TRICARE Demonstration Project for the Philippines

On Wednesday, September 28, 2011, the Department of Defense (DoD) published a notice of the Philippines Demonstration Project (PDP) (76 FR 60007-60008). This notice is to advise interested parties of an extension to a Military Health System demonstration project entitled ``TRICARE Demonstration Project for the Philippines.'' The purpose of this demonstration is to validate an alternative approach to providing healthcare services for those beneficiaries covered under the TRICARE Standard option in the Philippines, controlling costs, eliminating any balance billing issues, and ensuring that the billing practices comply with regulatory requirements. During the initial two years of the demonstration project, significant reductions in providers under Pre- Payment Review has been observed, resulting in less fraudulent claim investigations. In addition, beneficiaries have been over 93% compliant with utilizing approved network providers in the Philippines demonstration areas. The DHA's intent is to extend the demonstration project for an additional three years in order to determine if the cost savings to the Government in terms of the average cost per paid claim along with the savings on fraudulent claims can exceed the administrative costs related to the project while ensuring Standard beneficiaries are able to access high quality medical care within TRICARE access standards.