Now that the Cold War is over and the drawdown is nearly complete, the Department is focused on returning predictability and stability to military life and military careers. The Department is strongly committed to strengthening the quality of life programs supporting service members and to enhancing readiness, recruiting, and retention. Quality of life is an important component of Government Performance and Results Act Corporate-Level Goal 5. Part of this emphasis will be to aggressively address personnel tempo (PERSTEMPO) rates, which have a direct bearing on the quality of life for service members and military families.

Changes in American society—including higher expectations among young people, an increase in families with two working parents, and a strong economy with low unemployment—have necessitated changes in military quality of life programs. The Department’s quality of life strategy recognizes that young people want good pay, educational opportunities, meaningful work, challenging off-duty opportunities, and good places to live. To achieve these goals, the Department has established six quality of life guiding principles:

The May 1997 Report of the Quadrennial Defense Review strongly supported the Department’s ongoing emphasis on quality of life. The report reiterated the Department’s long-term commitment to provide adequate funding in areas such as housing; community and family support; transition assistance; and Morale, Welfare, and Recreation (MWR) activities. Educational assistance, including off-duty voluntary education, was particularly noted for its positive impact on recruitment and retention.

Secretary Cohen has institutionalized the Quality of Life Executive Committee initiatives of Secretary Perry. He has directed these advisors to monitor quality of life issues and advise him regularly on service members’ perceptions.

The Department has long recognized the importance of an appropriate level of compensation in sustaining a robust quality of life program. The military compensation package is made up of both pay and nonpay benefits—the components of a standard of living. Operating together, these elements of the compensation package stimulate enlistment and retention, which contribute to operational readiness of U.S. forces.

The Administration funded a 2.8 percent pay raise for FY 1998 and programmed for military pay raises through the Future Years Defense Program. This commitment reflects the recognition that adequate military pay is essential to attract and retain high quality personnel. While the military offers a strong line-up of compensation benefits, such as medical care, funds for college, inflation protected retirement, and survivor benefits, it is also important that military pay be competitive with the private sector.

Adequate allowances are also essential to reimburse members for their costs when necessities, such as housing, are not provided. In 1997, the Department proposed major reform of both the housing and subsistence allowances for implementation in 1998. These changes will provide DoD the flexibility to get the right amount of money to the right people—for example, those residing in high-cost housing areas.

Military retired pay is a critical element of effective force management and the military compensation package. The current system allows top-notch service members to be retained while maintaining the overall youth and vigor essential to an effective armed force. Service members want to know that the retirement benefits they expected when they joined the military will be available when they complete their military careers. Significant revisions to the retirement system in 1980 and 1986 substantially reduced the long-term value of the retirement, the effects of which are just now being felt. Consequently, the Department has strongly opposed any further changes to the retirement system.

The Department of Defense owns over 300,000 military family housing units and maintains over 400,000 barracks spaces. Currently, due to neglect over many years, approximately two-thirds of the Department’s housing stock—some 200,000 units—and more than 60 percent of barracks spaces require renovation or replacement. Those housing problems will not be resolved quickly. The Department’s FY 1999 budget request includes $611 million to construct, replace, or improve approximately 5,600 units. However, substantial progress in the maintenance, repair, and construction of military housing can only be made by using private sector capital to leverage federal funds. The Department has worked hard to develop and implement a strategy to privatize family housing. DoD’s desire is to find out what works in which locations and then leverage every housing dollar possible through privatization efforts. This effort is discussed in detail in Chapter 19.

The Department’s FY 1999 troop housing construction request of approximately $550 million will construct over 7,800 barracks spaces. In FY 1998, Congress appropriated $360 million in the Quality of Life Enhancement Account for the repair and maintenance of real property, specifically emphasizing barracks and living facilities. The Army received $100 million; the Navy, $70 million; the Air Force, $145 million; and the Marine Corps, $45 million.

The Department has recently created an important new standard in housing quality, specifically aimed at improving retention and quality of life for single service members. With the establishment of the new 1+1 barracks construction standard (two service members, each in a private bedroom, sharing a bath), the Department’s goal is to give unaccompanied service members a higher level of housing. Additionally, DoD is working toward eliminating gang latrines before 2008.

On April 17, 1997, President Clinton issued an executive memorandum recognizing the DoD child development program as a model for the nation He also directed the Department to share its expertise with federal and state agencies, and the private sector. Since then, DoD has developed partnerships with the Department of Health and Human Services, the General Services Administration, and the National Governors Association. The Department also established a National Clearinghouse of Military Child Development Programs as a way to share materials and lessons learned.

In FY 1997, the Department completed its biannual projection of child care need. As of the end of FY 1996, there were 166,322 child care spaces available to meet 56 percent of the maximum need for child care services. Child care is provided at 300 locations, including 9,700 family child care homes, 811 child development centers, and school-age care facilities. Key initiatives to increase child care spaces include more partnerships with elementary schools, on-and off-base to care for more school-age children, and expansion of off-base family child care homes through memorandums of agreement with state and local child care licensing agencies.

The Department also continues to explore contracting options for some of its child care needs, using the Navy and the Defense Logistics Agency (DLA) as executive agents. In 1997, the Navy contracted for spaces in 17 civilian accredited centers in California, Florida, Hawaii, and Virginia. In addition, DLA contracted for the management of a DLA-owned child care facility in Columbus, Ohio.

Worldwide, 450 youth centers at over 300 locations serve approximately 748,000 youth, 6-18 years of age. Youth programs offer positive alternatives for children during after school hours that develop leadership and life enhancing skills, in addition to traditional social, recreational, and athletic activities. Current youth initiatives include:

The 284 DoD family centers deliver an extensive array of human and social services to promote healthy personal and family life. The centers also help members and their families adapt to the unique challenges of military life. Various programs provide assistance in relocation, spouse employment, parenting, financial management, deployment and family separation, crisis or unexpected contingency, and other areas.

In February 1997, the Department launched the Spouse Employment Demonstration Project to help military spouses find employment outside the federal government. DoD and the Small Business Administration established a demonstration program in San Diego and Norfolk. The program trains and counsels participants on the skills required to start a business or expand an existing business. In 1998, the DoD sites will focus on portable careers and using technology to run a business.

The Department is developing an interactive multimedia course to assist young service members to understand the basics of personal financial management. The course will be fielded in 1998. To support this effort, the Department began providing professional training and certification for DoD financial counselors in December 1997.

DoD’s deployment programs are particularly effective in helping service members and families deal with challenges posed by military missions. Recently, the National Performance Review cited these and other Department family-friendly programs as being exemplary. When military families departed Saudi Arabia following the Khobar Towers bombing, family centers provided follow-on support to each family wherever they relocated. All Services have incorporated their reserve component family readiness programs into their active component plans.

The Department recently began delivering family program information and services to military members, their families, and center professionals through the Internet. Three major web sites and a new Internet service were activated in FY 1997. In September 1997, a public-access, customer service web site was added to the Department’s family program suite. The Military Assistance Program Site (MAPsite) provides information related to relocation and financial management issues, and features direct e-mail access to individuals through family centers. During 1998, the scope of the Department’s existing Web and Internet locations will be expanded and their use as distance learning vehicles explored.

Transition assistance is one of the Department’s most valued programs. In FY 1997, in the continental United States (CONUS) alone, separating service members used DoD transition assistance services such as seminars, automated systems, and employment experts 553,395 times; military spouses used these services 110,663 times. Also in CONUS, the military departments sponsored 914 job fairs, featuring a total of 19,990 corporate, federal, state, and local employers, which were attended by 304,592 service members and their spouses.

DoD sponsored overseas job fairs in Germany, South Korea, Okinawa, and Japan for transitioning service members, DoD civilians, and family members. Some 5,850 job seekers attended the 1997 overseas job fairs. Fifty-six private employers, as well as federal and state agencies, participated. Each employer committed to making a minimum of 50 provisional or conditional, near-or long-term job offers to qualified candidates. As of November 1997, these fairs have produced 1,153 firm job offers and 420 hires. These numbers will continue to increase in 1998.

The Department is committed to preventing spouse and child abuse, and each Service maintains a vigorous program in this area. The Marine Corps has been particularly successful with its New Parent Support programs. Of the families identified as being at high risk, only 4 percent who received New Parent Support program services for at least six months subsequently abused the child. Of the families identified as having previously abused the child, only 10 percent who received New Parent Support program services for at least six months subsequently abused the child. DoD has developed a Department-wide model for New Parent Support programs to maximize the use of existing resources.

Also in 1997, the Department consolidated Service repositories of substantiated reports of child and spouse abuse into a single, Department-wide central registry. This Department-wide registry will improve the accuracy of family violence data and speed the process of conducting background checks for those who provide DoD child care services.

MWR programs include those facilities and activities which create the basic community support and recreational infrastructure on an installation. They contribute significantly to retention and readiness. Their presence on an installation provides a safe and healthy environment for military families, contributes to the attractiveness of the military lifestyle, encourages healthy teamwork and socialization skills, and promotes individual intellectual and physical development of the force. Activities include physical fitness centers, youth centers, libraries, recreation centers, sports and athletics programs, clubs, and bowling facilities. Like other defense programs, MWR is rapidly evolving to meet the needs of the modern force and the challenges of the future.

MWR programs are arranged in three categories; they receive appropriated fund support based upon their relationship to the military mission. In 1995, the Department established funding standards for these programs to ensure that they are provided an adequate appropriated fund base. The military departments have made steady progress in achieving these standards. MWR accounts increased overall by $77 million in the FY 1998 budget, and are programmed to increase in FY 1999 within Army and Navy accounts.

In order to ensure that program management encourages efficient operations and postures the program for future improvements and changes, the Department is in the midst of executing the congressionally-directed Uniform Resource Demonstration Project. This project allows appropriated funds authorized for MWR programs to be spent using the laws and regulations applicable to nonappropriated funds. This test is under way at six installations to determine if there are operating and managerial efficiencies associated with this funding approach, and whether it improves customer service. While the Uniform Resource Demonstration test and evaluation is under way, the Department has initiated an interim MWR funding practice to allow controlled DoD-wide use of the efficiencies of nonappropriated fund practices.

Two of the most important and most used MWR programs are fitness and library. Because of the importance service members and their families attach to these programs, and because of their contribution to positive military outcomes, the Department is taking special action to improve and modernize the services offered. Operation Be Fit is a special fitness initiative launched to improve programs and increase individual participation in fitness activities. Funding for fitness in the Service accounts has increased steadily since 1995.

The Department of Defense operates 300 general libraries, as well as 315 libraries aboard ships and submarines. These libraries function as community resources and provide for unique defense needs. They are especially important overseas and where there are dependent schools. Libraries provide materials to support professional military and voluntary education programs; provide technical materials; and assist with information to ease transition out of the military. To ensure that libraries keep pace with modern needs, the Department is developing standards for operation and a strategic technology plan to guide library development.

The Defense Commissary Agency (DeCA) operates the worldwide system of 300 commissaries. This network provides quality groceries at cost, plus a 5 percent surcharge, to active duty military members, retirees, members of the National Guard and Reserve (limited access) and their families. Congress, through the General Accounting Office, has directed a study to determine the impact of expanding commissary access for reservists. The Department plans to study this in 1998. The commissary benefit continues to be rated as the most important nonpay compensation benefit by military members and their families. Important to both recruiting and retention, commissaries provide patrons with an average saving of approximately 25 percent on purchases.

DeCA has achieved major cost savings without impacting the level of the benefit or cost savings to the troops. It has already reduced operating costs by nearly 30 percent and continues to pursue additional efficiencies. Since becoming a Performance Based Organization in FY 1996, DeCA has adopted numerous innovative management practices and improved business processes. DeCA has been recognized with two Hammer Awards from the National Performance Review for its commonsense approach to business. The awards recognized the Agency’s facilities directorate for engineering initiatives in commissary design and the Inspector General’s office for improving management efficiency and integrity.

Today’s exchanges are an integral part of the military community at U.S. installations and deployment sites all over the world. These modern, state-of-the-art retailers are an important element of the military nonpay compensation package and a critical component of quality of life. There are three separate exchange systems: Army and Air Force Exchange System, Navy Exchange Command, and Marine Corps Exchange. Exchanges not only benefit authorized patrons by providing the goods and services that military families want, but have also contributed to quality of life programs by distributing more than $2 billion to MWR programs over the past ten years. The nonappropriated fund dividends generated by exchanges are crucial to the military MWR programs.

In order to sustain and improve the exchange benefit, the Department—with the consent of the Congress—has changed the Armed Forces Exchange regulations to permit exchange systems to expand merchandise assortments to better meet demands. A task force examined the merits of creating an integrated exchange system. This initiative identified potential opportunities to standardize systems and programs and to reduce costs and overhead. The study to determine the best means of realizing these benefits, while preserving the value of the exchange benefit for the service members, will be completed by March 1999.

Chaplains ensure the free exercise of religion by service personnel and their families. They also provide religious ministry for their respective faith group members and facilitate religious ministries for those of other religious denominations. Chaplains are educated, trained, and ordained or certified to conduct worship, provide religious education, conduct pastoral counseling, and deliver sacramental ministrations in accordance with their respective ecclesiastical endorsements.

Chaplains serve on commanders’ staffs with a primary advisory role in the areas of morale, ethical, and quality of life matters. Chaplains routinely serve in cooperation and partnership with family support and quality of life programs. They also provide a wide range of nondenominational programming which insures inclusive religious ministries.

Education opportunities are a primary incentive to young people joining the military. Participation in the voluntary education program remains strong, with over 600,000 enrollments in undergraduate and graduate courses and 28,000 degrees awarded in FY 1997. The high level of participation makes this program one of the largest and most diverse continuing education programs in the world.

The Department’s off-duty, voluntary education program provides service members and their families with the opportunity to participate in academic improvement and college degree programs comparable to those available to nonservice personnel. These programs, along with counseling, testing, and other services, are available at education centers located on nearly 300 military installations around the world. Instructor-delivered and interactive CD-ROM courses are provided to shipboard personnel. Additionally, the Marine Corps has established the Marine Corps Satellite Education Network, which provides academic skills and college degree programs via video teleconferencing. The Air Force has made distance learning programs available to its members by establishing Internet capabilities at its major installations. Service members may take tests for credit and college entrance without cost and receive financial assistance to cover up to 75 percent of tuition costs, depending on branch of Service. Beginning in FY 1999, all Services will provide a uniform level of tuition assistance for their members.

The DoD Education Activity (DoDEA) is the umbrella organization for the Department of Defense Dependents Schools (DoDDS) and the Department of Defense Domestic Dependent Elementary and Secondary Schools (DDESS). DoDDS provides schooling for students in foreign countries. DDESS provides schooling for students on military installations in selected areas of CONUS, the Commonwealth of Puerto Rico, and the territory of Guam. For school year 1997-1998, DoDDS is operating 160 schools in 14 foreign countries and serving approximately 80,000 students. DDESS is serving approximately 35,000 students in 14 districts in the United States, Puerto Rico, and Guam.

DoDEA’s Community Strategic Plan provides long-range educational and organizational goals. DoDEA is committed to:

The DoDDS provides a free public education of high quality for eligible minor dependents of U.S. military and DoD civilian personnel stationed overseas; a free, appropriate education for dependents with disabilities, ages 3 through 21; and a community college program for eligible students in Panama. Other children may be enrolled in DoDDS on a space available, tuition paying or tuition free basis.

The DoDDS curriculum includes traditional classroom subjects and a wide range of special programs, including talented and gifted programs, special education, English as a second language, and compensatory education. DoDDS enhances its core curriculum and its support programs through the use of technology and distance education courses.

DoDDS students continue to score well above the national average on standardized tests in reading, language arts, mathematics, science, and social studies. On the Scholastic Assessment Test, the DoDDS system has one of the highest participation rates in the United States. The mean Scholastic Assessment Test verbal and mathematics scores for DoDDS students have increased 7 points and 6 points, respectively, since 1994.

The Department operates schools on stateside military installations through its DDESS program. These schools provide an appropriate education for children residing on federal property where no state or local funds can be expended or where no local education agency is able to provide an appropriate education.

The DDESS educational programs are aligned with the programs of states or territories in which the schools are located. The curriculum includes traditional classroom subjects and a wide range of special programs, including talented and gifted programs, special education, English as a second language, and compensatory education. The core curriculum and support programs are enhanced through the use of technology and distance education courses. By 1997, all DDESS districts had implemented highly successful early childhood programs for four year olds. Fort Bragg’s program was awarded the North Carolina Governor’s Programs of Excellence award in January 1997. This program, like others in DDESS, is community based and incorporates the entire family into the learning program.

In 1997, a majority of the DDESS students scored above the national average in all areas tested. On the SAT, both the mean verbal and mathematics scores for DDESS students increased in 1997.

The Department of Defense Education Activity was one of the first school systems to volunteer to participate in the President’s voluntary national testing program. Also in support of the President’s National Education Goals 2000 Program, civilian and military leadership have become actively involved in partnering initiatives with local schools both on installations and in local communities. Examples of programs that support a family-friendly work environment are adopt-a-school; Drug Abuse Resistance Education; mentoring; and tutoring in math, science, and reading.

Health care continues as a major quality of life factor for the Department of Defense. The Military Health System is committed to a philosophy of excellence in its role to provide:

Coupled with this, the Military Health Service strives to integrate technologies to enable the best possible and most cost-beneficial clinical and management outcomes.

The Department’s health care mission is complex and continually evolving. The Military Health Service currently serves 8.2 million eligible beneficiaries. Direct care is delivered worldwide in 115 hospitals and over 450 clinics. The majority of civilian care is purchased through Managed Care Support contracts implemented under the TRICARE Program. DoD requires substantial resources to accomplish its DoD medical mission. The FY 1997 budget was $15.7 billion, which represented 6.2 percent of the entire defense program.

The Department is committed to responding to the health concerns of Gulf War veterans. In examining health consequences that may have resulted from service in the Persian Gulf, DoD efforts have concentrated in the areas of clinical care, outreach, research, and investigation.

Since June 1994, the Department has provided in-depth medical evaluations through the Comprehensive Clinical Evaluation Program (CCEP) to active duty and reserve component Gulf War veterans who choose to participate. Access to the CCEP is made available through a toll-free number or by direct contact with a military treatment facility, all of which have designated CCEP physician coordinators. Spouses and children of Gulf War veterans who are eligible for DoD health care may elect to participate in the CCEP as well. As of September 1997, over 29,900 of the 31,866 CCEP participants requesting examination had finished the clinical evaluation process. Based on the experience to date, there is no clinical evidence for a previously unknown, serious illness or syndrome among veterans participating in the CCEP. These findings are consistent with a review of the CCEP conducted by the Institute of Medicine, National Academy of Sciences, released in January 1996.

In order to capture lessons learned from the Gulf War experience in anticipation of future deployments, the Department published DoD Directive 6490.2, Joint Medical Surveillance, and DoD Instruction 6490.3, Application and Implementation of Joint Surveillance for Deployments, in August 1997.

Outreach to Gulf War veterans has been expanded to regular press conferences and media coverage concerning the CCEP findings, research results, and investigation findings. In 1997, DoD revised and expanded its GulfLINK worldwide web site to include e-mail access and to present comprehensive reviews of key issues through a case narrative reporting style. In addition, the Special Assistant for Gulf War Illnesses expanded the public outreach program to include routine press releases and multiple town meetings across the country with veterans’ service organizations. For active duty veterans, the family service centers received fact sheets to inform their counselors about Gulf War veterans’ issues. Surveys were conducted to assess the effectiveness and determine unaddressed concerns of Gulf War veterans and meetings were held with representatives from the Military Alliance.

In addition to providing comprehensive clinical care and outreach to Gulf War veterans, the Department initiated an aggressive research program. Although the types of conditions identified among CCEP participants appear similar to those seen in the general population, formal research studies involving appropriate comparison populations are needed to determine the degree to which certain kinds of symptoms and diagnoses may or may not be common among Gulf War veterans. DoD medical research efforts are ongoing in a variety of areas, including reproductive health, leishmaniasis, health effects of exposure to depleted uranium, pyridostigmine bromide, and possible chronic health effects resulting from subclinical exposure to chemical warfare agents. Findings of these studies are published in the peer-reviewed scientific literature and are noted in the annual report to Congress, Federally Sponsored Research on Persian Gulf Veterans’ Illnesses, by the Research Working Group of the Persian Gulf Veterans Coordinating Board.

In concert with the President’s commitment to better understand the illnesses reported by Gulf War veterans in 1997, the Department of Defense committed more than $27 million for research studies to government, nongovernment, and academic institutions to further understand the health effects of the Gulf War deployment. In an effort to promote openness in the scientific community at large, in September 1996 the data set for the CCEP was made available to qualified scientific researchers interested in conducting further analysis.

In 1994, the Deputy Secretary of Defense established the Persian Gulf Investigation Team to look for possible causes of illnesses in veterans by evaluating the vast amount of documents from the war, and by investigating specific incidents and theories presented by veterans and others. A toll-free telephone line was established to allow veterans to provide information on incidents they feel may have affected their health. The Office of the Special Assistant for Gulf War Illnesses (OSAGWI) absorbed and expanded the functions of the original team. As of September 1997, almost 2,800 incidents have been reported, and new information continues to be evaluated. OSAGWI works closely with the Services, the Intelligence Community, and other government and nongovernment agencies to gain a clearer understanding of factors surrounding the incidents and theories involving the health of Gulf War veterans.

The Department continues to collaborate with other federal agencies and to conduct comprehensive, cross-departmental programs to provide care to veterans and assess health consequences of service in the Gulf War. The Department has had consistent representation on the Persian Gulf Veterans Coordinating Board committees (the Clinical Working Group, Research Working Group, and Compensation and Benefits Working Group) since January 1994.

The Presidential Review Directive, PRD-5, Interagency Working Group has had Departmental representation on the four task forces: Deployment Health Issues, Record Keeping, Research, and Risk Communication. These four task forces contributed to the comprehensive federal strategic plan to assimilate the lessons from the Gulf War to prepare for the health outcomes of future deployments and to assist future veterans and their families.

Rapidly rising health care costs, the closure of military bases and their hospitals, and a nondiminishing population of beneficiaries presented DoD with the challenge of finding a better way to meet peacetime demands for health care while maintaining medical combat readiness. The TRICARE health benefits program is DoD’s effort to provide the highest quality and most cost-effective health care to active duty and retired members of the uniformed Services, their families, and survivors.

TRICARE is a triple option health benefits program that combines military and civilian resources into a regionally-based, integrated health care delivery system. Since March 1995, DoD has been phasing in partnerships with civilian contractors to expand and supplement the capabilities of its military hospitals and clinics.

TRICARE offers beneficiaries three choices for their health care:

The TRICARE program also has been extended to active duty personnel and their families stationed overseas. A major reengineering of DoD’s health care delivery system overseas has resulted in the establishment of three TRICARE regions (TRICARE Europe, TRICARE Pacific, and TRICARE Latin America) responsible for health care planning and delivery for personnel stationed outside the United States. The Department began offering a modified version of the TRICARE Prime benefit tailored to the overseas environment for active duty personnel and their families overseas in October 1996 and enrolled over 300,000 personnel into the program during 1997. Additional efforts are under way to address the health care needs of personnel at remote locations overseas.

When military beneficiaries become eligible for Medicare, usually by reaching 65 years of age, they are no longer eligible for CHAMPUS and cannot enroll in TRICARE Prime. This population of beneficiaries, known as dual-eligible beneficiaries because of their eligibility for benefits from both Medicare and the Military Health System, must then rely on space-available care at military treatment facilities or Medicare coverage for their health care services. Currently, there are 1.3 million dual-eligible beneficiaries.

The Department would like to allow these beneficiaries to take full advantage of their military health care benefit by offering them the opportunity to enroll in TRICARE Prime. However, to do this, DoD would require reimbursement from Medicare to cover the cost of providing their care. Congress must approve this type of reimbursement, known as subvention.

In September 1996, the Department of Defense signed an agreement with the Department of Health and Human Services (HHS), which administers the Medicare program, to conduct a demonstration program which would allow DoD to enroll Medicare-eligible beneficiaries in the TRICARE program. The goal of the demonstration is to test a cost-effective alternative for delivering accessible and quality care to dual-eligible beneficiaries that does not increase the total federal cost for either agency. DoD would continue to pay for care provided to dual-eligible beneficiaries up to the amount the Department currently spends to provide space-available care to these beneficiaries. Once DoD reached this level of expenditure, also known as the Department’s level of effort, Medicare would reimburse DoD for additional care provided to those enrollees. Payments would be on a capitated basis and at a rate less than that which Medicare pays commercial Medicare-risk HMOs.

The Balanced Budget Act of 1997 included a provision authorizing a three-year Medicare Demonstration similar to that described in the DoD/HHS Agreement. The legislation required DoD and HHS to implement a demonstration project at six sites under which dual-eligible beneficiaries are offered enrollment in a DoD-operated managed care plan, called TRICARE Senior. The legislation also authorizes Medicare HMOs in the demonstration sites to make payments to DoD for care provided to HMO enrollees by military treatment facilities participating in the demonstration. This part of the demonstration, called Medicare Partners, will allow DoD to enter into contracts with Medicare HMOs to provide dual-eligible beneficiaries the specialty care currently provided on a space-available basis.

The Department has implemented an aggressive program to improve and standardize access to dental care for family members living outside the United States. The Overseas Family Member Dental Program is a comprehensive, integrated plan tailored to each location and is an integral part of the regional health services plan for each overseas area. A sizable increase in dental resources already has been provided to overseas dental treatment facilities, resulting in improved dental care access for families. Phased implementation began in Europe and has been extended to the Pacific and other locations worldwide. This initiative is considered one of the single greatest quality of life improvements for family members overseas.

The Department is expanding the TRICARE Active Duty Family Member Dental Program overseas. This will permit enrolled family members overseas to obtain the same basic dental benefits now offered to enrollees in the TRICARE Family Dental Plan in the United States where such care is available. Services will either be provided in the direct care system, or if unavailable, the family member will be referred to a host nation provider identified by the local command who meets accepted U.S. dental practice standards. This will allow the Department to provide dental care for an even greater number of personnel and also facilitate access to dental care while traveling in the United States.

Section 703 of the National Defense Authorization Act for 1997 (Public Law 104-201) directed the Department to implement a dental insurance program for certain military retirees and family members. By law, the TRICARE Retiree Dental Program (TRDP) offers basic dental coverage, including diagnostic services, preventive services, basic restorative services (including endodontics), surgical services, and emergency oral examinations.

Coverage under the TRDP is available to military retirees receiving pay, members of the Retired Reserve, family members of retirees, and unremarried surviving spouses and dependents of retirees. Enrollment in the TRDP is voluntary. Coverage is offered in three categories: single enrollment, two party enrollment, and family enrollment. TRDP enrollees are responsible for paying the full cost of the geographically-based premiums; there is no government subsidy. Dental care delivery will begin in February 1998.

The 1996 and 1997 National Defense Authorization Acts required DoD to implement a dental program for members of the Selected Reserve who live in the 50 United States, District of Columbia, Guam, Puerto Rico, and U.S. Virgin Islands. Dental care delivery under the TRICARE Selected Reserve Dental Program (TSRDP) began in October 1997. Enrollment in TSRDP is voluntary. Family coverage is not offered under TSRDP.

The TSRDP offers basic dental coverage, including diagnostic services, preventive services, basic restorative services, and emergency oral examinations. The government pays 60 percent of the monthly premium. Reservists who want to enroll in the plan must have at least 12 months of service remaining and must initially enroll for 12 months. Coverage will terminate on the last day of the month in which the member is discharged, transferred to the Individual Ready Reserve, Retired Reserve, or ordered to active duty for more than 30 days.

The Department’s goal is to ensure the availability of an equitable transportable pharmacy benefit to all eligible DoD beneficiaries regardless of geographic location. In light of the numerous Base Realignment and Closure (BRAC) actions, the Uniform Pharmacy Benefit structure includes provisions intended to prevent the potential loss of the pharmacy benefit to beneficiaries who relied on a military treatment facility for obtaining pharmaceuticals. The Uniform Pharmacy Benefit has four components: military treatment facility pharmacies, where pharmaceuticals can be obtained at no cost to the beneficiary; mail order pharmacy programs provided at varying copays depending upon the status of the beneficiary; retail pharmacies in the Preferred Provider Network (PPN) within the managed care contracts; and retail pharmacies outside the PPN, with copays similar to the current benefit under CHAMPUS.

The National Mail Order Pharmacy (NMOP) Program began service in October 1997 and is being implemented in phases. The goal of this program is to offer patients more convenient and cost-effective access to their pharmacy benefit. Under the NMOP, DoD will maximize the use of Best Federal Pricing for pharmaceuticals distributed to DoD beneficiaries through the mail order pharmacy contractor. Best Federal Prices are at least 24 percent less than the Average Wholesale Price paid for pharmaceuticals.

The National Mail Order Pharmacy Program does not yet replace other mail order programs currently provided by TRICARE Managed Care Support contracts. However, the Department is consolidating the various TRICARE mail order pharmacy programs, which cannot use Best Federal Pricing, under the NMOP program. In the future, the NMOP program will also be made available to the remaining BRAC Medicare-eligible beneficiaries, and to all other CHAMPUS beneficiaries now covered by Managed Care Support contractors (both enrolled and nonenrolled).

The development of military treatment facility Enrollment-Based Capitation (EBC) represents the next—and most advanced—version of the capitation methodology that will be used to appropriately resource military treatment facilities. The original TRICARE capitation model introduced in FY 1994 was used to allocate Defense Health Program funds to the three military departments and acted as the foundation for EBC. The fundamental difference between the two methodologies is that in FY 1998, EBC has identified a specific military treatment facility allocation to the Departments, whereas the FY 1994 model allocated funds to the Services at the Service level based on an overall estimated user population. During this initial year of EBC implementation, the focus will be on accurate and timely data gathering and processing, which is key to the success of EBC.

The Department maintains its focus on quality clinical intervention while intensifying its emphasis on prevention and health promotion activities. DoD promotes a healthy lifestyle by first assessing health status, then implementing intervention through either clinical or health promotion activities. The Department has a policy that directs the use of an age-appropriate Health Enrollment Assessment Review as its health status tool. DoD is developing standardized policy to implement the HHS Put Prevention into Practice Program to improve the delivery and documentation of clinical preventive services using a tri-service preventive care flowsheet. The Department continues to identify and implement innovative health promotion and prevention initiatives in support of Healthy People 2000 goals. The Department has demonstrated great strides in the improvement of health status through performance measurements such as Healthplan Employers Data and Information Set (HEDIS), the DoD Worldwide Survey of Health Related Behaviors in Active Duty, and the DoD Annual Beneficiary Survey. For example, a civilian external peer review organization’s Quality Management Review of clinical preventive services in DoD shows that active duty cholesterol screening came close to and pap smears exceeded Healthy People 2000, HEDIS, and/or DoD Access Standard Goals.

DoD recognizes that women’s health care represents a unique area of medical knowledge which impacts military readiness. Ensuring a baseline knowledge level of women’s health issues is essential in providing high quality care at all levels. Therefore, the Department is establishing a task force to develop a Women’s Health Curriculum for providers at all levels of care. DoD is also working in partnership with the Department of Veterans Affairs (VA) to provide sexual trauma counseling to active duty members where the need exists. Finally, the Department is continuing a program to improve breast cancer services for beneficiaries, utilizing funds allocated in the National Defense Authorization Act for FY 1997. The first goal of the Breast Cancer Prevention, Education, and Diagnosis Program is to provide training for both beneficiaries and primary health care providers in early detection and risk factors associated with breast cancer. The second goal is to optimize early diagnosis of breast cancer by continuing to improve access and follow-through to high quality breast care services. DoD has developed specific performance measures to evaluate TRICARE regions’ progress in improving beneficiary access and feedback in breast cancer education, screening, and access. TRICARE regions are also developing better psychosocial support programs for patients and family members diagnosed with breast cancer.

The Departments of Defense and Veterans Affairs have established an Executive Council of senior DoD and VA health care executives. The Executive Council oversees a number of joint efforts to reduce costs and improve health care for veterans, active duty military personnel, retirees, and dependents:

Telemedicine combines the use of rapidly advancing telecommunications and medical technologies to deliver health care that is time and distance independent. DoD has been a leader in this area, developing programs that provide functional and technical interoperability, standardize and improve care, and produce economies of scale across the Military Health Service. As a result of these successes, new telemedicine initiatives have been introduced throughout DoD, other federal agencies, and the civilian sector. To prevent duplication and identify those projects with the most potential value to military medicine, the Military Health Service chartered the DoD Telemedicine Program Office to serve as a central coordinating office for all DoD telemedicine initiatives.

During 1997, the Department continued to support deployed telemedicine capabilities for U.S. forces in locations such as Bosnia, Macedonia, Haiti, and Southwest Asia. Numerous exercises were held to demonstrate integrated telemedicine capabilities between land, air, and naval forces. Efforts to integrate information generated from telemedicine technologies into a computer-based patient record also continued in projects such as the Composite Health Care System, the Pacific Medical Network, and the Theater Medical Information Program. The technologies and lessons will ultimately change the way the Department uses information management and information technology to provide health care across the Military Health Service.

The Computer/Electronic Accommodations Program (CAP) was established in 1990 as a centrally funded DoD program to provide assistive technology to DoD employees with disabilities. This model program, winner of the 1996 Federal Technology Leadership Award, helps disabled employees maximize their potential and ensures employment and advancement opportunities within DoD. CAP assists DoD managers in evaluating and selecting the appropriate assistive technology for an individual’s specific situation as it relates to visual, hearing, dexterity, and cognitive disabilities. The CAP Technology Evaluation Center, located at the Pentagon, was created to evaluate leading edge technology and to provide hands-on demonstrations of equipment.

The Department is committed to providing programs and services that support the unique culture of the military hometown. Military communities are unique, because military life—its missions, deployments, overseas and isolated assignments—impose special demands and separations on both service members and their families.

As a top Departmental priority, quality of life improvements must continue to keep pace with the greater American community and must adequately address the stressful military lifestyle. The Department of Defense will work diligently to improve program delivery, enhance efficiency, and gear programs and services to meet the needs of today’s service members and their families while designing military community support programs for tomorrow’s challenges.