Defense Health Primer: U.S. Coast Guard Health Services

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December 15, 2020
Defense Health Primer: U.S. Coast Guard Health Services
Established in 1790, the U.S. Coast Guard (USCG) is a
health care. These funds are separate from DOD’s Defense
military service in the Department of Homeland Security
Health Program account that funds the MHS.
(DHS) and a branch of the armed forces of the United
States. The role of USCG is to provide security, maritime
USCG Health Services Personnel
safety, and environmental stewardship on the high seas and
A variety of medical professionals staff the USCG Health
in the ports, inland waterways, and maritime economic
Services program, including physicians, dentists, advanced
zones of the United States. To support these tasks, 14
practice providers, nurses, corpsmen, and administrators. In
U.S.C. §504 authorizes USCG to administer a Health
FY2017, 1,360 personnel were assigned to the USCG
Services program to sustain the medical readiness of
Health Services program. This included a mix of USCG
approximately 47,000 active duty and reserve
officers and enlisted servicemembers (64%), USPHS
servicemembers of the Coast Guard. The USCG program
officers (21%), civil servants (5%), and contractors (10%).
also collaborates with the Military Health System (MHS) of
the Department of Defense (DOD) to offer health care
USPHS Support to USCG
services to 9.6 million beneficiaries eligible for TRICARE.
USPHS has historically provided health care support to
USCG, originally through its now-decommissioned Marine
Mission
Hospital Service. Unlike other military services, USPHS
The USCG Health, Safety, and Work-Life (HSWL)
comprises a notable portion of USCG’s overall medical
Directorate (CG-11) administers the USCG health services
force. By law (42 U.S.C. §253), USCG is entitled to
program; it:
USPHS support for “medical, surgical, and dental treatment

and hospitalization.” A 1990 Memorandum of
provides health care to active duty and reserve
Understanding (MOU) formalizes this medical support
servicemembers supporting USCG missions;

relationship, which assigns USPHS officers to fill certain
“ensure[s] the medical and dental readiness” of
servicemembers for “world
USCG personnel requirements on a reimbursable-basis.
-wide deployment;” and

USPHS officers may be assigned to a clinic or a ship and
ensures the availability of quality, cost-effective health
can deploy with certain USCG units.
care for all eligible Coast Guard beneficiaries (i.e.,
active and reserve servicemembers, retirees, and family
USCG Health Services
members).
USCG offers a limited range of outpatient medical and
Organization
dental care (e.g., primary care; occupational health; flight
medicine; optometry; mental health; physical therapy;
The CG-11 Director is typically a U.S. Public Health
dentistry; and basic laboratory, radiology, and pharmacy
Service (USPHS) Flag officer (O-8) assigned to USCG
services). USCG delivers these health care services in fixed
Headquarters and serves as the chief medical advisor (i.e.,
U.S. health care facilities, ships, and certain deployed
Surgeon General) to the USCG Commandant. The CG-11
environments. USCG operates 43 shore-based outpatient
Director also works under the immediate supervision of the
clinics in the United States (see Figure 1) and no inpatient
Assistant Commandant for Human Resources, who reports
facilities. The clinics function similarly to DOD’s military
to the Deputy Commandant for Mission Support.
treatment facilities (MTFs).
The CG-11 Director delegates day-to-day oversight and
administration of the program to the Chief of Health
Figure 1. USCG Shore-Based Clinics
Services, who also functions as the Deputy Surgeon
General of the Coast Guard. The HSWL Service Center
administers the various health programs under its purview,
which include 14 Regional Practice offices that provide
technical assistance and administrative oversight for all
USCG clinics, and shipboard medical assets.
Budget
Most USCG health-related spending is organized into
several Program, Project, and Activity categories of the
Coast Guard’s Operations and Support account in the
annual DHS appropriation. The fiscal year (FY) 2021
USCG budget includes requests for $696.3 million in

Source: CRS graphic based on data provided by USCG officials,
discretionary funds for health-related spending and $230.6
August 2020.
million in mandatory funds that pay for USCG retiree
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Defense Health Primer: U.S. Coast Guard Health Services
Additionally, most USCG ships are equipped with a sickbay
Services assessment of USPHS found that there is increased
staffed with at least one health care provider. Shipboard
demand for personnel to support federal agencies and
health services are generally limited to primary care and
public health deployments (e.g., U.S. Border Operations or
first-responder care; however, some ships may be equipped
domestic disaster relief). Under the 1990 MOU, USCG is
and staffed to conduct certain emergency surgical
responsible for notifying USPHS of its personnel
procedures. Typically, when a patient’s medical needs
requirements; while USPHS is to “attempt to provide the
exceed the medical capabilities of a USCG clinic or
special professional categories, grades, and numbers
sickbay, they can be referred or medically evacuated to a
requested by the Commandant” and exclude personnel
DOD MTF or civilian medical facility participating in
detailed to USCG from force reduction actions. Though
TRICARE. Approximately 60% of all active duty USCG
USPHS anticipates increases in its active duty and newly
servicemembers obtain their health care primarily at a
established reserve corps through 2024, USCG may require
USCG clinic, while others (including Coast Guard retirees
alternative staffing options if USPHS is unable to meet
and family members) receive their health care at a DOD
increasing demand to support other federal agencies.
MTF or TRICARE provider.
Disability Evaluation System
Interaction with TRICARE
USCG utilizes a legacy Disability Evaluation System
Chapter 55 of Title 10, U.S. Code, entitles all active duty
(DES) process to evaluate a servicemember’s fitness for
members, retirees, and family members of the uniformed
duty and make a determination on retention or separation
services (including USCG) to the benefits offered by the
from military service. Prior to 2012, DOD also used this
TRICARE program, including care in DOD MTFs. Section
process, which the GAO found to have long delays,
506 of Title 14, U.S. Code, requires DHS to reimburse
duplicate DOD and VA processes, and confuse
DOD for MTF care provided to Coast Guard beneficiaries.
servicemembers. The FY2010 National Defense
Non-USCG beneficiaries may receive primary care in
Authorization Act (P.L. 110-181 §1644) directed DOD to
USCG clinics under certain conditions established by the
conduct a pilot program that streamlined the DES and
HSWL Service Center and on a space-available basis. In
integrated certain VA processes to evaluate and assign a
general, USCG health services policies on quality and
disability rating for potential health or compensation
access to care mirror or defer to DOD’s policies.
benefits. DOD later implemented this new process, called
the Integrated Disability Evaluation System (IDES). In
Current Challenges
March 2020, USCG began a five-site pilot program to
There are a number of perceived challenges facing the
replace its legacy DES with IDES. USCG has not yet
USCG Health Services program, many of which have
announced its strategy or timeline to implement IDES
attracted congressional attention and ongoing oversight.
across all installations.
Electronic Health Record Modernization
Relevant Statutes, Regulations, and Policies
In 2010, USCG launched efforts to implement an Integrated
Chapter 55, Title 10, U.S. Code
Health Information System (IHiS) to replace its legacy
Sections 504 and 948, Title 14, U.S. Code
electronic health record (EHR) systems. Prior to this
initiative, USCG utilized DOD’s legacy EHR system (i.e.,
Section 253, Title 42, U.S. Code
Composite Health Care System) and experienced limited
Part 199, Title 32, Code of Federal Regulations
interoperability with DOD and Department of Veterans
Part 31, Title 42, Code of Federal Regulations
Affairs (VA) health record systems. In September 2010,
USCG Commandant Instruction M6000.1F, Coast Guard
USCG awarded a $14 million contract to Epic Systems
Medical Manual, June 2018
Corporation to implement a commercial-off-the-shelf EHR.
In September 2015, USCG cancelled its contract after
USCG Commandant Instruction M1850.2D, Physical Disability
spending approximately $60 million and citing certain
Evaluation System, May 19, 2006
“financial, technical, schedule, and personnel risks.” Since
CRS Products
then, USCG has used a paper medical record system. A
2018 Government Accountability Office (GAO) evaluation
CRS In Focus IF10530, Defense Primer: Military Health System,
noted that USCG “could not demonstrate effective project
by Bryce H. P. Mendez
management, lacked governance mechanisms, and did not
Other Resources
document lessons learned for the IHiS project.” In April
GAO, Coast Guard Health Records: Timely Acquisition of New
2018, USCG announced its decision to implement DOD’s
System is Critical to Overcoming Challenges with Paper Process,
newly acquired EHR system, MHS Genesis. The new EHR
GAO-18-59, January 24, 2018
system is to be deployed in USCG clinics in various waves,
beginning in the western-half of the United States, and is
HHS, The USPHS Commissioned Corps: America’s Health
scheduled to be complete in June 2024.
Responders, Presentation by Admiral Brett P, Giroir, Assistant
Secretary for Health, to the Association of Military Surgeons
USPHS Support to USCG
of the United States Annual Meeting, December 4, 2019
USPHS support is not exclusive to USCG. With a total of

approximately 6,100 officers, USPHS supports a number of
other federal agencies (e.g., Indian Health Service, Bureau
Bryce H. P. Mendez, Analyst in Defense Health Care
of Prisons, U.S. Centers for Disease Control and
Policy
Prevention). A recent Department of Health and Human
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Defense Health Primer: U.S. Coast Guard Health Services


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