Soldiers returning from the wars in Iraq and Afghanistan "are finding it more difficult" to receive mental health treatment because therapists say reimbursement rates for care are too low, the AP/Arizona Daily Star reports. According to the AP/Daily Star, about one-third of the 9.1 million people covered under the military health care system, called Tricare, seek mental health counseling in their first year after returning from war.

Wait lists for care "now extend for months to see a military doctor, and it can take weeks to find a private therapist" willing to treat members of the military, the AP/Daily Star reports. "The challenge appears great in rural areas, where many National Guard and Reserve troops and their families live," according to the AP/Daily Star.

A Defense Department mental health task force last month found that Tricare's psychological health benefit is "hindered by fragmented rules and policies, inadequate oversight and insufficient reimbursement." The Tricare reimbursement rate is tied to Medicare's, and the rate for mental health services was reduced by 6.4% this year as part of an adjustment of reimbursements for some specialties.

Under Tricare coverage plans, the amount paid to providers varies by plan, location, specialty and services performed. Psychologists who treat active-duty troops are paid 66% of what Tricare views as the customary rate. Active-duty troops can receive mental health care free of charge, while Guard and Reserve troops and their families often use Tricare Standard, a fee-for-service plan under which they pay an annual deductible of 20% of the amount Tricare pays the therapist. Tricare earlier this year found that about two out of three civilian psychiatrists in 20 states were willing to accept Tricare Standard patients, the lowest acceptance rate for any specialty.

Tricare spokesperson Austin Camacho said that since 2004 Tricare has made physician payments quicker to encourage more doctors to participate. Camacho added that reimbursement rates have been increased in Idaho, Alaska and other states to attract physicians to the Tricare program (AP/Arizona Daily Star, 6/11).

Congressional Action
In related news, Sen. Ben Nelson (D-Neb.) on Friday said that he supports legislation that would provide new compensation benefits and bonus incentives for military personnel, the Lincoln Journal Star reports. Nelson, chair of the Senate Armed Services Subcommittee on Military Personnel, said that the military health care system has been overwhelmed by "too many patients, too few doctors and too few facilities." In addition, he said that long waiting periods for care, fewer options and burdensome travel requirements have further complicated the system. Nelson said that he will push for more resources, incentives to recruit and retain military personnel and better coordination to assure timely care, the Journal Star reports.

He also said that his subcommittee is developing "wounded warrior" legislation that would strengthen the veterans' health system. Nelson said that he has added $3.5 billion to the Veterans Administration budget recommended by President Bush to achieve his goal of improved services.

He said, "Help is on the way," adding, "Paying more and waiting longer for less care represents a breach of faith with our veterans." Nelson on Saturday outlined his plan during speeches to the Disabled American Veterans and the American Legion (Walton, Lincoln Journal Star, 6/8).