Dental Care Care In Department Of Defense Medical Centers, Hospitals .

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Defense Health ProgramFiscal Year (FY) 2020 President's BudgetOperation and MaintenanceIn-House CareI. Description of Operations Financed:This Budget Activity Group provides for the delivery of medical and dental care pluspharmaceuticals received by Department of Defense eligible beneficiaries in MilitaryTreatment Facilities and Dental Treatment Facilities in the Continental United States(CONUS) and Outside the Continental United States (OCONUS). This program includes thefollowing:Care in Department of Defense Medical Centers, Hospitals and Clinics - Includes resourcesfor the provision of healthcare in DoD-owned and operated CONUS and OCONUS MilitaryTreatment Facilities which are staffed, and equipped to provide inpatient care for bothsurgical and medical patients and/or outpatient care for ambulatory patients.Dental Care - Includes resources for the provision of dental care and services in CONUSand OCONUS to authorized personnel through the operation of hospital departments ofdentistry and installation dental clinics, and the operation of Regional DentalActivities.Pharmaceuticals - Includes pharmaceuticals specifically identified and provided byPharmacy Services in DoD owned and operated CONUS and OCONUS facilities. Excludes thecost of operating Pharmacy Services in the Military Treatment Facilities.Between FY 2019 and FY 2020, there is minimal program growth within the In-House CareBudget Activity. Healthcare funding was net-zero reprioritized to provide betterhealthcare and improve medical readiness which subsequently controls growth and enablesmore accurate alignment of resource allocation with historical execution. In addition,resources supporting the Phase 1 Military Treatment Facilities were net-zero realignedfrom the Medical Services to the Defense Health Agency. Realignments include: WomackIn-House CareIHC-1

Defense Health ProgramFiscal Year (FY) 2020 President's BudgetOperation and MaintenanceIn-House CareI.Description of Operations Financed (cont.)Army Medical Center (includes Pope Medical Squadron), Keesler Medical Center, SeymourJohnson Clinic, Charleston Clinics, and Naval Hospital Jacksonville.II. Force Structure Summary:The In-House Care Budget Activity Group includes staffing in Military TreatmentFacilities to provide the full range of inpatient and ambulatory medical and dental careservices. In addition to medical and dental care, this Budget Activity Group alsoincludes medical center laboratories, substance abuse programs, facility on-the-jobtraining/education programs and federal health care sharing agreements. This BudgetActivity Group excludes operation of management headquarters, TRICARE Regional Offices,deployable medical and dental units and health care resources devoted exclusively toteaching organizations.In-House CareIHC-2

Defense Health ProgramFiscal Year (FY) 2020 President's BudgetOperation and MaintenanceIn-House CareIII. Financial Summary ( in thousands)FY 2019Congressional ActionA. BA Subactivities1. MEDCENs, Hospitals &Clinics (CONUS)2. MEDCENs, Hospitals &Clinics (OCONUS)3. Pharmaceuticals (CONUS)4. Pharmaceuticals(OCONUS)5. Dental Care (CONUS)6. Dental Care (OCONUS)TotalFY stimateAmountPercent Appropriated-191,022-2.86,667,124 6,704,315FY 40,2589,570,6151. FY 2018 actual includes 69,857K for OCO.2. FY 2018 actual does not include Department of Defense (DoD) Medicare-Eligible Retiree Health Care Fund (MERHCF) of 1,661,000K (O&Monly).3. FY 2019 estimate excludes 72,627K for OCO.4. FY 2019 estimate does not reflect anticipated DoD MERHCF receipts of 1,742,665K (O&M only).5. FY 2020 estimate excludes 57,459K for OCO.6. FY 2020 estimate does not reflect anticipated DoD MERHCF receipts of 1,800,211K (O&M only).7. Pharmacy Footnote: The FY 2019 projected requirement of 1,823.2M exceeds the current estimate of 1,650,647K by 172.7M. Currentexecution shows a 19% increase in the average cost per script over the same period in FY 2018. Current execution shows increased fillof specialty drugs targeted for very specific conditions. Although these drugs have low usage, the costs of the therapies areextremely high at thousands of dollars per treatment. The increase is the result of new, more expensive, brand named medicationsentering the market with no generics. The DHA Pharmacy Operations Division will continue to monitor execution to determine ifadditional funding is required.In-House CareIHC-3

Defense Health ProgramFiscal Year (FY) 2020 President's BudgetOperation and MaintenanceIn-House CareIII. Financial Summary ( in thousands)B. Reconciliation SummaryBaseline FundingCongressional Adjustments (Distributed)Congressional Adjustments (Undistributed)Adjustments to Meet Congressional IntentCongressional Adjustments (General Provisions)Subtotal Appropriated AmountFact-of-Life Changes (2019 to 2019 Only)Subtotal Baseline FundingSupplementalReprogrammingsPrice ChangesFunctional TransfersProgram ChangesCurrent EstimateLess: Wartime SupplementalNormalized Current EstimateChangeFY 2019/FY 20199,738,569-225,400-277,073ChangeFY 2019/FY 6279,236,096173,692-21,990182,8179,570,615In-House CareIHC-4

Defense Health ProgramFiscal Year (FY) 2020 President's BudgetOperation and MaintenanceIn-House CareIII. Financial Summary ( in thousands)C. Reconciliation of Increases and DecreasesFY 2019 President's Budget Request (Amended, if applicable)1. Congressional Adjustmentsa. Distributed Adjustments1) Medical Contracts Excess Growth2) Other Costs Excess Growth3) Pharmacy Program Excess Growth4) Printing Excess Growth5) Travel Excess Growthb. Undistributed Adjustments1) Undistributed Adjustmentc. Adjustments to Meet Congressional Intentd. General ProvisionsFY 2019 Appropriated Amount2. OCO and Other Supplemental Enacteda. OCO and Other Supplemental Requested1) Overseas Contingency Operations3. Fact-of-Life ChangesFY 2019 Baseline Funding4. Reprogrammings (Requiring 1415 Actions)Revised FY 2019 Estimate5. Less: OCO and Other Supplemental Appropriations andReprogrammings (Items 2 and 4)FY 2019 Normalized Current Estimate6. Price Change7. Functional Transfersa. Transfers Inb. Transfers Out1) Civilian Transfers to the Military Departments of theArmy and 90In-House CareIHC-5

Defense Health ProgramFiscal Year (FY) 2020 President's BudgetOperation and MaintenanceIn-House CareIII. Financial Summary ( in thousands)C. Reconciliation of Increases and DecreasesTransfer due to the implementation of the MilitaryHealth System organizational reforms required bySection 702 of the National Defense Authorization Actof FY 2017 which focuses on efforts to reduceredundant and unnecessary headquarters overhead byeliminating duplicative activities carried out by theelements of the Defense Health Agency and themilitary departments. Specifics included: ArmyMedical Command Transferred 37 Civilian FTEs andassociated funding to the Department of the Army ( 3,798K) and a transfer from Navy Bureau of Medicineand Surgery of 168 civilian FTES and associatedfunding (- 18,192K).8. Program Increasesa. Annualization of New FY 2019 Programb. One-Time FY 2020 Increasesc. Program Growth in FY 20201) a. Transfer Price to Replace Military Medical EndStrength:Resources required to mitigate potential access tocare issues caused by the reduction in militaryproviders. Funding will be used to increasethroughput and expand patient mixes to create a morecurrency rich environment to improve the knowledge,skills and abilities of practitioners in both thebattlefield and beneficiary care setting. Funds willalso be used to better prioritize resourcing forcritical career fields needed for operationalrequirements to improve readiness of the medicalAmountTotals277,228250,000In-House CareIHC-6

Defense Health ProgramFiscal Year (FY) 2020 President's BudgetOperation and MaintenanceIn-House CareIII. Financial Summary ( in thousands)C. Reconciliation of Increases and Decreasesforce. The FY 2019 In-House Care baseline funding is 9,236,096K. The FY 2019 In-House Care baselinecontractor staffing is 14,144 CMEs.2) b. Air Force Integrated Operational Support Team:The Operational Support Team (OST) Initiative embedsmental health and physical therapist providers insupport of the National Defense Strategy andSecretary of the Air Force's priorities to restorereadiness and create a more resilient force. Theinitiative focuses on preventive medicine and patienteducation, providing expedient, focused mental healthand musculoskeletal expertise in higher risk AirForce squadrons to optimize mission performance whilelowering military occupational related risk,mitigating down-time and ensuring a medically readyforce. The FY 2019 In-House Care baseline funding is 9,236,096K.3) c. Access to Care Management:Funds required for the Air Medical Serviceinvestments to fortify set Access to Care (ATC)initiatives intended to sustain a systematic,proactive, programmatic, and responsive accessprogram. ATC Management initiatives ensure access tohealthcare services within access standards, enhancepatient and staff satisfaction, and provide apatient-centered, first-call resolution appointmentsystem. The FY 2019 In-House Care baseline fundingis 9,236,096K.4) d. Virtual Health Expansion:AmountTotals6,6295,9232,000In-House CareIHC-7

Defense Health ProgramFiscal Year (FY) 2020 President's BudgetOperation and MaintenanceIn-House CareIII. Financial Summary ( in thousands)C. Reconciliation of Increases and DecreasesResources required to fund the incremental increasefor the Military Health System Virtual Health Programexpansion. Provides funds to contract program officesupport and additional providers to providebeneficiaries with expanded access to care throughthe use of Virtual Health Carts staffed by trainednurses. The FY 2017 National Defense AuthorizationAct, Section 718 provision to enhance the use ofvirtual health services for provider consultations,patient monitoring, and healthcare delivery in theMilitary Health System and leverage technology toimprove access to care for beneficiaries whereverthey are located. The FY 2019 In-House Care baselinefunding is 9,236,096K. The FY 2019 In-House Carebaseline contractor staffing is 14,144 CMEs.5) e. Navy Medical Readiness Initiatives:Realigned funding to support five key readinessinitiatives prioritized by the Surgeon General:Readiness Cost Reporting Program (RCRP), USMC MedicalHome Physical Therapy Services, Sports Medicine AndRehabilitation Team (SMART) Clinic Staffing, NavalExpeditionary Health Services Support (NEHSS)Capability Requirements Analysis, and ContractChiropractic Staff Augmentation at Naval HealthClinic (NHC) Quantico (NHCQ). The FY 2019 In-HouseCare baseline funding is 9,236,096K.6) f. Holistic Health and Fitness (H2F):Realigned funding to support medical servicesprovided by contract Registered Dietitians (RD) andAmountTotals6,5766,100In-House CareIHC-8

Defense Health ProgramFiscal Year (FY) 2020 President's BudgetOperation and MaintenanceIn-House CareIII. Financial Summary ( in thousands)C. Reconciliation of Increases and DecreasesCertified Athletic Trainers (AT) aligned to ArmyBrigades (BDE). The integration of RDs into BDEsreduces the number of Soldiers enrolled in the ArmyBody Composition Program (ABCP), thus increasing BDEhealth and readiness of the force. The addition ofthe AT compliments the integration of active dutyPhysical Therapists (PTs) into BDE formations, toreduce Musculoskeletal (MSK) injuries which are amongthe most common factors medically disqualifyingSoldiers assigned to FORSCOM units for deployments ortraining operations. The FY 2019 In-House Carebaseline funding is 9,236,096K.9. Program Decreasesa. Annualization of FY 2019 Program Decreasesb. One-Time FY 2019 Increasesc. Program Decreases in FY 20201) a. Military Health System Administration:Realigns 73 civilian FTEs and associated supportfunding from the In-House Care Budget Activity Groupto the Management Activities Budget Activity Group.Also reduce requirements for travel, supplies andother contract costs to implement reforms in supportof the FY 2017 National Defense Authorization Act,Section 702, Reform of the Administration of theDefense Health Agency and Military TreatmentFacilities and to eliminate duplicative activitiescarried out by the elements of the Defense HealthAgency and the Military Medical Services. The FY2019 In-House Care baseline funding is 9,236,096K.AmountTotals-94,411-55,997In-House CareIHC-9

Defense Health ProgramFiscal Year (FY) 2020 President's BudgetOperation and MaintenanceIn-House CareIII. Financial Summary ( in thousands)C. Reconciliation of Increases and DecreasesThe FY 2019 Dental Care contractor staffing is 1061CMEs.2) b. Desktop to Datacenter (D2D):Reduces funding for the Desktop to Datacenter (D2D)Program through centralization of helpdesk support(Global Service Center), network security, datacomputation and data storage, global directoryservices, and network management services that wereformerly provided by the individual Military HealthSystem (MHS) components or the Military Departments,and are now provided by Defense Health Agency (DHA)Health Information Technology (HIT). Reduction alsoincludes decrease for Functional Area Applicationsthat were found to be redundant or no longer requiredas the Military Health System (MHS) GENESIS isdeployed. The FY 2019 In-House Care baseline fundingis 9,236,096K.3) c. Realign Army and Navy Historical Under Execution:Internally realigned historical under-execution tosupport Navy Readiness initiatives and Army HolisticHealth and Fitness (H2F). The FY 2019 In-House Carebaseline funding is 9,236,096K.4) d. Air Force Medical Service Contracts:Realigned Air Force Medical Service internal contractfunding based on three internal efficiency studies:Contract Efficiency Review, Inpatient Bed Study, andWing Efficiency Review to support Operational SupportTeams and Access to Care Management requirements.The FY 2019 In-House Care baseline funding isAmountTotals-9,849-12,676-12,552In-House CareIHC-10

Defense Health ProgramFiscal Year (FY) 2020 President's BudgetOperation and MaintenanceIn-House CareIII. Financial Summary ( in thousands)C. Reconciliation of Increases and Decreases 9,236,096K.5) e. Vision Center of Excellence:Realigns Executive Agency of the Vision Center ofExcellence (VCoE) to the Defense Health Agency fromNavy Bureau of Medicine and Surgery. Funds realignedto support the VCOE Information Management/Information Technology Budget Activity requirementfor local area network, wide area network contractsupport, and Informatics and Information Managementprograms/projects. Funds also realigned toConsolidated Health Support Budget Activity Group tosupport contract requirements for data abstraction.The FY 2019 In-House Care baseline funding is 9,236,096K. The FY 2019 In-House Care baselinecontractor staffing is 14,144 CMEs.FY 2020 Budget RequestAmountTotals-3,3379,570,615In-House CareIHC-11

Defense Health ProgramFiscal Year (FY) 2020 President's BudgetOperation and MaintenanceIn-House CareIV. Performance Criteria and Evaluation Summary:In-House CareIHC-12

Defense Health ProgramFiscal Year (FY) 2020 President's BudgetOperation and MaintenanceIn-House CareIV. Performance Criteria and Evaluation Summary:In-House CareIHC-13

Defense Health ProgramFiscal Year (FY) 2020 President's BudgetOperation and MaintenanceIn-House CareIV. Performance Criteria and Evaluation Summary:In-House CareIHC-14

Defense Health ProgramFiscal Year (FY) 2020 President's BudgetOperation and MaintenanceIn-House CareIV. Performance Criteria and Evaluation Summary:In-House CareIHC-15

Defense Health ProgramFiscal Year (FY) 2020 President's BudgetOperation and MaintenanceIn-House CareIV. Performance Criteria and Evaluation Summary:In-House CareIHC-16

Defense Health ProgramFiscal Year (FY) 2020 President's BudgetOperation and MaintenanceIn-House CareIV. Performance Criteria and Evaluation Summary:In-House CareIHC-17

Defense Health ProgramFiscal Year (FY) 2020 President's BudgetOperation and MaintenanceIn-House CareV. Personnel Summary39,51813,36426,15447,926ChangeFY 2018/FY 20191,2221,09412845ChangeFY 2019/FY 6FY 2018FY 2019FY 2020Active Military End Strength (E/S) (Total)OfficerEnlistedActive Military Average Strength (A/S)(Total)OfficerEnlistedCivilian FTEs (Total)U.S. Direct HireForeign National Direct HireTotal Direct HireForeign National Indirect HireReimbursable CiviliansAverage Annual Civilian Salary ( 5.1Contractor FTEs (Total)14,546Explanation of changes in Active Military End Strength: The net increase from FY 2018 toFY 2019 ( 1,222) reflects FY 2018 medical military end strength executionadjustments ( 1,495: Army 668, Navy 89 and AF 738), mission transfers to the MilitaryDepartments for Medical Readiness Programs (-45: Navy -24, AF -21), Air Force reductionto military medical end strength (-250) and internal realignments to meet emergingrequirements ( 22). The net decrease from FY 2019 to FY 2020 (-16,815) includes transferto the military department for reductions to medical military end strength (-14,117: ArmyIn-House CareIHC-18

Defense Health ProgramFiscal Year (FY) 2020 President's BudgetOperation and MaintenanceIn-House Care-6,414; Navy -3,019; Air Force -4,684); reductions in support of Section 702 of the FY2017 National Defense Authorization Act, Reform of Administration of the Defense HealthAgency and military medical treatment facilities to include 10% reduction for MajorHeadquarters Activities (-4:Army -2; Navy -2); transfer to the Defense Health Agency forMajor Headquarters Activities Budget Activity Group (-31: Army -11; Navy -12; Air Force 8); mission transfers to the Military Departments for Medical Readiness Programs (-2,222:Army -1,645; Navy -80; Air Force -497); and internal Navy Bureau of Medicine and SurgeryDefense Health Program realignments to support emerging requirements (-441).Explanation of changes in Civilian FTEs: The net decrease from FY 2018 to FY 2019 (1,304) reflects FY 2018 over execution of civilian FTEs adjustment to FY 2019authorized levels (-1,420), Army MEDCOM’s realignment of FTEs ( 65) from ConsolidatedHealth Support ( 60) and Information Management/Information Technology ( 5) to In-HouseCare for sustained operations at United States Medical Material Center, Korea.Additional FTEs were internally realigned within the Army program to supportongoing requirements at OCONUS medical and dental treatment facilities ( 9). Theincrease also results from adjustment for full year execution of FTEs which underexecuted in prior fiscal year. ( 42). The decrease from FY 2019 to FY 2020 (-286)reflects adjustment for full year execution of FTEs which under-executed in prior fiscalyear ( 31), civilian FTE transfers to the military departments from the Defense HealthProgram (-205: Army -37, Navy -168); transfer of civilian FTEs from In-House Care BudgetActivity to the Defense Health Agency Management Activities (-113: Army 16, Navy 97).Explanation of changes in Contractor FTEs: The decrease from FY 2018 to FY 2019 (-402)is attributed to reduction taken as part of the Military Service Headquarters decreaseassociated with efficiencies gained through elimination of duplicative headquartersfunctions outlined in the FY 2017 National Defense Authorization Act, Section 702. Thedecrease from FY 2019 to FY 2020 (-286) is a result of reduced contract requirements inIn-House CareIHC-19

Defense Health ProgramFiscal Year (FY) 2020 President's BudgetOperation and MaintenanceIn-House CareIn-House Care to align funds in support of Defense Health Agency Strategy for MHS-widepriorities.In-House CareIHC-20

Defense Health ProgramFiscal Year (FY) 2020 President's BudgetOperation and MaintenanceIn-House CareVI.OP 32 Line Items as Applicable (Dollars in thousands):OP 32 Line101 Exec, Gen’l &Spec Scheds103 Wage Board104 FN DirectHire (FNDH)105 SeparationLiability (FNDH)107 Voluntary SepIncentives199 TOTAL CIVCOMPENSATION308 Travel ofPersons399 TOTAL TRAVEL401 DLA Energy(Fuel Products)402 Service FundFuel412 Navy ManagedSupply, Matl416 GSA Supplies& Materials417 Local PurchSupplies & Mat422 DLA MatSupply Chain(Medical)499 TOTALSUPPLIES &MATERIALS502 Army FundEquipment503 Navy FundEquipment505 Air ForceFund Equip506 DLA MatForeignCurrencyChangeFY 2018/FY 2019FY 2018Actuals4,311,507Rate Diff0Price21,989Program-120,092FY 880953003,81804,473,404ForeignCurrencyChangeFY 2019/FY 2020Rate Diff0Price0Program44,795FY 82200-14223In-House CareIHC-21

Defense Health ProgramFiscal Year (FY) 2020 President's BudgetOperation and MaintenanceIn-House CareOP 32 LineSupply Chain(Const & Equip)507 GSA ManagedEquipment599 TOTALEQUIPMENTPURCHASES611 Navy SurfaceWarfare Ctr614 Space & NavalWarfare Center633 DLA DocumentServices677 DISA TelecommSvcs Reimbursable699 TOTAL DWCFPURCHASES706 AMC ChannelPassenger719 SDDC CargoOps-Port hndlg771 CommercialTransport799 TOTALTRANSPORTATION901 ForeignNational IndirectHire (FNIH)902 SeparationLiab (FNIH)912 RentalPayments to GSA(SLUC)913 PurchasedUtilities (NonFund)914 PurchasedCommunicationsFY 2018ActualsForeignCurrencyRate DiffChangeFY 2018/FY 2019PriceProgramFY 2019EstimateForeignCurrencyRate DiffChangeFY 2019/FY 2020PriceProgramFY ,153023-368808In-House CareIHC-22

Defense Health ProgramFiscal Year (FY) 2020 President's BudgetOperation and MaintenanceIn-House CareOP 32 Line(Non-Fund)915 Rents (NonGSA)917 PostalServices(U.S.P.S)920 Supplies &Materials (NonFund)921 Printing &Reproduction922 EquipmentMaintenance ByContract923 FacilitiesSust, Rest, & Modby Contract924PharmaceuticalDrugs925 EquipmentPurchases (NonFund)932 Mgt ProfSupport Svcs933 Studies,Analysis & Eval934 Engineering &Tech Svcs937 LocallyPurchased Fuel(Non-Fund)955 Other Costs(Medical Care)957 Other Costs(Land andStructures)959 Other Costs(InsuranceFY 2018ActualsForeignCurrencyRate DiffChangeFY 2018/FY 2019PriceProgramFY 2019EstimateForeignCurrencyRate DiffChangeFY 2019/FY 2020PriceProgramFY 073055-3,128000001,491027-1,51800000In-House CareIHC-23

Defense Health ProgramFiscal Year (FY) 2020 President's BudgetOperation and MaintenanceIn-House CareOP 32 LineClaims/Indmnties)960 Other Costs(Interest andDividends)964 Other Costs(Subsistence andSupport ofPersons)986 Medical CareContracts987 Other IntraGovt Purch988 Grants989 OtherServices990 IT ContractSupport Services991 ForeignCurrency Variance999 TOTAL OTHERPURCHASESTotalFY 2018ActualsForeignCurrencyRate DiffChangeFY 2018/FY 2019PriceProgramFY 2019EstimateForeignCurrencyRate DiffChangeFY 2019/FY 2020PriceProgramFY 70,615In-House CareIHC-24

Johnson Clinic, Clinics, and Naval Hospital Jacksonville. II. Force Structure Summary: The In-House Care Budget Activity Group includes staffing in Military Treatment Facilities to provide the full range of inpatient and ambulatory medical and dental care services. In addition to medical and dental care, this Budget Activity Group also

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