[Federal Register: July 31, 2003 (Volume 68, Number 147)]
[Rules and Regulations]
[Page 44882-44884]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr31jy03-10]
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DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 199
RIN-0720-AA72
TRICARE Program; Waiver of Certain TRICARE Deductibles;
Clarification of TRICARE Prime Enrollment Period; Enrollment in TRICARE
Prime Remote for Active Duty Family Members
AGENCY: Office of the Secretary, DoD.
ACTION: Interim final rule.
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SUMMARY: A proposed rule to implement section 714 of the National
Defense Authorization Act (NDAA) for Fiscal Year 2000 was published on
April 18, 2002 (67 FR 19141) to authorize the Secretary of Defense to
waive the TRICARE deductible in certain cases for care provided to a
dependent of a member of a Reserve Component or the National Guard who
is called to active duty for more than 30 days but less than one year.
The proposed rule also established circumstances under which eligible
beneficiaries may enroll in TRICARE Prime for a period of less than one
year. The proposed rule is withdrawn and instead is implemented along
with section 702 of the NDAA for FY 2003, which establishes
circumstances under which dependents of Reserve Component and National
Guard members called to active duty in support of contingency
operations may enroll in TRICARE Prime Remote for Active Duty Family
Members, and dependents of TRICARE Prime Remote service members who are
enrolled in TRICARE Prime Remote for Active Duty Family Members may
remain enrolled when the service member receives orders for an
unaccompanied follow-on assignment. This interim final rule authorizes
the Secretary of Defense to waive the TRICARE deductible in certain
cases for care provided to a dependent of a member of a Reserve
Component or the National Guard who is called to active duty for more
than 30 days but less than 1 year. It establishes circumstances under
which eligible beneficiaries may enroll in TRICARE Prime for a period
of less than 1 year.
EFFECTIVE DATE: This interim final rule is effective September 29,
2003.
ADDRESSES: TRICARE Management Activity (TMA), Medical Benefits and
Reimbursement Systems, 16401 East Centretech Parkway, Aurora, CO 80011-
9043.
FOR FURTHER INFORMATION CONTACT: Stephen E. Isaacson, Medical Benefits
and Reimbursement Systems, TMA, (303) 676-3572.
SUPPLEMENTARY INFORMATION:
I. Summary of Interim Final Rule Provisions
The reader should refer to the proposed rule that was published on
April 18, 2002, (67 FR 19141) for more detailed information regarding
these changes. This interim final rule describes the circumstances
under which eligible dependents of active duty members, and eligible
dependents of Reserve Component and National Guard members called to
active duty in support of contingency operations may enroll in TRICARE
Prime Remote for Active Duty Family Members. In addition, this interim
rule describes the circumstances under which eligible dependents of
TRICARE Prime Remote service members who are enrolled in the TRICARE
Prime Remote for Active Duty Family Member program may remain enrolled
when the service member receives a follow-on accompanied assignment and
the dependents continue to reside in the TRICARE Prime Remote location.
Changes to the provisions for TRICARE Prime Remote for Active Duty
Family Members (TPRADFM) are required by Section 702 of P.L. 107-314
(the NDAA for FY 2003). First, family members who are enrolled in
TPRADFM may continue their enrollment when the member has relocated
without the family members pursuant to orders for a permanent change of
duty station, if the orders do not authorize dependents to accompany
the member to the new duty station at the expense of the United States,
and if the family members continue to reside at the same location at
which they were enrolled in TPRADFM. Second, family members of a
reserve component member ordered to active duty for a period of more
than 30 days may enroll in TPRADFM if they reside with the member and
if the residence is more than fifty (50) miles, or approximately one
hour driving time, from the nearest military medical treatment facility
adequate to provide the needed care.
The changes related to TPRADFM were not included in the original
proposed rule, but, since they are statutorily required and also
require a change to a paragraph of 32 CFR Part 199.17 that was being
revised pursuant to the proposed rule, we are including all of the
changes in this interim final rule.
II. Public Comments
We provided a 60-day comment period on the proposed rule. We
received no public comments.
III. Changes in the Interim Final Rule
In both paragraph (f)(2)(i)(H) of Section 199.4 and paragraph
(o)(2) of Section 199.17, we have clarified that these provisions apply
only to members of the National Guard who are ordered to federal active
duty under authority of the President and not to those members who are
ordered to active duty under the authority of a governor of a state. In
addition, in paragraph (f)(2)(i)(H) of Section 199.4, we have changed
``the Secretary of Defense, or a designee,'' to ``the Director, TRICARE
Management Activity'' as the authority to waive the annual fiscal year
deductible. This is only a wording change and not a substantive change,
since the Secretary of Defense, through 32 CFR 199.1(c)(2) and 32 CFR
part 367, has delegated authority to the Assistant Secretary of Defense
(Health Affairs), who has delegated authority to the Director, TRICARE
Management Activity, to provide policy guidance, management control,
and coordination as required by CHAMPUS.
The proposed rule would have established in the regulation an
administrative authority for Reservists and members of the National
Guard who are called or ordered to active duty for a period of 179 days
or more to enroll in TRICARE Prime. We are changing that provision in
this interim final rule.
Reserve components (including both reservists and members of the
National Guard) participate in military conflicts and peacekeeping
missions in areas such as Bosnia, Kosovo, and southwest Asia, and
assist in homeland security. The operational tempo following the events
of September 11, 2001, showed a dramatic increase in the number of
reservists activated for these requirements. These reservists receive
varying levels of medical benefits according to their primary residence
location, length of call up, and type of activation order. For example,
the Department established a demonstration in order to ease the burden
imposed on the large number of reserve component members who have been
activated in response to September 11 under Operations Noble Eagle and
Enduring Freedom (66 FR 55928). This demonstration which is called the
TRICARE Reserve Family Member
[[Page 44883]]
Demonstration Project (TRFMDP) provides three enhancements to the
TRICARE Standard benefit for their family members: the annual
deductible was waived, the requirement to obtain a non-availability
statement was waived, and TRICARE will pay up to fifteen percent above
the TRICARE maximum allowable charge for services received from
nonparticipating providers. However, the demonstration is due to expire
on November 1, 2003, although large numbers of individuals continue to
be activated. In addition, family members of reserve component members
who are activated under other authorities do not receive these enhanced
benefits.
In order to eliminate these discrepancies while continuing to
provide some enhanced benefits to family members of activated reserve
component members, the Department has authorized family members of
activated reserve component members who live in military treatment
facility catchment areas to enroll in TRICARE Prime if the member is
activated for more than 30 days rather than for 179 days or more. A
catchment area is established by zip codes, but is generally a home
residence within 50 miles, or approximately one hour driving time, from
the nearest military treatment facility adequate to provide care. This
change accomplishes three goals. First, it provides family members of
these activated reserve component members with substantially the same
benefits available to family members of activated reserve component
members under the TRFMDP. Second, it provides these family members with
the same benefits available to family members who live outside
catchment areas under the TPRADFM through the provisions of Section 702
of P.L. 107-314. Third, it ensures that the medical benefits available
to family members of activated reservists are as similar as possible to
those available to family members of active duty members.
This interim final rule establishes specific regulatory authority
for this provision.
IV. Regulatory Procedures
Executive Order 12866 requires that a regulatory impact analysis be
performed on any major rule. A ``major rule'' is defined as one that
would result in the annual effect on the national economy of $100
million or more, or have other substantial impact. The Regulatory
Flexibility Act (RFA) requires that each Federal Agency prepare, and
make available for public comment, a regulatory flexibility analysis
when the agency issues regulations which would have a significant
impact on a substantial number of small entities.
This interim final rule is not major rule under the Congressional
Review Act. The changes set forth in this interim final rule are minor
revisions to existing regulation. The changes made in this interim
final rule involve an expansion of TRICARE benefits. In addition, this
interim final rule will have minor impact and will not significantly
affect a substantial number of small entities. In light of the above,
no regulatory impact analysis is required.
This rule has been designated as significant and has been reviewed
by the Office Management and Budget as required under the provisions of
E.O. 12866.
This interim final rule will not impose additional information
collection requirements on the public under the Paperwork Reduction Act
of 1995 (44 U.S.C. Chapter 55).
List of Subjects in 32 CFR Part 199
Claims, handicapped, health insurance, and military personnel.
PART 199--[AMENDED]
0
1. The authority citation for part 199 continues to read as follows:
Authority: 5 U.S.C. 301; 10 U.S.C. Chapter 55.
0
2. Section 199.4 is amended by adding a new paragraph (f)(2)(i)(H) as
follows:
Sec. 199.4 Basic program benefits.
(f) * * *
(2) * * *
(i) * * *
(H) The Director, TRICARE Management Activity, may waive the annual
individual or family fiscal year deductible for dependents of a Reserve
Component member who is called or ordered to active duty for a period
of more than 30 days but less than one year or a National guard member
who is called or ordered to full-time federal National guard duty for a
period of more than 30 days but less than one year, in support of a
contingency operation (as defined in 10 U.S.C. 101(a)(13)). For
purposes of this paragraph, a dependent is a lawful husband or wife of
the member and a child as defined in paragraphs (b)(2)(ii)(A) through
(F) and (b)(2)(ii)(H)(1), (2) and (4) of Part 199.3.
* * * * *
0
3. Section 199.17 is amended by revising paragraphs (g)(3), (o) and
(o)(2) as follows:
Sec. 199.17 TRICARE Program.
(g) * * *
(3) Eligibility.
(i) An active duty family member is eligible for TRICARE Prime
Remote for Active Duty Family Members if he or she is eligible for
CHAMPUS and, on or after December 2, 2003 meets the criteria of either
(g)(3)(i)(A) and (B), or (g)(3)(i)(C):
(A) The family member's active duty sponsor has been assigned
permanent duty as a recruiter; as an instructor at an educational
institution, an administrator of a program, or to provide
administrative services in support of a program of instruction for the
Reserve Officers' Training Corps; as a full-time adviser to a unit of a
reserve component; or any other permanent duty designated by the
Director, TRICARE Management Activity that the Director determines is
more than 50 miles, or approximately one hour driving time, from the
nearest military treatment facility that is adequate to provide care.
(B) The family members and active duty sponsor, pursuant to the
assignment of duty described in paragraph (g)(3)(i)(A) of this section,
reside at a location designed by the Director, TRICARE Management
Activity, that the Director determines is more than 50 miles, or
approximately one hour driving time, from the nearest military medical
treatment facility that is adequate to provide care.
(c) The family member, having resided together with the active duty
sponsor while the sponsor served in an assignment described in
(g)(3)(i)(A), continues to reside at the same location after the
sponsor relocates without the family member pursuant to orders for a
permanent change of duty station, and the orders do not authorize
dependents to accompany the sponsor to the new duty station at the
expense of the United States.
(ii) A family member who is a dependent of a reserve component
member is eligible for TRICARE Prime Remote for Active Duty Family
members if he or she is eligible for CHAMPUS and meets all of the
following additional criteria:
(A) The reserve component member has been ordered to active duty
for a period of more than 30 days.
(B) The family member resides with the member.
(C) The Director, TRICARE Management Activity, determines the
residence of the reserve component member is more than 50 miles, or
approximately one hour driving time, from the nearest military medical
treatment facility that is adequate to provide care.
(D) ``Resides with'' is defined as the TRICARE Prime Remote
residence
[[Page 44884]]
address at which the family resides with the activated reservist upon
activation.
* * * * *
(o) TRICARE program enrollment procedures. There are certain
requirements pertaining to procedures for enrollment in Prime and
TRICARE Prime Remote for Active Duty Family Members. (These procedures
do not apply to active duty members, whose enrollment is mandatory).
(1) * * *
(2) Enrollment period. The following provisions apply to enrollment
periods on or after March 10, 2003.
(i) Beneficiaries who select the TRICARE Prime option or the
TRICARE Prime Remote for Active Duty Family Members option remain
enrolled for 12 months increments until: they take action to disenroll;
they are no longer eligible for enrollment in TRICARE Prime or TRICARE
Prime Remote for Active Duty Family Members; or they are disenrolled
for failure to pay required enrollment fees if applicable. For those
who remain eligible for TRICARE Prime enrollment, no later than 15 days
before the expiration date of an enrollment, the sponsor will be sent a
written notification of the pending expiration and renewal of the
TRICARE Prime enrollment. TRICARE Prime enrollments shall be
automatically renewed upon the expiration of the enrollment unless the
renewal is declined by the sponsor. Termination of enrollment for
failure to pay enrollment fees is addressed in paragraph (o)(3) of this
section.
(ii) Exceptions to the 12-month enrollment period.
(A) Beneficiaries who are eligible to enroll in TRICARE Prime but
have less than one year of TRICARE eligibility remaining.
(B) The dependents of a reservist who is called or ordered to
active duty or of a member of the National Guard who is called or
ordered to full-time federal National Guard duty for a period of more
than 30 days.
* * * * *
Dated: July 24, 2003.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 03-19453 Filed 7-30-03; 8:45 am]
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