Army Family Action Plan (AFAP) General Officer Steering Committee (GOSC) Meeting Summary

Army Family Action Plan (AFAP) General Officer Steering Committee (GOSC) Meeting Summary General Peter W. Chiarelli, Vice Chief of Staff, Army (VCSA) chaired the 3 February 2011 AFAP GOSC meeting which reviewed 40 AFAP issues. Attendees at the meeting included senior officials from the Department of Defense (DoD), Department of the Army (DA), the Army Staff, Commands, military support organizations, local senior spouses, and select AFAP Conference delegates. # Issue Title Civilian Personnel Issues Lead agency Briefed 524 Military Spouse Unemployment Compensation G-1 (CP) Active Active Final 545 Federal Retiree Pre-Tax Health Insurance Premiums G-1 (CP) Unattainable Unattainable 615 Donation of Leave for DoD Civilian Employees G-1 (CP) Active Active 634 Death Gratuity for Beneficiaries of DA Civilians G-1 (CP) Active Active # Issue Title Wounded Warrior, Caregiver and Survivor Issues Lead agency Briefed Final 617 Federal Hiring Process for Wounded Warriors CHRA Completed Completed 610 TBI Rehabilitation Program at Military Medical Centers of Excellence OTSG Completed Completed 630 Availability of Standardized Respite Care for Wounded Warrior Caregivers OTSG Completed Completed 631 Career Coordinators for Army Wounded Warriors, Family Members and Caregivers OTSG Active Active 632 Community Support of Severely Wounded, Injured and Ill Soldiers and Families OTSG Completed Completed 651 Extended Transitional Survivor Spouses' TRICARE Medical Coverage OTSG Unattainable Unattainable 621 Minimum Disability Retirement Pay for Medically Retired Wounded Warriors G-1 (PRC) Active Active 626 Traumatic Servicemembers Group Life Insurance for PTSD, TBI and Uniplegia G-1 (PRC) Active Active 643 Service Members Group Life Insurance (SGLI) Cap G-1 (PRC) Unattainable Unattainable 553 Survivor Benefit Plan and Dependency & Indemnity Compensation Offset G-1 (HR) Active Active # Issue Title Force Support Issues Lead agency Briefed 609 Total Army Sponsorship Program ACSIM Active Active Final 457 Modification of Weight Allowance Table G-4 Unattainable Unattainable 612 Army Career and Alumni Program G-1 (AHRC) Active Active 529 Retirement Services Officer Positions at Regional Support Commands G-1 (HR) Active Active 655 Reduced Eligibility Age for Retirement of RC Soldiers Mobilized in Support of Overseas Contingency Operations G-1 (HR) Unattainable Unattainable 657 RC Inactive Duty Training (IDT) Travel and Transportation USAR Active - will be Unattainable recrafted by USAR 483 Incentives for RC Military Technicians USAR Unattainable Unattainable

Medical Issues # Issue Title 488 TRICARE Prime Remote for Family Members Not Residing with Military Sponsor 558 TRICARE Prime Travel Cost Reimbursement for Specialty Referrals Lead agency Briefed OTSG Active Active OTSG Active Active Final 572 Family Member Eyeglass Coverage OTSG Unattainable Unattainable 583 597 Advanced Life Support Services on CONUS Army Installations Co-Pay for Replacement Parts of Durable Medical Equipment and Prosthetics OTSG Active Active OTSG Unattainable Unattainable 618 Army Wellness Centers OTSG Active Active 629 24/7 Out of Area TRICARE Prime Urgent Care Authorization and Referrals OTSG Completed Active 638 Medical Nutrition Therapy Benefits for All TRICARE Beneficiaries OTSG Active Active 644 Shortages of Medical Providers in Military Treatment Facilities OTSG Active Active 648 Behavioral Health Services Shortages OTSG Completed Active 656 RC Government Employee and Family Members' Access to TRICARE Reserve Select OTSG Unattainable Unattainable Family Support Issues # Issue Title Lead agency Briefed Final 458 Newly Acquired Dependent Travel Entitlement G-1 (PRC) Unattainable Unattainable 592 Post Secondary Visitation for OCONUS Students G-1 (PRC) Active Active 620 Medical Entitlements for College Age Family Members G-1 (AHRC) Completed Completed 633 Cost of Living Allowance (COLA) Dependents Cap G-1 (PRC) Unattainable Active 515 Application Process for Citizenship/Residency for Soldiers and Families ACSIM Active Active 566 Childcare Fee Categories ACSIM Completed Completed 625 Transitional Compensation Benefits for Pre-existing Pregnancies ACSIM Active Active 639 OCONUS Orders for Soldiers with Exceptional Family Members ACSIM Completed Completed 2

Summary of the Army Family Action Plan (AFAP) General Officer Steering Committee (GOSC) Meeting Civilian Personnel Issues Issue 524: Military Spouse Unemployment Compensation (UC) Proponent: G-1 (Civilian Personnel) Issue recommendation: Establish relocation during PCS moves as involuntary separation, thereby granting unemployment compensation (UC) to all qualified recipients Progress: 38 States provide UC to re-locating military spouses. MD and DC evaluate eligibility on a case by case basis; OH and TN have legislation in progress; the remaining 9 States deny UC eligibility for military spouses based on relocation. G-1 incorporated UC into G-1 talking points to engage CASA Reps and State Governors on scheduled visits. In Dec 10, the IMCOM Commander discussed UC at CASA Luncheon. IMCOM forwarded AG-1 CP's STRATCOM message to G-6 for distribution to installation commanders in AL, LA and VA to further engage State governors about the importance of providing UC to military spouses. Way ahead: Army will monitor responses from the states of AL, LA, and VA to engagement of installation commanders from those states. Issue 545: Federal Retiree Pre-Tax Health Insurance Premiums Proponent: G-1 (Civilian Personnel) Issue recommendation: Authorize Federal retirees to pay health insurance premiums with pre-tax dollars. Resolution: Issue was declared unattainable because legislative proposals were not supported. Bills (H.R. 1203 & S.491) reintroduced in the 111th Congress to amend the Internal Revenue Code of 1986 to allow Federal civilian and military retirees to pay health insurance premiums on a pretax basis were unsuccessful in gaining OSD and Congressional support. Issue 615: Donation of Leave for DoD Civilian Employees Proponent: G-1 (Civilian Personnel) Issue recommendations: Create a DoD-wide leave donation bank for all DoD civilian employees for donation and automatic collection of unused "use or lose" annual leave. Progress: HQDA in coordination with Defense Finance and Accounting Service (DFAS) drafted an Army Leave Donation Policy, which includes guidance on the VLTP, Leave Banks and voluntary donation of annual leave (to include use or lose). The ASA(M&RA) policy memo is under legal review in the Office of the Judge Advocate General. DFAS is working on requirements for a payroll system adjustment that will collect donated use or lose leave and deposit it into a Leave Bank. Way ahead: Army will monitor DFAS' payroll system change. Issue 634: Death Gratuity for Beneficiaries of DA Civilians Proponent: G-1 (Civilian Personnel) Issue recommendations: Authorize 100% payment of civilian death gratuity to any person(s) designated by the DA Civilian regardless of their relationship. 3

Progress: A legislative proposal to authorize payment of 100% of a DA Civilian employee's death gratuity to any person designated by the DA Civilian was submitted for the FY12 Unified Legislative and Budgeting (ULB) Cycle. The proposal was reviewed and approved by the OSD and other Services to move forward through the Omnibus process. Way ahead: Monitor the FY12 ULB legislative proposal to authorize 100% of a DA Civilian employee's death gratuity ($100,000) to any person designated by the DA Civilian. Wounded Warrior, Caregiver and Survivor Issues Issue 617: Federal Hiring Process for Wounded Warriors Proponent: Civilian Human Resources Agency (CHRA) Issue recommendations: Create a Priority Placement Program employment category for Wounded Warriors. Develop an automated system where Wounded Warriors and hiring officials can query jobs and applicants. Educate hiring officials and Wounded Warriors on noncompetitive governmental employment. Final issue status: Completed Resolution: A new priority placement category for Wounded Warriors was not supported. Initiatives implemented by the Civilian Human Resources Agency (CHRA), Department of Veterans Affairs (VA) and the Army Career and Alumni Program (ACAP) have improved Federal hiring of Wounded Warriors and education of hiring officials. VA's Veteran Resume Inventory (VetSuccess.gov) was integrated into Army recruitment process. CHRA developed a Wounded Warrior Webpage on Civilian Personnel Online (CPOL), a Wounded Warrior referral process, and Wounded Warrior and spouse web-based Resume Inventory. Web-based Veteran employment education tools are marketed by CHRA and ACAP. The Wounded Warrior referral process was integrated into New Supervisor's training. HR Specialists have been designated at Veteran Employment Coordinators (collateral duty). CHRA provided input for a "SA Sends Note" to Senior Army Leaders, re-emphasizing the importance of hiring disabled Veterans. Issue 610: TBI Rehabilitation Program at Military Medical Centers of Excellence Issue recommendation: Establish a comprehensive integrated rehabilitative program for TBI patients at military Medical Centers of Excellence. Final issue status: Completed Resolution: Comprehensive integrated TBI screening, identification, treatment, and rehabilitation services are in place at each Army MTF, proportionate to TBI patient population. TBI programs are validated to ensure comprehensive, consistent programs focused on improving detection, documentation, evaluation, treatment, rehabilitation, restoration, follow-up, family support, education and training for patients with TBI, specifically mild TBI. 40 facilities have achieved full validation; 10 have initial validation. All non-fully validated programs completed their validation tasker in Jan 11 and will receive memos granting full validation by Mar 11. Issue 630: Availability of Standardized Respite Care for Wounded Warrior Caregivers Issue recommendation: Provide uniform availability of standardized respite care to all caregivers of Wounded Warriors. Final issue status: Completed Resolution: Service members who incur a serious injury or illness on active duty are authorized respite care per FY08 NDAA. Respite services may be provided by a TRICARE-authorized Home Health Agency. The VA expanded respite services to include care in VA Community Living Centers, community nursing homes and non-va/non- 4

institutional settings such as adult day health care and in-home respite services. On 1 Feb 11, the VA stood up CONUS-wide support lines to connect survivors to the multiple services throughout the United States that support caregivers. Issue 631: Career Coordinators for Army Wounded Warriors (AW2), Family Members and Caregivers Issue recommendation: Increase AW2 Career Coordinator authorizations and funding to reach the industry standard of 1:30. Progress: The Warrior Transition Command (WTC) Education and Employment Initiatives and Army Wounded Warrior (AW2) career cells work collaboratively with ACAP, CHRA, Vocational Rehabilitation and Employment, Veterans Employment Coordination Services and Department of Labor REALife Lines to meet career, educational and employment needs of AW2 Soldiers/Veterans and their Families. The Federal Recovery Coordination Program, initiated in 2010, coordinates access to federal, state and local programs, benefits and services for Wounded Warriors and their Families. Way ahead: Coordinate/integrate WTC and AW2 education and employment initiatives, policies and procedures. Establish partnership with federal, state and private sector for employment and education opportunities. Provide AW2 Advocates and WTU Transition Coordinators guidance and training on education and employment opportunities. Develop assessment tools. Conduct regional Career Expos in FY11. Issue 632: Community Support of Severely Wounded, Injured and Ill Soldiers and Their Families Issue recommendation: Implement and communicate a collaborative support program that connects community resources to Severely Wounded, Injured and Ill Soldiers and their Families. Final issue status: Completed Resolution: Issue was completed based on the establishment of the AW2 Community Support Network that connects community resources to Severely Wounded, Injured and Ill Soldiers and their Families. The AW2 Program implemented a management plan and standard operating procedure to expand, inform and periodically evaluate the effectiveness of the AW2 Community Support Network. During quarterly conference calls, AW2 and Community Support Network organizations discuss topics such as PTSD/TBI, adaptive sports and severe burns. Blogs by AW2 Community Support Network organizations raise awareness of their services among AW2 Soldiers, Veterans and Families. Issue 651: Extended Transitional Survivor Spouses' TRICARE Medical Coverage Issue recommendation: Extend Transitional Survivor Spouses TRICARE Prime medical coverage at the active duty Family Member status from three to five years. Resolution: Issue was declared unattainable based on lack of TMA support for legislative change. The Surgeon General of the Army sent a formal request to TMA to assess the feasibility of legislation to enhance the TRICARE Survivor Medical Benefit from 3 to 5 years. TMA's cost estimate for the extended benefit was $6.6M for FY 11-16. TMA stated they would not support a legislative change to extend the benefit. They consider the $230 annual Prime enrollment fee and modest co-pays to be fair. 5

Issue 621: Minimum Disability Retirement Pay for Medically Retired Wounded Warriors Issue recommendation: Award medical retirement pay to all Servicemembers with a 30% or higher disability rating to the equivalent retirement pay of an E-6 with 10 years of service or current entitlement, whichever is higher. Progress: In Jul 08, Chief of Staff, Army asked General (Ret) Franks Jr. to lead an effort to review the medical evaluation board (MEB) and physical evaluation board (PEB) processes. The Task Force made three strategic recommendations, but did not specifically address this recommendation. This issue was scheduled to be included in the Oct 10 SOC agenda, but did not make the final SOC agenda. Way ahead: Monitor LOA 8 work to determine way ahead. Issue 626: Traumatic Servicemembers Group Life Insurance (TSGLI) for PTSD, TBI and Uniplegia Issue recommendation: Award medical retirement pay to all Servicemembers with a 30% or higher disability rating to the equivalent retirement pay of an E-6 with 10 years of service or current entitlement, whichever is higher. Progress: Uniplegia and TBI that result in the inability to perform at least two activities of daily living (when TSGLI standards met) have been added to the TSGLI. PTSD is still excluded. The FY10 NDAA requires a study on the treatment of PTSD by the Institute of Medicine (IOM) of National Academy of Sciences or other independent study. The contract for the PTSD study was awarded, and IOM is the project manager. The first formal committee meeting, along with the public session, is scheduled for 28 Feb 11. Way ahead: Army G-1 will monitor the results of the IOM study. Issue 643: Service Members Group Life Insurance (SGLI) Cap Issue recommendation: Increase SGLI coverage to $1,000,000, offered in $50,000 increments. Resolution: Issue was declared unattainable because the VA s Insurance Service opposed increasing the maximum SGLI coverage to $1M. Extra hazards" payment is the reimbursement DoD pays to VA to cover the costs of SGLI claims in excess of the peacetime mortality level. FY10 extra hazards cost to DOD was $200M, 40% was the Army s portion. Increasing SGLI coverage to $1M at current mortality levels, would result in an extra hazards payment of $500M by DOD, 40% ($200M) would be the Army's cost. Issue 553: Survivor Benefit Plan (SBP) and Dependency & Indemnity Compensation (DIC) Offset Issue recommendation: Eliminate the DIC Offset to SBP and award full SBP and DIC for service-connected deaths. Progress: OSD opposes elimination of the SBP and DIC offset. The 111 th Congress did not refer bills supporting this issue (HR 208 and S 644/831) to full committees. Legislation was reintroduced in the 112 th Congress. The total unfunded liability cost to the US 6

Treasury to eliminate the offset is $16B. The Chief of Staff, Army requested OSD convene an interagency working group to explore a single survivor payment. The US Court of Appeals for the Federal District upheld Sharp v. United States allowing three military surviving spouses to receive both SBP and DIC with no offset, based upon remarriages after age 57 and being eligible for SBP and DIC. Partial relief is provided by the Special Survivor Indemnity Allowance (SSIA). SSIA payments were initially set at $50/month (FY09) with $10 increments each year through 2013. SSIA will increase to $150/month in FY14, $200/month in FY15, $275/month in FY17 and $310/month in FY17. Way ahead: Monitor legislation in the 112 th Congress and OSD s support of an interagency working group to explore a single survivor payment. Force Support Issues Issue 609: Total Army Sponsorship Program (TASP) Proponent: Assistant Chief of Staff for Installation Management Issue recommendation: Standardize and enforce the TASP through the Army via the Command Inspection Program (CIP); add TASP to the CIP using the checklist in AR 600-8-8 Appendix B. Progress: OACSIM staffed an Executive Order (EXORD) that makes it mandatory for Soldiers in rank of E-1 thru 06 and Civilians in grades GS-15 and below to be assigned a sponsor and offers sponsorship to Family members who transition without their sponsor (e.g., deployments, extended training, etc.). IMCOM G1 is responsible for resourcing IMCOM TASP positions based on ACSIM s approval to realign IMCOM positions in resourcing IMCOM Sponsorship Program Manager and Integrator positions. IMHR-M commenced modifying the Mobilization Planning Data Viewer at Fort Hood to enhance Soldier Readiness Processing (SRP). Pending a successful test, Phase II will consist of improving installation in- and out- processing and adding the new TASP requirements. Way ahead: Resource IMCOM TASP positions. Implement the Mobilization Planning Data View initiative. Revise AR 600-8, TASP to include the new requirements. Issue 457: Modification of Weight Allowance Table Proponent: Deputy Chief of Staff, G-4 Issue recommendation: Increase enlisted permanent change of station (PCS) weight allowance to more closely match officer weight allowances. Resolution: Issue was closed as unattainable because, although enlisted PCS weight allowances have increased, they are not at a level that closely matches officer weight allowances. Between 2002 and 2009, administrative weight allowances and PCS weight allowance for grades E1 - E4/E7 - E9 increased; authority was granted for the Services to increase PCS weight allowances on a case-by-case basis for hardship (limit: 18,000 pounds) and 500 pounds of spouse professional weight allowance was authorized. In May 10, the Chairman, Joint Chief of Staff s report to Congress advised that weight allowances are currently adequate and suitable for members of the Armed Forces. In July and December 2010, the Office of the Army G-4 briefed the Sergeant Major of the Army, Command Sergeant Majors and other Service Senior Enlisted Advisors on past weight allowance increases and Army s initiatives to increase the weight allowances. Issue 612: Army Career and Alumni Program (ACAP) Funding (AHRC) 7

Issue recommendation: Eliminate future ACAP budget reductions; expand budget to maintain a viable program for Soldiers and Families; maintain professional staff to provide personalized services. Progress: For FY10, the Army established a critical base funding level of $6.4M, funded $4.7M, but congressional/macom adjustments reduced to $4.1M. Overseas Contingency Operation funding sustained RC operations in prior years. FY10 shortfall mitigated by $1.3M from Army; ACSIM restored $0.8M for FY11. The Army increased ACAP funding by $1M annually through FY12-16; resulting in a funded level of $5.8M per year. Mission continues to increase with support to WTUs and AW2 populations, as well as supporting the G-1 s Continuum of Service concept. On 1 April 2010, the VCSA directed the United States Military Academy to review ACAP. The independent review resulted in 16 recommendations. Way ahead: Monitor the USMA ACAP Study Group and report to the VCSA. Issue 529: Retirement Services Officer (RSO) Positions at Regional Support Commands (RSCs) Issue recommendation: Authorize and fund a Retirement Service Officer at each RSC. Progress: USARC initiated a Pilot RSO Program in Dec 10; results will be used to develop permanent RSO positions at each RSC. Staff coordination continues between Army RSO, NGB, OCAR, HQs USARC, and HRC to create a new, holistic policy to improve retirement services to AR Soldiers and Families. Agreement between Army RSO and USAR G1 is for four Army Reserve RSOs at each Regional Personnel Support Center. Way ahead: USARC authorize and fund RSO positions. Issue 655: Reduced Eligibility Age for Retirement of RC Soldiers Mobilized in Support of Overseas Contingency Operations (OCO) Issue recommendation: Credit OCO eligible active duty service prior to 29 Jan 08 towards reduced eligibility age for retirement of RC Soldiers. Resolution: Issue was declared unattainable based on inability to pass necessary legislation. HR 208 and S 644/831 met resistance in the Armed Services Committees for the past two years (111 th Congress) because implementation would cost $2.1B over the next 10 years. The Office of the Secretary of Defense (Reserve Affairs) opposes legislation due to cost, administrative burden and potential adverse manpower impact. Issue 657: RC Inactive Duty for Training (IDT) Travel and Transportation Allowances Proponent: Issue transferred from Deputy Chief of Staff, G-1 to US Army Reserve Issue recommendation: Authorize travel and transportation allowances for RC Soldiers traveling over 50 miles for IDT.. Issue will be recrafted by the US Army Reserve to address out of pocket costs for RC Soldiers travelling to IDT. Resolution: The issue as originally written is unattainable because the other Services do not support changing the JFTR to provide a general "residence to duty to residence" compensation entitlement for RC IDT travel. Issue will be recrafted by the Army Reserve. The FY08 NDAA authorizes reimbursement (up to $300 per round trip) for RC Soldiers: (1) qualified in a critical skill; (2) assigned to a unit or in a reserve pay grade with a critical manpower shortage; or (3) assigned to a unit or position that is disestablished or relocated 8

due to BRAC or force structure reallocation and the member is required to commute outside the local commuting distance. Issue 483: Incentives for RC Military Technicians (MTs) Proponent: US Army Reserve Issue recommendation: Authorize MTs (civil service personnel also required to be reservists) to receive incentives outlined in the Selective Reserve Incentive Program (SRIP). Resolution: Issue is unattainable because Army does not support changing DOD policy and Army Regulations to allow MTs eligibility for SRIP benefits. Medical Issues Issue 488: TRICARE Prime Remote (TPR) for Family Members Not Residing with Military Sponsor Issue recommendations: Eliminate the requirement that an Active Duty Family Member (ADFM) must live with the military sponsor in order to enroll in TPR. Progress: A 2008 legislative proposal to allow TPRADFM enrollment when separated from AD sponsor because of activation of a Family Care Plan or college attendance (added by TMA) was unsuccessful. An attempt to use a section of the FY06 NDAA to authorize TPR to Family Members with an activated Family Care Plan was not supported by the Office of the General Counsel and the Assistant Secretary of Defense (Health Affairs). Inclusion within Congressional markup process for the FY11 NDAA was also unsuccessful. Way Ahead: Draft/submit legislative proposal to authorize TRICARE Prime Remote for Families geographically separated from their military sponsor because of Family Care Plan activation. Issue 558: TRICARE Prime Travel Cost Reimbursement for Specialty Referrals Issue recommendations: Reimburse TRICARE Prime and TPR enrollees cumulative travel costs for specialty provider care. Progress: The Assistant Secretary of Defense (Health Affairs) disapproved an OTSG request for cumulative travel cost reimbursement. The FY10 NDAA authorizes travel reimbursement in exceptional circumstances. TMA is working on a proposed rule that would define "exceptional circumstances" as travel time in excess of 1 hour but less than 100 miles. Way Ahead: Determine scope of TMA proposed rule. Issue 572: Family Member Eyeglass Coverage Issue recommendation: Fund a portion of the cost of eyeglasses under TRICARE, outsource eyeglass fabrication through contracted vendors or provide frame of choice program from military lab. Resolution: Issue was closed as unattainable based on lack of support for any of the issue recommendations, with the exception of the availability of low cost glasses through AAFES. OTSG placed a ULB proposal for an eyeglass benefit, but without an increase in 9

user premiums or funding offset, the recommendation is unattainable. AAFES provides low cost options for prescriptive eyewear through 133 optical stores worldwide and FramesDirect, an online optical service. DoD Optical Fabrication Enterprise is dedicated to the military readiness mission and does not have the ability to provide a Frame of Choice for Families or retirees. A TMA-sponsored Eyeglass Insurance Program is unattainable due to premium costs and administrative and overhead fees. Retirees may receive prescription military eyeglasses at military eye care clinics. Retirees with a 10 percent disability may obtain prescription eyewear from VA. Issue 583: Advanced Life Support Services (ALS) on CONUS Army Installations Issue recommendations: Mandate all CONUS Army installations provide ALS services on or near the installation in accordance with the National Fire Protection Association standard. Progress: MEDCOM and IMCOM agreed to adopt DoDI 6055.6, Fire and Emergency Services Program, which establishes response time standards. A MOA signed 6 March 10 called for MEDCOM to transfer $7.7M to IMCOM effective in POM 12-16. In concert, IMCOM was to seek $11.5M in the POM to fund EMS UFRs. HQDA validated IMCOM s Emergency Medical Services (EMS) UFR requirements during the POM 12-16 review, but the requirements were not approved as critical and remain unfunded. Installations and MTFs have been advised to maintain status quo until funding is secured. Way Ahead: Resubmit EMS requirements during the POM 13-17 cycle. MEDCOM and IMCOM will jointly develop implementing instructions for completion of local MOAs. Issue 597: Co-Pay for Replacement Parts of Durable Medical Equipment (DME) and Prosthetics Issue recommendation: Eliminate the TRICARE co-pay for replacement parts of durable medical equipment and prosthetics. Resolution: Issue was closed as unattainable because the TRICARE Management Agency (TMA) does not support elimination of co-payment fees for DME and prosthetic replacement parts. TMA does not support eliminating the co-pay for DME and prosthetic replacement parts. TMA believes the fiscal year catastrophic cap ($1,000 for ADFMs and $3,000 for Retirees and Family Members) is sufficient to hold down out of pocket costs for these beneficiaries. TMA implemented an enhanced marketing focus on DME and prosthetics, to include replacement parts, fact sheets, web updates, and news releases for public and other media entities. Issue 618: Army Wellness Centers (AWC) Issue recommendations: Create an integrated AWC at each installation (separate from the hospital) modeled after AWCs in Europe. Progress: An MOA reflecting shared responsibilities between MEDCOM, IMCOM, FORSCOM, TRADOC and AMC was prepared. The MOA was approved by FORSCOM. IMCOM, TRADOC and AMC approval is pending. Funding for space, equipment and staffing remains an issue. The original resource requirements were submitted to both the Army and DHP 12-17 POM and were not supported. An implementation guide has been prepared by APHC(P). An AWC at Ft Bragg was established in Nov 10 on a demonstration basis. 10

Way Ahead: Staff and obtain approval for a MOA addressing funding, staffing and space. Resubmit revised requirements ($86M) in the 13-17 PBR. Issue 629: 24/7 Out of Area TRICARE Prime Urgent Care Authorization and Referrals Issue recommendations: Establish a 24/7 centralized toll free number for TRICARE beneficiaries to request and acquire out of area urgent care authorization and referral assistance. Progress: The DoD Military Health System Innovation Investment Process approved a CONUS-based Nurse Advice Line (NAL) and referral assistance service. OTSG/MEDCOM convened a sub-working group of MEDCOM MTFs that currently have NALs to support OTSG/MEDCOM's contributions to the DRAFT RFP. The Enterprise working group (WG) has strong backing of ASD(HA)/TMA and the Services. OTSG anticipates that the NAL and referral assistance service will be operational 1 st Qtr FY12. Way Ahead: Implement a CONUS-based NAL and referral assistance service. Issue 638: Medical Nutrition Therapy (MNT) Benefits for All TRICARE Beneficiaries Issue recommendations: Establish MNT as a TRICARE benefit for all TRICARE beneficiaries. Progress: The Office of the Surgeon General submitted a proposal for outpatient MNT as a TRICARE benefit in Jul 99. In Jan 01, the proposal was disapproved due to funding limitations. In Jul 10, a formal request was staffed to TMA, asking MNT be added as a benefit for all TRICARE beneficiaries. In Oct 10, OSD(HA) agreed to conduct an analysis and literature review to determine if MNT is safe and effective, and to identify conditions it treats. Upon completion, they will prepare a decision paper with options for coverage. Way Ahead: Await TMA analysis and decision. Issue 644: Shortages of Medical Providers in Military Treatment Facilities Issue recommendations: Implement new strategies for recruiting and retaining medical providers; expedite the staffing of military, civilian and contract medical providers to support needs identified by the MTF Commander. Progress: Demand for healthcare exceeds provider availability in MTFs, and patients are referred to purchased care where appropriate. Army will allocate to MEDCOM 545 military billets needed to meet emerging medical workload generated by Grow the Army, and multiple developmental programs are being utilized to increase the number of civilian providers in MTFs. DoD direct hiring authority covers 24 occupations. Army awarded 75 Direct Care Medical Services contracts valued at an estimated $967M for physicians, ancillary services, and nursing services. Way Ahead: Examine current requirements and authorizations to distribute FY12 Human Capital resources equitably. Implement a hybrid pay system similar to the NSPS for GS physicians and dentists. Issue 648: Behavioral Health (BH) Services Shortages Issue recommendations: Increase the number of readily available BH providers and services for Soldiers, retirees, Family Members, and previously deployed DA Civilians. Increase the use of alternative methods of delivery; such as tele-medicine. 11

Progress: Since 2007, the Army has added 1,229 civilian, military and contract BH providers (65% increase) to help meet Active Component needs. The BH inventory for military, civilians, and contract providers continues to grow, but needs continue to grow as well. Army-wide there is a shortage of 388 providers. The civilian BH workforce doubled between 2006 and 2010, with emphasis on incentives and pay and reduced turnover rate; but still carries 354 open recruitment actions. The new Tele-Health Division focuses on BH and mtbi Issues. Tele-Health focuses on BH and mtbi issues, helps address the lack of providers in rural and geographically dispersed areas and provides surge capacity. MEDCOM has provided over 7,000 consultations in 41 countries and in 39 medical specialties (including BH). Way Ahead: OTSG will conduct an analysis to validate behavioral health staffing model. OTSG will then assess impact of increased staffing on ability of beneficiaries to obtain access to care for behavioral health services. Issue 656: RC Government Employee Access to TRICARE Reserve Select (TRS) Issue recommendation: Provide all Government employees and their Family members who serve in the RC the option of selecting health insurance from the FEHB Program or TRS. Resolution: Issue was closed as unattainable because TMA does not support a legislative change to authorize TRS to Government employees who serve in the RC. OTSG sent a formal request to TMA to allow RC Soldiers and their Family members who serve as RC Personnel to have the option to enroll into TRS. TMA did not support this request because of concerns that it would shift costs from the government employee s Title 5 healthcare costs to the Title 10 Defense Health Program costs. Family Support Issues Issue 458: Newly Acquired Dependent Travel Entitlement Issue recommendation: Establish date of marriage, adoption, or other legal action as the authorization date for travel and transportation requirements. Resolution: Issue was closed as unattainable because of lack of support in the legislative process. Transportation entitlements only allow shipment of HHG and travel of dependents acquired before the effective date of orders, which is the date the Soldier signs into a new duty station. The Per Diem, Travel, & Transportation Committee reviewed the proposal in 1999-2005; other Services had mixed support for changing the JFTR. A ULB submitted for FY09 was deferred until FY10, and the majority of voting members in ULB process did not support in final ULB vote for FY10. Army G-1 revised and submitted a FY13A ULB that included recommendations from the Council of Colonels. OSD (P&R) rejected the FY13A ULB due to a No vote during the FY 10 ULB cycle review. There is no exception to policy waiver to fully support this issue. Issue 592: Post Secondary Visitation for OCONUS Students Issue recommendations: Authorize a one-time round trip airfare to a CONUS point of entry for one guardian and an OCONUS student who has been accepted to a post secondary school. 12

Progress: The Army ULB Council of Colonels (CoC) did not support the FY11 ULB. Army G-1 revised cost estimate and submitted a FY12 ULB; the proposal was deferred to FY13 ULB. Recommendations from the CoC, included providing a better business case to include DOD civilians and address the inequity between CONUS and OCONUS students. DAPE-PRC requested USAREUR G-1 provide a better business case and current position on the issue. USAREUR G-1 response was that they have nothing to add to strengthen the business case on this issue. Way Ahead: Work with USAREUR to acquire the necessary empirical data that will determine the viability to resubmit for the FY14A cycle. Issue 620: Medical Entitlements for College Age Family Members (AHRC) Issue recommendation: Extend medical benefits (TRICARE) to full time students, up to age 25 years. Final issue status: Completed Resolution: Issue was declared completed because the FY11 NDAA, Title VII, Section 702 authorizes TRICARE Standard and Prime to dependent children up to age 26 if they do not have their own coverage. TMA will likely implement in a phased approach, starting with TRICARE Standard. Earliest anticipated implementation is Apr 11. Premium payments will be applicable. Sponsors may have the chance to retroactively enroll to the 1 Jan 11 effective date. Legislation does NOT authorize Dental, Commissary, or Exchange privileges. ID Card re-issuance will be required once enrolled. Issue 633: Cost of Living Allowance (COLA) Dependents Cap Issue recommendation: Eliminate the five dependent cap in determination of OCONUS COLA. Progress: CONUS COLA is paid at a with and without dependent rate, regardless of the number of dependents. The OCONUS COLA calculation considers the number of dependents. The Service s representatives to the PDTATAC expressed no support for lifting the dependent OCONUS COLA cap, stating the rationale of this issue is based on a false premise - that as the number of dependents increase, so does disposable income. In some pay grades with more than five dependents, the Family actually spends less on COLA types of goods and services. It is at the five dependent level that the member maxes out the percentage of income they can devote to spending on their dependents. Way Ahead: To be determined by G-1. Issue 515: Application Process for Citizenship/Residency for Soldiers and Families Proponent: Assistant Chief of Staff for Installation Management Issue recommendations: Designate and train an installation liaison to assist Family Members with citizenship process; obtain Citizenship and Immigration Service (CIS) approval of DOD administered fingerprinting and physical exams. Progress: Revision to AR 608-1 (Dec 06) assigns USCIS liaison function within the Army Community Service (ACS) Relocation Readiness Program. In Dec 10, USCIS confirmed they will accept fingerprint cards from domestic installations. However, the preferred method for biometric collection continues to be the use of the USCIS mobile fingerprint unit. In Jul 10, USCIS began developing policy regarding the Civil Surgeon designation to include fee structure for designation. USCIS determined that physicians employed by the US Armed Forces would be fee exempt. 13

Way Ahead: OTSG/MEDCOM leadership will determine course(s) of action for Army physicians to be designated as civil surgeons to perform physical examinations for Family members as required by USCIS. Issue 566: Childcare Fee Categories Proponent: Assistant Chief of Staff for Installation Management Issue recommendation: Reduce the wide income range in existing child care fees by increasing the number of fee categories and fee ranges within categories. Final issue status: Completed Resolution: Issue recommendation was achieved. The DoD Child Care Fee Policy for SY 2010-2011, effective 1 Oct 10, added 3 new Total Family Income (TFI) categories, increasing top TFI from $85K to $125K, and expanded the fee ranges within each Category. To reduce impact, Army has DoD exception for a 3 year implementation plan resulting in a single Army Fee in each TFI Category by FY13. ALARACT 298/2010 EXORD 323-10 School Year 2010-1011 DoD Child Care fee Ranges outlines comprehensive implementation policy guidance including STRATCOM. Issue 625: Transitional Compensation (TC) Benefits for Pre-existing Pregnancies Proponent: Assistant Chief of Staff for Installation Management Issue recommendation: Upon birth, authorize TC benefits for the child of a pregnant abused Family member. Progress: In Jul 10, a ULB proposal to change the definition of dependent in the TC Statute was submitted under the FY13A ULB cycle. In Sep 10, OSD sponsored the ULB proposal. A final decision regarding the approval of all FY13A ULBs will be made by the Under Secretary of Defense for Personnel and Readiness, in early 2011. Way Ahead: Monitor the progress of the FY13A ULB. Issue 639: OCONUS Orders for Soldiers with Exceptional Family Members (EFMs) Proponent: Assistant Chief of Staff for Installation Management Issue recommendation: Require deferment of Advanced Individual Training (AIT) Soldiers with EFMs until notification is received from OCONUS travel approval authority concerning availability of services and command sponsorship/family travel decision. Final issue status: Completed Resolution: Revision to AR 608-75 (paragraph 1-29e) will state (for Initial Military Training (IMT) Soldiers): If notification of availability of exceptional Family member services has not been received from OCONUS travel approval authority 30 days prior to Soldier s graduation, contact HRC for issuance of new assignment instructions. Rapid Action Revision is at Army Publishing Directorate for final policy review and authentication. 14