time to extend the active
duty service of injured or ill Army National Guard and Army Reserve
soldiers. We reported that because ADME was designed to accommodate
reserve component soldiers injured during annual training exercises and
weekend drills and not soldiers mobilized in support of the Global War
on Terrorism (GWOT), the Army was overwhelmed by the number of ADME
requests. As a result, injured and ill reserve component soldiers
experienced gaps in pay and benefits, creating financial hardships for
these soldiers and their families.
In response, the Army implemented a new program, known as the Army's
Medical Retention Processing (MRP) program, which took the place of
ADME for reserve component soldiers returning from operations in
support of GWOT activities. In conjunction with MRP, the Army also
implemented the Community-Based Health Care Initiative (CBHCI), a
program that allows the reserve component soldiers on MRP orders to
return home and receive medical care through a civilian health care
provider instead of receiving care at one of the Army's military
treatment facilities (MTF), which are located at various Army
installations throughout the country. Whether a soldier is treated at
an MTF or by a civilian provider as part of CBHCI, the Army's goal is
the same--to ensure that the soldier attains the optimal level of
physical or mental condition and to determine whether he or she can be
returned to duty, released from active duty, or released from military
service. However, according to the Army, because soldiers treated
though CBHCI are treated by civilian providers and managed remotely
there is a greater risk that these soldiers may be retained on active
duty longer than medically necessary.
The Senate Committee on Armed Services report[Footnote 2] that
accompanied the National Defense Authorization Act (NDAA) for fiscal
year 2006[Footnote 3] directed GAO to periodically monitor the
implementation of the MRP program as a follow-up to our February 2005
report.[Footnote 4] In response to this mandate, we determined whether
(1) MRP has resolved the issues we identified previously with ADME and
(2) the Army has the metrics it needs to determine whether it is
effectively managing the risk that soldiers treated through CBHCI may
be retained on active duty longer than medically necessary.
To achieve our objectives, based on the size of the injured or ill
reserve component population served, we performed work at four of the
top five Army installations and MTFs and four of the Army's top six
regional CBHCI operating locations. At these locations, we interviewed
Army officials; performed walk-throughs of the Army's processes;
reviewed applicable policies, procedures, and program guidance;
observed MRP and CBHCI operations; and randomly selected and
interviewed 25 injured or ill reserve component soldiers.
One of the locations we visited was Walter Reed Army Medical Center,
which has been the focus of recent media accounts and congressional
hearings because of significant problems with the Army's medical and
physical evaluation processes as well as the facilities used to house
injured outpatient soldiers. Because, as directed by the fiscal year
2006 NDAA, we focused on the pay and benefit-related issues we
previously reported on, the scope of our work did not include the
medical and facilities issues recently identified at Walter Reed.
In addition to the 4 Army installations we visited, we contacted Army
officials at 13 other Army installations to obtain information on
training provided to those responsible for managing injured or ill
reserve component soldiers. To determine whether the Army had overpaid
soldiers released early from the MRP program, we selected a stratified
random sample of all soldiers released early from their MRP orders from
May 6, 2004, to November 1, 2006. We also interviewed officials at the
Army National Guard Bureau, Army Reserve, and Army Human Resource
Command. In addition, we interviewed officials with the Army's Office
of the Surgeon General, the office responsible for managing MRP and
CBHCI, and requested and analyzed all available data and metrics--
including metrics related to (1) soldiers' satisfaction with the Army's
MRP and CBHCI programs, (2) the amount of time injured or ill reserve
component soldiers had spent on MRP orders, and (3) the timeliness of
processing MRP requests. To ensure that the Army data we used to
support this report were sufficiently reliable for our analyses, we
conducted detailed reliability assessments of the data sets that we
used. We restricted these assessments, however, to the specific
attributes that were pertinent to our analyses. We did not evaluate the
Army's medical evaluation board or physical evaluation board processes
or any aspect of soldiers' experiences with these processes. We also
did not evaluate the quality of medical care provided or other quality
of life issues affecting injured reserve component soldiers.
We performed this work from July 2006 through March 2007 in accordance
with generally accepted government auditing standards. Further details
on our scope and methodology are included in appendix I. We requested
comments on a draft of this report from the Secretary of Defense or his
designee. Written comments from the Deputy Under Secretary of Defense
(Program Integration) are reprinted in appendix III.
Results in Brief:
The implementation of the Army's MRP program has eliminated the
widespread delays associated with processing active duty orders for
injured and ill reserve component soldiers. As a result, the Army has
resolved the most significant pay and benefits[Footnote 5] problems we
identified previously. According to Army data, since MRP's inception in
May 2004, the Army has extended approximately 15,000 reserve component
soldiers on active duty using MRP orders. As of January 2007, about
3,300 reserve component soldiers remained on MRP orders. According to
the Army's metrics, 98 percent of all MRP orders are processed and
updated in the pay system such that soldiers do not miss a payday. The
25 injured reserve component soldiers we interviewed confirmed that
they did not experience gaps in pay and associated benefits because of
order processing delays. However, some of the soldiers we spoke with
experienced problems with pay and associated benefits because of
weaknesses in the Army's automated systems that control pay and access
to benefits. These problems are not an MRP-specific issue but rather an
Army-wide challenge that affects the MRP program.
In response to our prior work in this area, the Army has fully
implemented 17 of the 22 recommendations we made previously, including
developing comprehensive guidance on managing the retention of injured
and ill reserve component soldiers on active duty, implementing
improved processes for reserve component soldiers requesting to be
retained on active duty, providing a more effective means of tracking
soldiers in the MRP program, addressing the problems we identified
previously related to inadequate administrative support to process
active duty extension or retention orders, and developing performance
measures to evaluate MRP. Of the 5 recommendations the Army has not
fully implemented, 2 are related to providing adequate training to
reserve component soldiers in the MRP program and Army personnel
responsible for managing these soldiers, the majority of whom are
reserve component soldiers themselves, and 3 deal with improving the
Army's order-writing, pay, personnel, and medical eligibility systems.
Providing adequate training and information to injured and ill reserve
component soldiers about the MRP program is an important part of
allowing them to focus on recovering. Although the Army has issued a
soldiers' handbook that provides injured and ill reserve component
soldiers with guidance on key policies and standards of conduct when
transitioning to MRP orders and most installations offered some type of
training or informational briefing for new soldiers in the program, the
Army has not established specific Army-wide training standards for MRP
units. As a result, the training and information provided varied from
installation to installation--with only 4 of the 17 installations we
contacted having formalized or documented training programs for
soldiers entering the MRP program. In addition, 4 of the 25 soldiers we
interviewed did not receive a copy of the soldiers' handbook.
Similarly, although the Army has developed a biannual training
conference for Army personnel responsible for managing soldiers in the
MRP program, this training was often not augmented with adequate on-
the-job training or desk procedures at the installation level. For
example, at 8 of the 17 installations we contacted, reserve component
soldiers responsible for managing injured soldiers in the MRP program
were not trained by the soldier they were replacing because those
soldiers had already been released from active duty and were no longer
at the installations. Further, only 4 of the 17 installations we
contacted had formal, or documented, training for personnel responsible
for managing injured and ill reserve component soldiers. Effective
training, including on-the-job training, and detailed desk procedures
describing the duties associated with the position to be filled could
enhance the continuity of care provided to injured reserve component
soldiers.
The three remaining open recommendations address actions needed to
improve the Army's order-writing, pay, personnel, and medical
eligibility systems. These actions are part of a continuing Army-wide
systems integration challenge that affects all soldiers, not just those
in the MRP program. Because the Army's systems are not integrated and
therefore the same or similar data must be manually entered into
multiple systems, information that may affect a soldier's pay and
access to pay-related benefits is not always appropriately updated in
each system. As a result, the injured reserve component soldiers we
interviewed reported some problems related to their families' medical
eligibility status. According to 7 of the 25 soldiers we interviewed,
their families' medical benefits were temporarily disrupted when they
transitioned to MRP orders. Although soldiers can resolve disruptions
to their pay and benefits by presenting copies of their MRP orders to
the appropriate pay, personnel, and medical eligibility staff, some
injured soldiers expressed frustration because information on how to
resolve these discrepancies was not readily available. According to a
few soldiers, their MRP unit commander and unit support staff were
unable to help them resolve these discrepancies because they were often
reserve component soldiers, were new to their positions, and had no
prior experience dealing with the Army's pay and personnel processes.
As a result, these soldiers--who were already under considerable stress
because of their medical conditions--had to figure out how to resolve
discrepancies in pay and associated benefits on their own.
The lack of integrated pay, personnel, and other systems can also cause
overpayment problems when soldiers are released from active duty but
still have time left on their MRP orders. If the payroll system is not
updated appropriately, the Army will continue to pay these soldiers
until their MRP orders expire, sometimes months after they have been
released from active duty. Although the Army reported that it had
implemented a monthly reconciliation process intended to identify and
resolve differences between the Army payroll and personnel system, our
work indicates that this control has not been effectively implemented.
As a result, we identified numerous instances in which the Army
overpaid soldiers released from active duty before the end dates on
their MRP orders. The Army was unaware of these overpayments until our
testing revealed the problem. Based on our random sample of soldiers
released early from MRP, over nearly a 3-year period, we estimate that
the Army overpaid these soldiers by at least $2.2 million. As we
recently reported,[Footnote 6] these overpayments can result in
collection actions that can create a financial hardship for these
injured or ill soldiers and their families.
Although the Army has indicated that soldiers participating in CBHCI
are at greater risk of being retained on active duty longer than
medically necessary, it currently lacks the data needed to determine
whether it is effectively managing this risk. According to the Army's
metrics, soldiers treated by civilian providers through CBHCI are, on
average, retained on active duty 117 days longer than soldiers treated
at MTFs, which could indicate that soldiers treated through CBHCI are
being retained on active duty longer than medically necessary. However,
it is possible that the metrics for soldiers treated at MTFs are skewed
lower because of the Army's CBHCI selection criteria--which exclude
soldiers whose injuries or illness are expected to be treated within 60
days. Until the Army obtains more comparable information for the
patient populations treated through CBHCI and the MTFs, the Army cannot
reliably determine whether it is effectively managing the risk that
soldiers treated through CBHCI may be retained on active duty longer
than medically necessary.
We are making six new recommendations in this report aimed at improving
training for injured reserve component soldiers in the MRP program and
the staff responsible for managing these soldiers, developing
performance metrics for CBHCI, and providing short-term actions to help
address the Army's existing integration problems associated with the
systems that control injured reserve component soldiers' access to pay
and benefits. The Department of Defense (DOD) concurred with five of
our six recommendations and partially concurred with the remaining
recommendation to develop metrics that will allow a comparison between
the length of stay for soldiers treated through community-based health
car organizations (CBHCO) and those treated at MTFs. In its written
response, DOD has proposed developing metrics to compare administrative
process timelines for CBHCOs and medical retention processing units
(MRPU). Although DOD does not provide more specific information on the
proposed metrics, the intent of our recommendation could be satisfied
with metrics that allow a comparison of the operating efficiency of
these programs if the Army appropriately excluded soldiers whose
injuries are expected to be treated within 60 days and thus would not
be eligible to participate in CBHCI--which would allow a more
meaningful comparison of the two populations.
Background:
The Army has several mechanisms for providing needed health care
services for reserve component soldiers who become injured or ill while
mobilized on active duty. Some soldiers choose to be released from duty
when their mobilization orders expire and seek care through their
private insurers. Eligible soldiers may also seek care through the
Department of Veterans Affairs or the transitional medical assistance
program.[Footnote 7] Finally, soldiers may also request to remain on
active duty for medical evaluation, treatment, or processing through
the Army disability evaluation system. Remaining on active duty
entitles soldiers to continue receiving full pay and allowances as well
as health care without charge to the soldiers and their dependents.
Prior to May 1, 2004, when the Army implemented MRP, if a soldier
became injured or ill while supporting GWOT operations and requested to
remain on active duty for medical evaluation and treatment, the Army
extended the soldier's active duty orders using its existing ADME
process. ADME was designed to accommodate reserve component soldiers
injured during annual training, weekend drills, or other activities
associated with their Army National Guard or Army Reserve duties that
would require care beyond 30 days. At that time, a soldier choosing to
be extended on active duty for medical treatment or evaluation
submitted an ADME order application packet to the Army Manpower Office
at the Pentagon. Officials in that office evaluated the application
packet and determined (1) whether the ADME order should be approved;
(2) the length of the extension, if approved; and (3) the MTF to which
the soldier should be attached. Army Manpower officials made these
determinations based on the information included in the application
packets. However, as the mobilization orders for the first wave of
injured and ill reserve component soldiers coming back from Iraq and
Afghanistan began to expire in 2003, the Army was not prepared and
lacked the infrastructure to process the ADME requests. As a result, in
our February 2005 report, we documented many instances in which these
injured and ill soldiers were inappropriately dropped from active duty
status in the automated systems that control pay and access to medical
care, resulting in significant hardships for these soldiers and their
families.
We reported that the Army lacked an adequate control environment and
management controls over ADME.
* First, the Army's guidance for processing ADME orders did not clearly
define organizational responsibilities or standards for being retained
on active duty orders, how soldiers would be identified as needing
extensions, and how and to whom ADME orders would be distributed.
Without clear and comprehensive guidance, the Army was unable to
establish straightforward, user-friendly processes that would provide
reasonable assurance that injured and ill reserve component soldiers
receive the pay and benefits to which they are entitled without
interruption.
* Second, the Army lacked integrated order-writing, payroll, personnel,
and medical eligibility systems. As a result, the Army lacked
visibility over injured or ill reserve component soldiers and sometimes
lost track of these soldiers. In addition, because the Army lacked
these integrated systems, information did not always flow from one
system to the next as it should--resulting in disruptions to pay and
benefits as well as overpayments.
* Third, the Army did not adequately educate reserve component soldiers
about ADME or train Army personnel responsible for helping soldiers
apply for ADME orders. As a result, many of the soldiers we interviewed
at the time said that neither they nor the Army personnel responsible
for helping them clearly understood the process. This confusion
resulted in delays in processing ADME orders and for some meant that
they fell from their active duty orders and lost pay and medical
benefits for their families.
Finally, the Army lacked the infrastructure and resources needed to
assist soldiers trying to navigate their way through the ADME process.
Specifically, the Army lacked the staff needed to process ADME
paperwork and help soldiers file their ADME requests.
Medical Holdover:
Reserve component soldiers who were mobilized in support of GWOT
operations and are receiving medical treatment or being evaluated for
conditions that made them unfit for duty are referred to as medical
holdover (MHO) soldiers. MHO soldiers fall into three groups. The first
comprises soldiers who are being treated while still on mobilization
orders. Depending on the amount of time left on these soldiers'
mobilization orders, they may be treated and returned to duty or
released from duty before their mobilization orders expire. Soldiers in
this group fall outside the scope of our audit. The second group
comprises soldiers whose mobilization orders have expired but who have
been retained on active duty on MRP orders and are receiving medical
treatment or being evaluated at an MTF. The third group comprises
soldiers who are on MRP orders and whom the Army has agreed can return
home as part of CBHCI and receive medical care through TRICARE--DOD's
worldwide network of civilian health care providers--rather than
remaining at an Army installation and receiving care through an MTF.
The focus of this report is on the management of the second and third
group of soldiers and the processes used to retain these soldiers on
active duty so that they can receive medical treatment or evaluation.
Regardless of the soldiers' MHO classification, the goals are the same-
-to ensure that each soldier attains the optimal level of physical or
mental condition and to determine whether he or she can be returned to
duty, released from active duty, or released from military service.
Once an Army physician determines that a soldier has attained an
optimal level of physical and mental condition, the Army determines--as
part of its medical and physical evaluation board processes--whether
the soldier will be returned to duty or released from military service
with or without benefits. The Army's medical and physical evaluation
board processes fall outside the scope of our audit and, therefore, we
did not evaluate and are not reporting on any aspect of soldiers'
experiences with those processes.
MRP Program:
In an effort to correct the problems we identified as part of our work
related to ADME, the Army implemented the MRP program on May 1, 2004,
for reserve component soldiers mobilized in support of GWOT operations.
Since MRP's inception, the Army has processed about 15,000 soldiers
through the program. While ADME is still used for Army reserve
component soldiers injured or who became ill during training, drills,
or military operations not associated with GWOT, all eligible soldiers
who were previously on ADME orders were allowed to apply for transfer
to MRP orders when their original ADME orders expired.
If the Army determines that a soldier (1) cannot return to duty within
60 days from the time he or she was injured or became ill or (2) can
return to duty within 60 days but has 120 days or fewer beyond the
return to duty date remaining on his or her mobilization order, the
soldier can request to be retained on active duty on MRP orders. MRP
requests are processed through Human Resource Command-Alexandria (HRC-
A). Once the MRP request packet has been submitted and approved by HRC-
A, the injured or ill reserve component soldier is attached to an MRPU
that is responsible for command and control of mobilized reserve
component soldiers who are not medically fit for duty. The MRPU
consists of a unit commander, an executive officer, platoon sergeants,
and supply and other administrative support staff. These soldiers are
also assigned a case manager located at the MTF who is responsible for
helping reserve component soldiers schedule medical appointments and
understand what steps they need to take to progress through the
treatment or evaluation process--to include applying for new MRP orders
if necessary.
According to the Army's MRP procedural guidance, initial and any
subsequent MRP orders are written for 179 days. Although the procedural
guidance does not limit the number of times or the total number of days
that soldiers may be on MRP orders for the purpose of medical treatment
or evaluation, according to a DOD directive, if a soldier remains
medically unfit for duty for a year, the Army is to examine whether the
soldier can be returned to duty, released from active duty, or put
before a medical evaluation board and entered into the physical
disability evaluation process to determine the likelihood of return to
duty.[Footnote 8]
Community-Based Health Care Initiative:
In March 2004, in conjunction with MRP, the Army also implemented
CBHCI. CBHCI allows selected reserve component soldiers to return to
their homes and receive medical care through TRICARE--DOD's worldwide
network of civilian health care providers--rather than remaining at an
Army installation and receiving care through an MTF. Unless
specifically excluded by the Army's minimum eligibility criteria, all
soldiers on MRP orders may be considered for CBHCI. Before a soldier
may considered for CBHCI, he or she must:
* be able to perform duties within a limited duty profile;
* be unable to return to duty within 60 days;
* be unencumbered by legal or administrative action or holds;
* reside in a state or regional catchment area participating in CBHCI;
* have a residence with a valid street address (not just a PO Box) and
phone number that will accommodate the soldier's medical condition;
* volunteer to remain on or extend active duty under MRP status while
undergoing medical treatment and adjudication of unresolved medical
condition;
* have access to transportation to and from medical appointments, as
well as his or her designated place of duty;[Footnote 9]
* have a preliminary diagnosis and care plan that can be supported by
CBHCI (appropriate medical care is available within 50 miles of the
soldier's residence); and:
* live within 50 miles of a duty location that has duties to be
performed within the limits of the soldier's physical profile.
According to Army guidance, in most cases, soldiers should not be
considered for CBHCI if their medical problems involve issues not
commonly treated by civilian practitioners--including exposure to
depleted uranium or chemical, biological, radiological, or nuclear
agents or a confirmed or working diagnosis of leishmaniasis.[Footnote
10]
The Army currently has eight CBHCOs in operation providing coverage for
the continental United States (CONUS).The CBHCOs serving CONUS are
located in Alabama, Arkansas, California, Florida, Massachusetts, Utah,
Virginia, and Wisconsin. Each CBHCO serves the soldiers living in a
particular geographic region. For example, the Alabama CBHCO, which is
located in Birmingham, Alabama, serves a multistate region comprising
Alabama, Kentucky, Mississippi, and Tennessee. The Army has also
located smaller CBHCO facilities in Alaska, Hawaii, and Puerto Rico to
serve soldiers living outside CONUS. Like soldiers who are being
treated at MTFs, soldiers attached to a CBHCO are assigned a case
manager who is responsible for helping them schedule medical
appointments and understand what steps they need to take to progress
through the treatment or evaluation process and a platoon sergeant who
is responsible for command and control functions--such as making sure
the soldiers are reporting to their assigned duty stations. However,
unlike soldiers treated through an MTF, these functions are performed
remotely in that the Army physician, case manager, and platoon sergeant
are physically located at the CBHCO and the injured or ill soldier is
at his or her residence--possibly in another state.
Significant Progress Made in Resolving Previously Identified Pay
Problems, but Some Challenges Remain:
The Army's MRP program has resolved most of the pay-related problems we
identified previously with ADME. As a result, most reserve component
soldiers who request to be retained on active duty to receive medical
treatment or evaluation, did not experience delays in obtaining MRP
orders and therefore have not experienced significant gaps in pay and
benefits. In response to our prior work in this area, the Army has
fully implemented 17 of the 22 recommendations we made in our previous
report and partially implemented 2 recommendations aimed at improving
training for reserve component soldiers in the MRP program and the Army
personnel responsible for managing these soldiers. The 3 remaining open
recommendations address actions needed to improve the Army's order-
writing, pay, personnel, and medical eligibility systems. These actions
are part of a continuing Army-wide systems integration challenge that
affects all soldiers, including those in the MRP program. Because the
Army's systems are not integrated and therefore the same or similar
data must be manually entered into multiple systems, information that
may affect a soldier's pay and access to medical care is not always
appropriately updated in each system. When this happens, it can result
in disruptions to pay and benefits or, conversely, overpayments and
potentially unauthorized access to benefits. See appendix II for a
complete list of prior recommendations and their implementation status.
Significant Improvements to Processes and Guidance Result in Fewer Pay
Problems:
In response to our previous work related to ADME, the Army has
implemented a more streamlined, customer-friendly process for
requesting MRP orders, implemented comprehensive guidance intended to
effectively manage injured and ill reserve component soldiers, provided
a more effective means of tracking injured and ill reserve component
soldiers in the MRP program, addressed the issues we identified
previously related to the Army's capacity to house and manage injured
and ill reserve component soldiers, and developed performance measures
to evaluate MRP. According to Army officials and injured reserve
component soldiers we interviewed, these improvements have virtually
eliminated the widespread delays in order processing that were
associated with the ADME request process.
Unlike the ADME request process, MRP requests are not processed through
the Army Manpower Office at the Pentagon. Instead, once signed and
approved by the MRPU commander, MRP requests are sent directly to HRC-
A to be processed. The Army Manpower Office, which is a policy-setting
organization, was ill-equipped to handle the workload associated with
processing ADME orders. As a result, soldiers' active duty orders often
expired before ADME orders were approved--creating gaps in pay and
benefits. In addition, because all MRP orders are issued for 179 days,
MRP has reduced the workload associated with processing orders. ADME
orders were often issued with a much shorter duration and therefore
soldiers often had to reapply for extensions every 30, 60, or 90 days.
According to the metrics recently developed based on our
recommendation, the Army has met and surpassed its 98 percent goal of
processing all MRP orders on time.[Footnote 11] However, out of the 25
randomly selected injured or ill reserve component soldiers we
interviewed, only 1 reported that he experienced an order processing
delay. As a result, the wounded national guardsman stated his family's
medical benefits were temporarily disrupted for approximately 2 weeks
until the MRP order was processed.
Based on recommendations included in our previous report, the Army has
improved its guidance related to retaining soldiers on active duty so
that they can receive medical treatment. In July 2006, the Army issued
the Department of the Army Medical Holdover (MHO) Consolidated
Guidance, which includes comprehensive guidance for effectively
managing the MRP program. Among other things, the guidance now
provides:
* specific organizational responsibilities for administering MRP;
* an order distribution list covering the command and control, pay,
personnel, and medical eligibility functions;
* eligibility criteria for being retained on active duty, including
guidelines for extension of orders beyond 1 year;
* criteria that clearly establish priorities for where a soldier may be
attached for medical care (i.e., medical facility has the specialties
and the capacity needed to treat the soldier, proximity to soldiers'
residence);
* minimum eligibility criteria for soldiers applying for MRP and ADME
programs;
* avenues through which eligible soldiers may apply for MRP and ADME;
* a list and examples of the specific documentation required to retain
or extend active duty orders for the purpose of medical treatment or
evaluation; and:
* a list of the entitlements available for injured reserve component
soldiers and their dependents.
Although the Army continues to lack an integrated personnel system to
provide visibility over all soldiers--including injured and ill reserve
component soldiers--the Army has, as we recommended, increased use of
the Medical Operational Data System (MODS) for this purpose. This,
combined with improved guidance related to the distribution of MRP
orders, has improved the Army's visibility over injured and ill reserve
component soldiers. In response to recommendations included in our
previous report, the Army now requires that all Army installations use
MODS to track the administrative and clinical status of these soldiers
and makes MHO unit commanders responsible for the accuracy of the data.
For example, MODS contains information such as the number of days in
the program, the MRP order start and end date, the unit the soldier is
attached to, and information on the soldier's medical status (e.g.,
orthopedic, neurological, internal medicine). Previously, installations
were not required to use MODS and therefore used their own local
databases to track the status of injured and ill soldiers-- limiting
Army-wide visibility over these soldiers. For example, the Army
previously did not know how many reserve component soldiers had been
extended on active duty to receive medical treatment or the duration of
the extended service. Based on our assessment of the data contained in
MODS as of July 25, 2006, the Army has greatly improved the
completeness and reliability of MODS data and its ability to monitor
the status of injured and ill soldiers. For example, we traced the data
from source documents to MODS for 564 soldiers and noted only 5 cases
in which the soldier was not listed in MODS. (Additional information on
the procedures used to assess the reliability of MODS data are
discussed in app. I.) Further, all the sites we visited used MODS-
generated reports to enhance their ability to monitor soldiers whose
MRP orders would soon expire. These reports list all soldiers in the
MRP program whose orders will expire in 30, 60, or 90 days-- alerting
Army officials that each soldier may need to submit another request to
be retained on active duty for an additional 179-day period.
In addition, new guidance related to maintaining visibility over
injured or ill soldiers who are transferred from one MTF to another has
improved the Army's ability to monitor the movement of these soldiers.
Previously, according to Army officials, when ADME orders were used to
attach a soldier to an MTF for treatment, the receiving MTF was not
notified in advance of the soldier's arrival. As a result, the
receiving MTF had no knowledge that it was responsible for the injured
or ill soldier until he or she arrived. Such knowledge is necessary to
ensure that the soldier is assigned a case manager and receives
appropriate medical attention. Now, according to the Army's MHO
guidance, the losing unit's commander must contact the gaining unit's
commander and coordinate the movement of injured or ill reserve
component soldiers. According to Army officials at the installations we
visited, they were not experiencing the problems they had previously
related to the transfer of soldiers.
The Army has also addressed most of the problems we identified
previously related to inadequate administrative support and resources
by taking steps to improve its capacity to house and manage injured and
ill reserve component soldiers. The Army has improved its capacity to
house and manage injured and ill reserve component soldiers by
implementing CBHCI and by increasing the overall number of case
managers it has on staff. As discussed previously, CBHCI allows injured
and ill reserve component soldiers to return home, while remaining on
active duty MRP orders, to receive medical treatment through a civilian
provider in DOD's TRICARE network. As of January 2007, of the 3,358
soldiers who the Army reported were on MRP orders, about 1,365--or 41
percent--were receiving care through civilian providers as part of
CBHCI. Allowing these soldiers to return home for treatment reduces the
number of injured and ill soldiers being housed and treated at Army
installations. According to the Army's MHO capacity report, as of
January 2007, all of its installations reported having excess capacity.
In addition, the Army has reduced its soldier-to-case manager ratios.
When we last reported, the Army had 105 case managers and maintained,
at best, a 50-to-1 soldier-to-case manager ratio. As of January 2007,
the Army reported having 208 case managers providing coverage to
soldiers at Army installations and participating in CBHCI and soldier-
to-case manager ratios for each location ranging between 12-to-1 and 24-
to-1. As noted previously, we did not evaluate the quality of the
medical care or facilities provided or other quality of life issues.
In addition, based on our prior recommendation, the Army has begun to
survey injured soldiers about their satisfaction with MRP and CBHCI.
According to the results of the first survey given in December 2006, 81
percent of soldiers receiving care at an MTF and 93 percent of soldiers
receiving care through CBHCI were either completely satisfied or
somewhat satisfied with their case management.
In response to the problems we identified with ADME, the Army has
improved the information it provides to injured or ill reserve
component soldiers about MRP by creating the Medical Holdover (MHO)
Soldier's Handbook. The handbook provides injured and ill reserve
component soldiers with guidance on key policies and standards of
conduct when transitioning to MRP orders--including the role of
soldiers' primary care providers and case managers, as well as
soldiers' rights and responsibilities related to receiving medical
treatment. While the soldier's handbook is a big improvement over the
lack of information available to soldiers under ADME, 4 of the 25
soldiers we interviewed reported that they did not receive the
handbook. Providing these soldiers with MRP guidance is an important
part of easing their burden and allowing them to focus on recovering.
In addition, some enhancement could be made to the soldiers' handbook.
For example, the Important Numbers section of the handbook does not
contain point-of-contact information for soldiers to use if they need
to resolve problems associated with pay and benefits--including the
Defense Finance and Accounting Service (DFAS) ombudsman responsible for
assisting soldiers with pay-related problems. As discussed later, when
pay and benefit discrepancies have occurred, some soldiers we
interviewed expressed frustration because information on how to resolve
these discrepancies was not always readily available.
Further, the Army has not established specific Army-wide training
standards for MRP units--a practice common in all other Army units. As
a result, the training and information provided to injured reserve
component soldiers varied from installation to installation--with only
4 of the 17 installations we contacted having formalized or documented
training programs for soldiers entering the MRP program. For example,
some installations provided only a general overview of the MRP program
while others provided a series of comprehensive training courses on the
program benefits and responsibilities related to MRP and CBHCI. The
Army's Systems Analysis and Review team--which was formed in May 2005
to assess the status of each MRP unit and make recommendations for
improvement--found similar issues related to training across the
installations it reviewed.
Similarly, the Army lacks training standards for the Army personnel
responsible for managing injured and ill reserve component soldiers--
the majority of whom are reserve component soldiers themselves.
According to the new Department of the Army Medical Holdover (MHO)
Consolidated Guidance, the Army Medical Command is responsible for
providing training to case manager and CBHCO medical staff and the
Installation Management Command (IMCOM) is responsible for training
MRPU command and control staff to ensure their competency to perform
their duties. According to the Army guidance, MRPU staff are supposed
to receive instruction in finance and personnel management. In an
effort to address our prior recommendation, IMCOM developed formal
training that it offers approximately every 6 months. However, at the
sites we contacted, the adequacy of the training provided at the
installation upon the arrival of new staff was inconsistent. For
example, 8 of the 17 Army installations we contacted about training
relied exclusively on the IMCOM training and on-the-job training.
However, for 5 of these installations, the reserve component soldier
who had previously filled the position was gone before his or her
replacement arrived--diminishing the effectiveness of on-the-job
training. Further, only 4 of the 17 installations we contacted had a
formal or documented training program for personnel responsible for
managing injured and ill reserve component soldiers. For example, they
provided more structured on-the-job training--requiring that new staff
train under the more experienced staff before taking over the position-
-or, in some cases, installations appointed training officers and
provided formal training for newcomers. Effective training, including
on-the-job training, and detailed desk procedures describing the duties
associated with the position to be filled could enhance the continuity
of care provided to injured and ill reserve component soldiers.
Lack of Integrated Systems Continues to Be a Challenge:
The three recommendations from our prior work that the Army has not yet
addressed were all aimed at improving the Army's order-writing, pay,
personnel, and medical eligibility systems. These actions are part of a
continuing Army-wide systems integration challenge that affects all
soldiers, including those in the MRP program. Because the Army's
systems are not integrated and therefore the same or similar data must
be manually entered into multiple systems, information that may affect
a soldier's pay and benefits is not always appropriately updated in
each system. When this happens, it can result in disruptions to pay and
benefits or, conversely, overpayments and potentially unauthorized
access to benefits. DOD has a major system modernization effort under
way known as the Defense Integrated Military Human Resources System for
Personnel and Pay (DIMHRS), intended to ultimately replace more than 80
legacy systems, including all pay and personnel systems. However, as we
have reported,[Footnote 12] DOD has encountered a number of challenges
with DIMHRS, including the program's overly schedule-driven approach
and DOD's difficulty in overcoming its long-standing cultural
resistance to departmentwide solutions. As a result, the Army is not
scheduled to begin implementing DIMHRS until April 2008.
When the Army retains a soldier on active duty by issuing an MRP order,
it must update and extend the soldier's active duty pay and benefits
status in the appropriate pay, personnel, and medical eligibility
systems. However, because these systems are not integrated, information
that affects a soldier's pay and access to benefits must be manually
entered into each system, which can result in delayed processing or
input errors that may cause disruptions in pay and benefits. For
example, when a soldier is retained on active duty MRP orders, if
information related to the soldier's active duty status and resulting
medical eligibility is not promptly updated in the medical eligibility
system, it can result in a disruption to the medical benefits available
to the soldier's family through TRICARE. According to 7 of the 25
soldiers we interviewed, their families experienced problems getting
medical appointments because the soldiers' active duty status was not
updated in the medical eligibility system in a timely manner and
therefore it appeared as if they and their families were no longer
eligible to receive TRICARE benefits.
Although soldiers can resolve disruptions to their pay and benefits by
presenting copies of their MRP orders to the appropriate pay,
personnel, and medical eligibility staff, some injured soldiers
expressed frustration because information on how to resolve pay and
benefit discrepancies was not always readily available. According to
some of the soldiers we interviewed, their MRP unit commanders and unit
support staff were often reserve component soldiers new to their
positions and with no prior experience dealing with the Army's pay and
personnel processes. As a result, they did not always know how to help
soldiers resolve pay and benefit discrepancies, creating an additional
burden for soldiers who may already be under considerable stress
because of their medical conditions.
The lack of integrated pay, personnel, and other systems can also cause
problems when soldiers are released from active duty but still have
time left on their MRP orders. When the Army processes orders that
affect pay, including MRP orders, the order end date, or stop pay date,
is entered into the Army's pay system. If soldiers are released from
active duty before their MRP orders expire, the finance officials must
manually adjust the stop pay dates recorded in the pay system or else
these soldiers will continue to receive active duty pay. As we reported
in the past,[Footnote 13] when the Army initiates collection actions to
recoup the debt associated with overpayments such as these, depending
on the indebted soldiers' financial situation, these actions can create
financial hardships for these soldiers. For example, we reported that
hundreds of battle-injured soldiers were pursued for repayment of
military debts through no fault of their own, including at least 74
soldiers whose debts had been reported to credit bureaus and private
collection agencies at the time we initiated our audit in June 2005.
In response to our previous work in this area, DFAS implemented a
process intended to identify discrepancies between the order end date
in its reserve component pay system and the active duty release date
reflected in the Army's personnel separation system. According to DFAS
officials, they perform this comparison monthly and forward any
discrepancies to Army installation finance officials to identify and
resolve potential overpayments. Although accurately stopping pay when a
soldier is released early from active duty is a documented challenge
for the Army, the rules governing the use of leave for soldiers on MRP
orders present an additional challenge for the Army with respect to
overpayments. According to the Department of the Army Medical Holdover
(MHO) Consolidated Guidance, soldiers on MRP orders must sell back all
unused leave before being released from active duty. In contrast,
soldiers on regular mobilization orders are not required to sell back
their leave and have the option of taking unused leave before being
released from active duty. As a result, while these soldiers are on
leave, and before they have been released from active duty, DFAS has
time to make adjustments to the stop pay date in the payroll systems
and straighten out potential pay issues. This same time is not
available to DFAS for soldiers being released from MRP orders.
To determine whether the Army's procedure for detecting potential
overpayments has been effective, using MODS data we selected a
stratified random sample of all soldiers released early from MRP, from
May 6, 2004, through November 1, 2006. For the 380 soldiers we
selected, we obtained a copy of each soldier's Certification of Release
or Discharge from Active Duty, DD Form 214, and compared the soldier's
separation date with the stop pay date recorded in the pay system. If
the stop pay date was later than the soldier's separation date, we
concluded that the soldier had been overpaid. Based on our analysis we
determined that the Army overpaid in 44 of the cases we tested.
Overpayments ranged from about $65 to $32,000 with 29 cases being
overpaid less than $3,000 and 37 cases being overpaid for less than 30
days. Until we brought it to the Army's attention, Army officials were
unaware of these overpayments. In projecting our sample results to the
population of 11,575 soldiers released early from MRP orders, we
estimate that the Army overpaid 12 percent of these soldiers a total of
at least $2.2 million.[Footnote 14]
The Army Lacks the Data Needed to Determine Whether It Is Effectively
Managing the Additional Risks Associated with CBHCI:
Although the Army has identified several factors associated with CBHCI
that put soldiers at greater risk of being retained on active duty
longer than medically necessary, the Army currently lacks the data
needed to determine whether it is effectively managing this risk.
According to the Army's metrics, soldiers treated by civilian providers
through CBHCI are, on average, retained on active duty 117 days longer
than soldiers treated at MTFs--which could indicate that the Army is
not managing the added risks associated with CBHCI. However, the
metrics used by the Army to compare soldiers treated at the MTFs to
those treated through CBHCI may not be comparable. For example,
according to Army officials, the metrics for soldiers treated at MTFs
may be skewed lower because of the Army's CBHCI selection criteria.
Specifically, the CBHCI selection excludes soldiers whose injuries or
illnesses are expected to be treated within 60 days. Without more
information about the patient populations that constitute these two
groups, the Army does not know whether it is effectively managing the
risk that soldiers treated through CBHCI may be retained longer than
medically necessary.
Whether a soldier is treated at an MTF or by a civilian provider as
part of CBHCI, the Army's goal is the same--to ensure that the soldier
attains the optimal level of physical or mental condition and to
determine whether he or she can be returned to duty, released from
active duty, or released from military service. However, according to
the Army, there is a greater risk that soldiers treated through CBHCI
may be retained on active duty longer than medically necessary.
According to the Army, this risk is greater because of (1) the remote
physical locations of soldiers being treated from home, which precludes
the Army from directly monitoring their medical care and progress, and
(2) the reliance on civilian doctors, who may not be as familiar with
Army standards of care or MRP program goals. As discussed previously,
each soldier participating in CBHCI is assigned an Army physician, case
manager, and platoon sergeant who are physically located at a regional
CBHCI operating location, whereas the injured or ill soldier is
physically located at his or her home--which could be in another state.
For example, an Army physician, case manager, and platoon sergeant
located at the CBHCO in Birmingham, Alabama, are responsible for
managing injured or ill soldiers who live in Alabama, Mississippi,
Tennessee, and Kentucky. Unlike soldiers treated at MTFs, soldiers
participating in CBHCI are not treated by Army physicians. Instead, the
Army physician and case manager assigned to an injured soldier
participating in CBHCI review medical documentation provided by the
civilian doctor to monitor the soldier's progress toward attaining an
optimal level of physical or mental condition. Similarly, the injured
soldier's platoon sergeant is not personally overseeing the soldier's
well-being. Instead, platoon sergeants located at the CBHCI operating
location call the soldiers assigned to them each day--to make sure the
soldiers have reported for duty.
To ensure that soldiers are not retained on active duty longer than
medically necessary, the Army actively monitors the status of
individual soldiers, regardless of whether they are being treated at
MTFs or through CBHCI. For example, at each of the four CBHCI regional
operating locations we visited, case managers, platoon sergeants, and
Army physicians met on a biweekly basis to discuss the status of each
soldier approaching 180 days, 270 days, and 365 days on MRP orders,
including a discussion of past appointments, scheduled appointments,
and the steps remaining in the civilian providers' treatment plans.
Although the Army recently started comparing the average length of stay
of soldiers treated by civilian providers through CBHCI with the
average length of stay of soldiers treated at MTFs, these metrics may
be misleading. According to the Army's metrics, the average length of
stay, before being returned to duty or medically separated, for
soldiers treated by civilian providers through CBHCI is 288 days
whereas the average length of stay for soldiers treated at MTFs is 171
days. These metrics indicate that soldiers treated through CBHCI are
retained on active duty 117 days longer than soldiers treated at MTFs-
-which might indicate that soldiers treated through CBHCI are more
likely to be retained on active duty longer than medically necessary.
Army officials have suggested that the metrics may not accurately
reflect how well they are managing the risk that soldiers treated
through CBHCI may be retained on active duty longer than medically
necessary. According to the Army's CBHCI selection criteria, soldiers
whose injuries are expected to be treated within 60 days are not
eligible to participate in CBHCI, causing the metrics for soldiers
treated at MTFs to be skewed lower than those for soldiers treated
through CBHCI. However, the Army does not track the information needed
to identify data that may inappropriately skew its metrics and remove
it from its calculation to ensure that the populations of soldiers
being treated through MTFs and CBHCI are comparable. Without additional
information about the patient populations that make up these two
groups, the Army does not know whether it is effectively managing the
risk that soldiers treated through CBHCI may be retained on active duty
longer than medically necessary.
Conclusion:
Through the corrective actions taken in response to our prior report on
this topic, including developing comprehensive MRP guidance,
implementing improved MRP applications processes, and developing
performance measures to evaluate MRP, the Army has demonstrated its
commitment to improving its processes and programs for managing and
paying injured reserve component soldiers who request to be retained on
active duty to receive medical care. We recognize that it may take
several more years to fully address the pay-related problems stemming
from weaknesses in the Army's automated systems that control pay and
access to pay-related benefits. In the interim, the Army can take
several steps in the areas of training, improved CBHCI performance
metrics, and payroll and personnel system reconciliation procedures to
further improve the implementation and management of its MRP and CBHCI
programs.
Recommendations for Executive Action:
We reiterate our previous recommendations to design and implement
integrated order-writing, pay, personnel, and medical eligibility
systems that provide visibility over injured and ill reserve component
soldiers and ensure that the order-writing system automatically updates
the pay, personnel, and medical eligibility systems. We also recommend
that the Secretary of the Army direct the Assistant Secretary of
Manpower and Reserve Affairs, in coordination with the Army's Office of
the Surgeon General, the Installation Management Command, and the
Defense Finance and Accounting Service, to take the following six
actions:
* Develop and apply consistent Army-wide standards for installation-
level training of new MRPU staff, including the use of desk procedures,
to help ensure that they are adequately trained before they assume
their new job responsibilities.
* Develop and apply consistent standards for training of reserve
component soldiers in the MRP program to ensure that they understand
the requirements, benefits, and processes associated with the program.
* Develop and disseminate points of contact, including the names,
telephone numbers, and e-mail addresses, for the Army officials
responsible for assisting injured or ill reserve component soldiers
with resolving discrepancies in pay or benefits. Also include in this
information the name, telephone number, and e-mail address of the DFAS
ombudsman responsible for assisting injured or ill reserve component
soldiers with pay-related issues.
* Require that the local finance offices at Army installations
reconcile all discrepancies between the stop pay date recorded in the
Army's payroll system and the separation date recorded in the Army's
personnel system and adjust the Army's payroll and personnel systems
accordingly.
* Evaluate the efficacy of allowing reserve component soldiers to take
unused leave before they are released from active duty.
* Develop metrics that will allow comparison between the length of stay
for soldiers treated through CBHCI and those treated at MTFs to
determine whether the Army is effectively managing the additional risk
associated with CBHCI.
Agency Comments and Our Evaluation:
In its written comments on a draft of this report, which are reprinted
in appendix III, DOD concurred with five of our six recommendations and
partially concurred with the remaining recommendation. DOD partially
concurred with our recommendation to develop metrics that will allow a
comparison between the length of stay for soldiers treated through
CBHCOs and those treated at MTFs. According to DOD, timely access to
care for soldiers treated through CBHCOs depends on the willingness of
local civilian health care providers to accept TRICARE patients and the
variance of the number and type of health care providers available by
geographic region; therefore, a soldier's length of stay at a CBHCO
cannot be directly compared to MRPUs. We agree that the access to care
timeline for soldiers treated by civilian TRICARE providers may be
longer than for soldiers treated at MTFs, which is why we have
recommended that the Army develop metrics to determine how well it is
managing this risk. In its written response, DOD has proposed
developing metrics to compare administrative process timelines for
CBHCOs and MRPUs. Although DOD does not provide more specific
information on the proposed metrics, the intent of our recommendation
could be satisfied with metrics that allow a comparison of the
operating efficiency of these programs if the Army appropriately
excluded soldiers whose injuries are expected to be treated within 60
days and who thus would not eligible to participate in CBHCI, which
would allow a more meaningful comparison of the two populations.
Although DOD concurred with our recommendation to reconcile all
discrepancies between its payroll and personnel records, in commenting
on this recommendation, DOD asserted that the findings in our report
reflect one-half of 1 percent of the sample population. However, DOD's
assertion is incorrect. As discussed in appendix I, we selected a
stratified random sample of 380 soldiers from the population of 11,575
soldiers released from active duty, from May 6, 2004, through November
1, 2006, and before their MRP orders expired. Our use of statistical
sampling allowed us to project our sample results to the population of
11,575 soldiers released early from MRP orders. Based on our sampling
results, we estimated that the Army overpaid 12 percent of these
soldiers a total of at least $2.2 million.[Footnote 15]
We will send copies of this report to interested congressional
committees, the Secretary of the Army, and the Director of the Office
of Management and Budget. We will make copies available to others upon
request. In addition, the report will be available at no charge on the
GAO Web site at http://www.gao.gov.
If you or your staff have any questions concerning this report, please
contact me at (202) 512-9095 or williamsml@gao.gov. Contact points for
our Offices of Congressional Relations and Public Affairs may be found
on the last page of this report. Staff members who made key
contributions to this report were Diane Handley, Assistant Director;
Francine DelVecchio; Jamie Haynes; and Christopher Spain.
Signed by:
McCoy Williams:
Director:
Financial Management and Assurance:
List of Congressional Committees:
The Honorable Carl Levin:
Chairman:
The Honorable John McCain:
Ranking Member:
Committee on Armed Services:
United States Senate:
The Honorable Daniel K. Inouye:
Chairman:
The Honorable Ted Stevens:
Ranking Member:
Subcommittee on Defense:
Committee on Appropriations:
United States Senate:
The Honorable Ike Skelton:
Chairman:
The Honorable Duncan Hunter:
Ranking Member:
Committee on Armed Services:
House of Representatives:
The Honorable John P. Murtha:
Chairman:
The Honorable C.W. Bill Young:
Ranking Member:
Subcommittee on Defense:
Committee on Appropriations:
House of Representatives:
[End of section]
Appendix I: Objectives, Scope, and Methodology:
To determine whether the Army's Medical Retention Processing (MRP)
program has resolved the issues we identified previously with the
Active Duty Medical Extension (ADME) program, we reviewed applicable
policies, procedures, and program guidance; observed MRP operations;
and interviewed appropriate agency officials. Specifically, we obtained
and reviewed procedural guidance for reserve component soldiers on
medical retention processing orders, including the Department of the
Army Medical Holdover (MHO) Consolidated Guidance, Medical Holdover
(MHO) Soldier's Handbook, and Department of Defense (DOD) and Army
regulations. We also relied on the Standards for Internal Control in
the Federal Government[Footnote 16] to provide a framework for
assessing the Army's MRP program and its Community-Based Health Care
Initiative (CBHCI).
We applied the policies and procedures prescribed in these documents to
the observed and documented procedures and practices followed by the
key Army and DOD components involved in providing active duty pays and
medical benefits to reserve component soldiers. We selected
installations for review based on the reported populations of medical
retention processing and medical holdover (MHO) soldiers, as well as
other specialized traits, including presence of regional medical
commands. The installations we selected for review were four of the top
five installations based on the size of the MRP and MHO populations.
The installations we visited are listed in table 1.
Table 1: Installations GAO Visited:
Installation: Fort Benning, Georgia;
Characteristics: Large medical retention processing and MHO
populations; power projection platform”1st U.S. Army.
Installation: For Dix, New Jersey;
Characteristics: Large medical retention processing and MHO
populations; power projection platform”1st U.S. Army; reserve component
only.
Installation: For Lewis, Washington;
Characteristics: Large medical retention processing and MHO
populations; Western Regional Medical Command; power projection
platform”5th U.S. Army.
Installation: Walter Reed Army Medical Center, Washington, D.C.;
Characteristics: Large medical retention processing and MHO
populations; North Atlantic Regional Medical Command.
Source: GAO.
Note: A power projection platform is an Army installation that
strategically deploys one or more high-priority active component
brigades or larger, mobilizes and deploys high-priority Army reserve
component units, or both.
[End of table]
At each installation, we interviewed officials who were responsible for
counseling soldiers on the MRP program, officials who prepared and
submitted the MRP application packets, case managers, primary care
managers, MHO unit commanders, and installation payroll personnel. We
obtained documentation on and performed walk-throughs of the process to
request an MRP order for a reserve component soldier, the command and
control structure of MHO units, the case management function,
installation MRP tracking systems, as well as the Medical Operational
Data System (MODS) and the medical-extension-to-pay system interface.
We also randomly selected and interviewed 25 injured or ill reserve
component soldiers from the installations we visited to ensure that the
Army's MRP program was operating as effectively as Army officials had
asserted. Specifically, we asked these soldiers questions related to
their experiences filing for and receiving MRP orders, accessibility of
Army staff administering the program, and whether they had any problems
related to their military pay and medical benefits while in the MRP
program.
In addition to the 4 Army installations we visited, we contacted Army
officials at 13 other Army installations to obtain information on
training provided to those responsible for managing and treating
injured or ill reserve component soldiers. Specifically, we asked
whether the medical retention processing units (MRPU) provided
formalized training for new staff when they arrive at the MRPUs for
duty and if so, whether training officers were assigned to coordinate
the training.
We also interviewed and obtained documentation on various aspects of
MRP with officials from the following offices or commands:
* National Guard Bureau, Arlington, Virginia:
* Army Human Resource Command, Alexandria, Virginia:
* U.S. Army Reserve Command, Fort McPherson, Georgia:
* Army's Office of the Surgeon General, Falls Church, Virginia:
* Army G-1, Army Pentagon, Washington, D.C.
* Army Task Force CBHCO-West, Fort Sam Houston, Texas:
* Army Task Force CBHCO-East, Fort Jackson, South Carolina:
* Defense Finance and Accounting Service (DFAS), Indianapolis, Indiana:
As part of our work with the Army's Office of the Surgeon General, we
requested and analyzed all available data and metrics related to MRP
and CBHCI--including metrics related to (1) soldiers' satisfaction with
these programs, (2) the amount of time injured or ill reserve component
soldiers had spent on MRP orders (by treatment location), and (3) the
timeliness of processing MRP requests.
With respect to the Army's automated systems, we assessed whether they
provided reasonable assurance that once an MRP order was issued, the
appropriate pay, personnel, and medical eligibility systems are updated
in an accurate and timely manner. To accomplish this, we interviewed
and obtained available documentation from individuals responsible for
entering MRP order transactions into the Army's order-writing, pay,
personnel, and medical eligibility systems. We did not test computer
security or access controls or test individual transactions. To assess
the reliability of the Army's MODS, which houses, among other things,
information on soldiers in the MRP program, we (1) reviewed existing
documentation related to the data sources, such as patient rosters and
MRP application packages; (2) interviewed knowledgeable agency
officials about the data, including officials at the Office of the
Surgeon General, case managers, and MRPU commanders; (3) manually
tested the data for missing data items, outliers, and obvious errors;
and (4) traced the data from source documents to MODS for 564 soldiers
and noted only 5 cases in which the data were lacking. We determined
that the data were sufficiently reliable for the purposes of this
report.
To determine whether the Army had overpaid reserve component soldiers
who were released early from MRP, using MODS data we selected a
stratified random sample of 380 soldiers from the population of 11,575
soldiers released from active duty, from May 6, 2004, through November
1, 2006, and before their MRP orders expired. We stratified the
population into two groups based on whether the soldier had been
released early from the initial MRP order or an extended MRP order.
With this probability sample, each soldier in the population had a
known, nonzero probability of being selected. Each selected soldier was
subsequently weighted in the analysis to account statistically for all
soldiers in the population, including those who were not selected.
Because we selected a sample of soldiers, our results are estimates of
the population and thus are subject to sample errors that are
associated with samples of this size and type. Our confidence in the
precision of the results from this sample is expressed in 95 percent
confidence intervals, which are expected to include the actual results
in 95 percent of the samples of this type. All percentage estimates in
this report have a margin of error of plus or minus 5 percent or less.
For the 380 soldiers we selected, we obtained[Footnote 17] a copy of
each soldier's Certification of Release or Discharge from Active Duty-
-DD Form 214--and compared the soldier's separation date with the stop
pay date recorded in the DFAS monthly Global War on Terrorism Army
National Guard/Reserve payment file from October 2001 through December
2006 containing 80,972,329 component of pay level records. In cases
where the Army's pay system showed a pay stop date that occurred after
the soldier's separation date, we calculated the amount of the
overpayment based on the soldier's base pay per day while on active
duty during the period in question. In cases where the pay system did
not show a pay stop date and a soldier was still receiving active duty
pay, we calculated the amount of the overpayment based on the soldier's
base pay per day while on active duty during the period in question up
until the date of our test.
To determine whether the Army has effectively managed the risk that
soldiers treated through CBHCI may be retained on active duty longer
than medically necessary, we reviewed applicable policies, procedures,
and program guidance; observed CBHCI operations; interviewed
appropriate agency officials; and obtained and analyzed all data and
performance metrics related to CBHCI operations. The community-based
health care organizations (CBHCO) we selected for review (see table 2)
were four of the top six CBHCOs based on the number of soldiers.
Table 2: Community-Based Health Care Organizations Visited:
CBHCO: CBHCO-Alabama;
States served: Alabama, Mississippi, Tennessee, and Kentucky.
CBHCO: CBHCO-Arkansas;
States served: Missouri, Louisiana, Texas, Oklahoma, Kansas, and
Nebraska.
CBHCO: CBHCO- Massachusetts;
States served: Massachusetts, New York, New Hampshire, Vermont,
Connecticut, Rhode Island, New Jersey, and Maine.
CBHCO: CBHCO-Virginia;
States served: Virginia, Maryland, North Carolina, West Virginia, Ohio,
Pennsylvania, New Jersey, and the District of Columbia.
Source: GAO.
[End of table]
At each CBHCO, we interviewed case managers, platoon sergeants, CBHCO
commanders, and the Army physicians responsible for determining whether
injured or ill soldiers have attained an optimal level of physical or
mental condition. We obtained documentation and observed the command
and control structure, the case management function, and the systems
and procedures used to track soldiers' administrative and medical
status. Using Army data, we also analyzed the amount of time injured or
ill soldiers were on MRP orders--comparing the length of stay data for
soldiers participating in CBHCI with the same data for soldier treated
solely at military treatment facilities (MTF).
We briefed DOD, Department of the Army, Army Reserve, and National
Guard Bureau officials from the selected sites on the details of our
audit, including our findings and their implications. We conducted our
fieldwork from July 2006 through March 2007 in accordance with
generally accepted government auditing standards. On March 30, 2007, we
requested comments on a draft of this report from the Secretary of
Defense or his designee. Written comments from the Deputy Under
Secretary of Defense (Program Integration) received on May 1, 2007, are
summarized and evaluated in the Agency Comments and Our Evaluation
section of this report and are reprinted in appendix III.
[End of section]
Appendix II: Status of Prior Recommendations:
Table 3 summarizes the status of the Army's effort to implement the 22
recommendations we made in our February 2005 report entitled Military
Pay: Gaps in Pay and Benefits Create Financial Hardships for Injured
Army National Guard and Reserve Soldiers (GAO-05-125).
Table 3: The Status of the Army's Effort to Implement Prior GAO
Recommendations:
Develop comprehensive, integrated policies and procedures for managing
and treating reserve component soldiers with service-connected injuries
or illnesses. At a minimum, standard operating procedures and guidance
should be developed that address:
Recommendation: 1. Specific organizational responsibilities for
managing programs that deal with injured or ill reserve component
soldiers;
Complete: X;
Action: Issued Department of the Army Medical Holdover (MHO)
Consolidated Guidance.
Recommendation: 2. Where orders that extend a soldier‘s active duty
status are to be issued, how they are to be distributed, and to whom
they are to be distributed;
Complete: X;
Action: Issued Department of the Army Medical Holdover (MHO)
Consolidated Guidance.
Recommendation: 3. Standards for being retained on active duty orders,
including time frames and criteria for extension or retention beyond 1
year;
Complete: X;
Action: Issued Department of the Army Medical Holdover (MHO)
Consolidated Guidance.
Recommendation: 4. Criteria that clearly establish priorities for where
a soldier may be attached for medical care;
Complete: X;
Action: Issued Department of the Army Medical Holdover (MHO)
Consolidated Guidance.
Recommendation: 5. Minimum eligibility criteria for soldiers applying
for such programs as ADME and MRP;
Complete: X;
Action: Issued Department of the Army Medical Holdover (MHO)
Consolidated Guidance.
Recommendation: 6. Avenues through which soldiers may apply for such
programs;
Complete: X;
Action: Issued Department of the Army Medical Holdover (MHO)
Consolidated Guidance.
Recommendation: 7. Specific documentation required to retain or extend
active duty orders for medical treatment or evaluation;
Complete: X;
Action: Issued Department of the Army Medical Holdover (MHO)
Consolidated Guidance.
Recommendation: 8. Entitlements of each program for both the soldier
and his/her dependents;
Complete: X;
Action: Issued Department of the Army Medical Holdover (MHO)
Consolidated Guidance.
Recommendation: 9. Correctly linking the cost of these programs to the
mission or operation in which the soldier was involved;
Complete: X;
Action: Issued Department of the Army Medical Holdover (MHO)
Consolidated Guidance.
Require that the officials designated with the responsibility for
managing these programs develop performance measures to evaluate the
programs‘ success. Such performance measures should be sufficient to
enable the Army to:
Recommendation: 10. Evaluate the efficiency and effectiveness of these
programs”including timeliness of application processing, soldier
satisfaction, and the length of time soldiers are in the program;
Complete: X;
Action: Metrics developed that track timeliness of application
processing, soldier satisfaction, and the length of time soldiers are
in the program.
Recommendation: 11. Take any corrective actions needed to address
documented shortcomings in program performance;
Complete: X;
Action: Systems Analysis Review teams periodically review and report on
MRP and CBHCI operations.
Provide the infrastructure and resources needed to support these
programs and make needed process improvements to provide reasonable
assurance that:
Recommendation: 12. Officials responsible for managing and treating
injured and ill reserve component soldiers are adequately trained on
program requirements, benefits, and processes;
Complete: [Empty];
Action: Not complete. Although the Army has implemented a biannual
training conference for MRPU staff and case managers, improvements to
on-the-job and local installation training are needed.
Recommendation: 13. Reserve component soldiers and unit commanders will
be educated on these programs, their requirements, and their benefits;
Complete: [Empty];
Action: Not complete. Although the Army has issued the Medical Holdover
(MHO) Soldier‘s Handbook and most installations provide some type of
training or informational briefings for newcomers, a more formalized
training program is needed.
Recommendation: 14. The administrative burden on the soldier is
alleviated through coordinated, customer-friendly processes and easy
access to staff responsible for both the administrative and medical
treatment aspects of the programs;
Complete: X;
Action: Application process simplified as well as increase in the
number of case managers and improved soldier-to-case manager ratios.
Recommendation: 15. Paper-intensive application processes are replaced
with user-friendly automated processes, to the extent possible, through
which soldiers are notified or have easy access to the current status
of their applications;
Complete: X;
Action: Application process simplified, eliminating the need for an
automated notification system. Instead of months to process requests,
it now takes only a few days.
Recommendation: 16. The practice of garnishing soldiers‘ wages to
resolve accounting problems created by the use of retroactive
rescissions of soldiers‘ orders is ended;
Complete: X;
Action: New simplified processes do not result in MRP order processing
delays; therefore, ad hoc procedures that resulted in garnishments are
no longer needed.
For automated systems, in the near term, require that:
Recommendation: 17. The gaining MTF is notified and receives a copy of
the soldier‘s orders when a soldier is transferred from one MTF to
another for treatment;
Complete: X;
Action: Requirement included in Department of the Army Medical Holdover
(MHO) Consolidated Guidance. According to unit commanders, this is no
longer a problem.
Recommendation: 18. The information in MODS is routinely updated and
utilized to the maximum extent possible to provide visibility over and
manage injured and ill reserve component soldiers;
Complete: X;
Action: Requirement included in Department of the Army Medical Holdover
(MHO) Consolidated Guidance. Our data reliability assessment and
fieldwork indicated that MODS is routinely updated and used.
Recommendation: 19. New orders extending active duty for injured or ill
soldiers are sent directly to the staff responsible for updating the
appropriate pay, personnel, and medical eligibility systems;
Complete: X;
Action: Requirement included in Department of the Army Medical Holdover
(MHO) Consolidated Guidance. Our work confirmed that MRP orders are
routed correctly.
Recommendation: 20. Controls are put in place to provide assurance that
the order end date in the pay system is changed to reflect the actual
date the soldier was released from active duty when soldiers are
released from active duty before their orders expire;
Complete: [Empty];
Action: Not complete. Although the Army implemented a process to
identify and reconcile differences between its payroll and personnel
records, our work has shown that the control has not been implemented
effectively.
In the long term, design and implement integrated order-writing, pay,
personnel, and medical eligibility systems that:
Recommendation: 21. Provide visibility over injured and ill reserve
component soldiers;
Complete: [Empty];
Action: Not complete.
Recommendation: 22. Ensure that the order-writing system automatically
updates the pay, personnel, and medical eligibility systems;
Complete: [Empty];
Action: Not complete.
Source: GAO analysis of the Army's effort to implement prior GAO
recommendations.
[End of table]
[End of section]
Appendix III: Comments from the Department of Defense:
Office Of The Under Secretary Of Defense:
4000 Defense Pentagon:
Washington, D.C. 20301-4000:
Personnel And Readiness:
McCoy Williams:
Director, Financial Management and Assurance:
Government Accountability Office:
441 G. Street NW:
Washington, D.C. 20548:
Dear Mr. Williams:
This is the Department of Defense (DoD) response to the GAO draft
report 07-608, `Military Pay: Improvements Made to Processes for
Retaining Injured Army National Guard and Reserve Soldiers on Active
Duty, But Some Challenges Remain,' dated March 30, 2007, (GAO Code
195090). Enclosed is our response by recommendation.
My point of contact is Mr. Michael Lincecum, who can be reached at 703-
696-8710 or via email at lincecummj@osd.pentagon.mil.
Sincerely,
Signed by:
Jeanne B. Fites:
Deputy Under Secretary of Defense:
Program Integration:
Enclosure:
As stated:
GAO Draft Report Dated March 30, 2007 GAO-07-608 (GAO Code 195090):
"Military Pay: Improvements Made To Processess For Retaining Injured
Army National Guard And Reserve Soldiers On Active Duty, But Some
Challenges Remain"
Department Of Defense Comments To The GAO Recommendations:
Recommendation l: The GAO is reiterating a previous recommendation
contained in GAO Report 05-125, that the Secretary of the Army direct
the Deputy Chief of Staff, Army G-1 to design and implement integrated
order writing, pay, personnel, and medical eligibility systems that
provides visibility over injured and ill reserve component soldiers and
ensures that the order writing system automatically updates the pay,
personnel, and medical eligibility systems. (p.32/GAO Draft Report):
DoD Response: The Army concurs with this recommendation. The Defense
Integrated Military Human Resource System (DIMHRS) will provide an
integrated orders writing capability for all Army components and DIMHRS
integrates well with pay and personnel. DIMHRS will interface with the
Defense Eligibility Enrollment Reporting System (DEERS), which
determines medical eligibility, and will also interface with a variety
of other medical systems. The Army will implement DIMHRS on 1 August
2008.
Recommendation 2: The GAO recommends that the Secretary of the Army
direct the Assistant Secretary of the Army for Manpower and Reserve
Affairs, in coordination with the Army's Office of the Surgeon General,
the Installation Management Command, and the Defense Finance and
Accounting Service, to develop and apply consistent Army-wide standards
for installation-level training of the new Medical Retention Processing
Unit (MRPU) staff, including the use of desk procedures, to help ensure
that they are adequately trained before they assume their new job
responsibilities. (p. 33/GAO Draft Report):
DoD RESPONSE: The Army concurs with this recommendation. As part of the
Army Action Plan, a job specific training; program is being developed
for the command, support and care provider positions. Army Installation
Command (IMCOM) is also requiring the MRPUs, on IMCOM installations,
develop and publish Standard Operating Procedures (SOPs) for repetitive
critical tasks. IMCOM will then extrapolate the minimum criteria for
each task and issue updated guidance for publication.
Recommendation 3: The GAO recommends that the Secretary of the Army
direct the Assistant Secretary of the Army for Manpower and Reserve
Affairs, in coordination with the Army's Office of the Surgeon General,
the Installation Management Command, and the Defense Finance and
Accounting Service, to develop and apply consistent standards for
training of reserve component soldiers in the Military Retention
Program (MRP) to ensure that they understand the requirements,
benefits, and processes associated with the program. (p. 33/GAO Draft
Report):
DoD Response: The Army concurs with this recommendation. We note that
the MHO Soldier's Handbook is currently used as the standard for
educating MHO Soldiers on the requirements, benefits and processes
associated with the MRP Program. The Army will review this handbook to
improve and augment it with additional guidance, as appropriate. An MHO
Soldier's Interactive Test is also available to evaluate Soldier
comprehension of MHO operations.
Recommendation 4: The GAO recommends that the Secretary of the Army
direct the Assistant Secretary of the Army for Manpower and Reserve
Affairs, in coordination with the Army's Office of the Surgeon General,
the Installation Management Command, and the Defense Finance and
Accounting Service (DFAS), to develop and disseminate to points of
contact, including the name, telephone number, and e-mail address, for
the Army official(s) responsible for assisting injured or ill reserve
component soldiers with resolving discrepancies in pay or benefits.
Also include in this information the name, telephone number, and e-mail
address of the DFAS ombudsman responsible for assisting injured or ill
reserve component soldiers with pay-related issues. (p. 33/GAO Draft
Report):
DoD Response: The Army concurs with this recommendation. The MHO
Soldier's Handbook will include all applicable contact information to
facilitate expeditious resolution of pay-related issues.
Recommendation 5: The GAO recommends that the Secretary of the Army
direct the Assistant Secretary of the Army for Manpower and Reserve
Affairs, in coordination with the Army's Office of the Surgeon General,
the Installation Management Command, and the Defense Finance and
Accounting Service, to require that the local finance office at Army
installations reconcile all discrepancies between the stop pay date
recorded in the Army's payroll system and the separation date recorded
in the Army's personnel system and adjust the Army's payroll and
personnel systems accordingly. (p. 33/GAO Draft Report):
DoD Response: The Army concurs with this recommendation. The Army is
acutely aware of the importance of payroll system reconciliation and
implemented a process in February 2004 for improvements. As a result,
accuracy rose to 96%, has been sustained above 99% for over a year and
these statistics are briefed quarterly to the GAO and the House
Government Reform Committee. The findings in this current GAO Report
reflect one half percent of the sample population.
Recommendation 6: The GAO recommends that the Secretary of the Army
direct the Assistant Secretary of the Army for Manpower and Reserve
Affairs, in coordination with the Army's Office of the Surgeon General,
the Installation Management Command, and the Defense Finance and
Accounting Service, to evaluate the efficacy of allowing reserve
component soldiers to take unused leave before they are released from
active duty. (p. 33/GAO Draft Report):
DoD Response: The Army concurs with this recommendation. The Army
encourages Reserve Component Soldiers to take leave prior to
demobilization consistent with AR 600-8-10, paragraph 2-2, Leaves and
Passes. HQDA, G-1 is currently reviewing the leave policy for Reserve
Component Soldiers who separate early using medical retention
processing (MRP) orders. Collaboration is also underway with the United
States Army Finance Command to reduce or eliminate any possible
overpayments to Soldiers due to early release from active duty.
Recommendation 7: The GAO recommends that the Secretary of the Army
direct the Assistant Secretary of the Army for Manpower and Reserve
Affairs, in coordination with the Army's Office of the Surgeon General,
the Installation Management Command, and the Defense Finance and
Accounting Service, to develop metrics that will allow comparison.
between the length of stay for soldiers treated through Community Based
Health Care Initiative (CBHCI) and those treated at military treatment
facilities (MTFs) to determine whether the Army is effectively managing
the additional risk associated with CBHCI. (p. 33/GAO Draft Report):
DoD Response: The Army partially concurs. Soldier length of stay at
CBHCOs cannot be directly compared to Medical Retention Processing
Units (MRPUs). Depending on the willingness of local civilian health
care providers to accept TRICARE patients and the variance of the
number and type of health care providers available by geographical
location,, access to care timelines for CBHCO Soldiers are often longer
and otherwise difficult to measure and predict. A more practical
approach would be to develop metrics to compare administrative process
timelines between CBHCOs and MRPUs. The administrative processes for
CBHCOs and MRPUs are similar, thus allowing for appropriate comparison
and measurement to determine how well Soldiers are being
administratively supported.
[End of section]
FOOTNOTES
[1] GAO, Military Pay: Gaps in Pay and Benefits Create Financial
Hardships for Injured Army National Guard and Reserve Soldiers, GAO-05-
125 (Washington, D.C.: Feb. 17, 2005).
[2] S. Rep. No. 109-69, at 339-40 (May 17, 2005).
[3] S. 1042, 109th Cong. (2005), enacted as Pub. L. No. 109-163, 119
Stat. 3136 (Jan. 6, 2006).
[4] GAO-05-125.
[5] Prior to adoption of the MRP program, when soldiers' active duty
orders expired before their ADME orders were approved, the medical
eligibility status of these soldiers' families was adversely affected.
[6] GAO, Military Pay: Hundreds of Battle-Injured GWOT Soldiers Have
Struggled to Resolve Military Debts, GAO-06-494 (Washington, D.C.: Apr.
27, 2006).
[7] Under the transitional assistance management program, prior to
October 2004, service members with fewer than 6 years of active service
were eligible for health care benefits for 60 days. With 6 years or
more of active service, eligibility increased to 120 days. National
Defense Authorization Act for Fiscal Year 1991, Pub. L. No. 101-510, §
502(a), 104 Stat. 1485, 1555 (Nov. 5, 1990) (codified at 10 U.S.C. §
1145). In November 2003, Congress increased this period to 180 days
through the end of September 2004. Emergency Supplemental
Appropriations Act for Defense and for the Reconstruction of Iraq and
Afghanistan, 2004, Pub. L. No. 108-106, § 1117, 117 Stat. 1209, 1218
(Nov. 6, 2003). In October 2004, the Congress permanently extended the
period of eligibility to 180 days for all categories of service
members, Ronald W. Reagan National Defense Authorization Act for Fiscal
Year 2005, Pub. L. No. 108-375, Div. A, §706(a)(1), 118 Stat. 1817,
1983 (Oct. 28, 2004).
[8] Soldiers who do not meet medical military retention standards may
be placed on the temporary disability retired list or the permanent
disabled retired list; may be separated from service with severance;
or, in rare cases, may be retained with disabilities if the soldiers
are still needed by the military. DOD Directive 1332.18, Separation or
Retirement for Physical Disability (Nov. 4, 1996); DOD Instruction
1332.38, Physical Disability Evaluation (rev. July 10, 2006).
Department of the Army Regulation 635-40, Physical Evaluation for
Retention, Retirement, or Separation (Feb. 8, 2006).
[9] Soldiers participating in CBHCI, as well as soldiers who remain at
an Army installation to receive medical treatment are expected to
perform duties within the limits of their physical profile. For
soldiers being treated through CBHCI, this typically involves
performing duties at their local Army National Guard or Army Reserve
units.
[10] Leishmaniasis is a parasitic disease spread by the bite of
infected sand flies.
[11] The Army defines on time to mean that the MRP order is received
and updated in the pay system such that the soldier does not miss a
payday.
[12] GAO, DOD Systems Modernization: Management of Integrated Military
Human Capital Program Needs Additional Improvements, GAO-05-189
(Washington, D.C.: Feb. 11, 2005).
[13] GAO-06-494.
[14] This amount represents the one-sided 95 percent confidence level
lower bound from the sample-based estimate.
[15] This amount represents the one-sided 95 percent confidence level
lower bound from the sample-based estimate. All percentage estimates in
this report have a margin of error of plus or minus 5 percent or less.
[16] GAO, Standards for Internal Control in the Federal Government,
GAO/AIMD-00-21.3.1 (Washington, D.C.: November 1999). These standards
provide the overall framework for establishing and maintaining
effective internal control and for identifying and addressing areas of
greatest risk for fraud, waste, abuse, and mismanagement.
[17] Of the 380 soldiers selected in the sample, we could not obtain 32
soldiers' Certification of Release or Discharge from Active Duty forms.
For these soldiers, we used the most conservative approach possible and
counted these as non-overpayments.
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Web site: www.gao.gov/fraudnet/fraudnet.htm E-mail: fraudnet@gao.gov
Automated answering system: (800) 424-5454 or (202) 512-7470:
Congressional Relations:
Gloria Jarmon, Managing Director, JarmonG@gao.gov (202) 512-4400 U.S.
Government Accountability Office, 441 G Street NW, Room 7125
Washington, D.C. 20548:
Public Affairs:
Paul Anderson, Managing Director, AndersonP1@gao.gov (202) 512-4800
U.S. Government Accountability Office, 441 G Street NW, Room 7149
Washington, D.C. 20548:
