Senators question military health program’s new lab-fee policy

A bipartisan group of senators has raised concerns about a change to the Defense Department’s health-care reimbursement policies that will force troops and their families to pay the full cost of certain tests done outside military clinics.

The lawmakers, led by Sens. Richard Burr (R-N.C.) and Kay Hagan (D-N.C.), asked Defense Secretary Chuck Hagel in a letter on Thursday to answer questions about how the Pentagon justified the change and communicated it to beneficiaries, as well as what the appeals process would look like for whose lab work is not covered.

U.S. troops listen to Defense Secretary Chuck Hagel in Afghanistan. (Mark Wilson/AP). U.S. troops listen to Defense Secretary Chuck Hagel in Afghanistan. (Mark Wilson/AP).

“Our military families have sacrificed so much for our country and shouldn’t be forced to pay out of pocket for routine lab tests that are available to most patients,” Hagan said in a statement on Friday.

The change, which took effect on Jan. 1, relates to more than 100 diagnostic genetic tests, including one that can help determine whether a pregnant woman will give birth to a child with cystic fibrosis.

The military’s health system will still cover the tests in question, known as “molecular pathology laboratory tests,” when beneficiaries use Defense Department treatment facilities, but it will not provide reimbursement for those who use civilian clinics. That’s because the Tricare program, which covers treatment at private clinics, cannot pay for laboratory work that the Food and Drug Administration has not approved.

The senators said the new policy discriminates against troops and families who have limited access to military health clinics. In their letter, they expressed concern that the change “denies military families and patients access to care simply because they either choose to receive care at a civilian medical provider or are unable to access a [military treatment facility].”

Jonathan Woodson, the Pentagon’s head of health affairs, told a congressional subcommittee on Wednesday that his division was working on a fix to ensure equal reimbursement for the tests among individuals who use military and civilian clinics. “None of the beneficiaries will be denied the test that they need to get great care,” he said.

Lt. Col. Catherine Wilkinson, a Defense Department spokeswoman, declined to comment on the letter to Hagel, citing a Pentagon policy of not publicly discussing the secretary’s correspondence with members of Congress.

Follow Josh Hicks on TwitterFacebook or Google+. Connect by e-mail at  josh.hicks@washpost.comVisit The Federal Eye, The Fed Page and Post Politics for more federal news. E-mail federalworker@washpost.com with news tips and other suggestions.

Josh Hicks covers Maryland politics and government. He previously anchored the Post’s Federal Eye blog, focusing on federal accountability and workforce issues.

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Josh Hicks · February 28, 2014