[Federal Register: May 18, 2004 (Volume 69, Number 96)]
[Notices]
[Page 28124-28125]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr18my04-44]
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DEPARTMENT OF DEFENSE
Office of the Secretary
[RIN 0720-ZA05]
Office of the Secretary of Defense (Health Affairs)/TRICARE
Management Activity
AGENCY: Department of Defense.
ACTION: Notice of a TRICARE demonstration project for the State of
Alaska.
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SUMMARY: This notice is to advise interested parties of a Military
Health System (MHS) demonstration project entitled TRICARE
Demonstration Project for the State of Alaska. The delivery of health
care services in the State of Alaska represents a unique situation that
cannot be addressed fully by applying all of the at-risk standards that
apply to the health services and support contractors who provide
services in the other 49 states without some modification. Under this
demonstration, the health services and support contractor who will be
providing healthcare services for the Western Region Health Services
and Support contract will be exempt from the underwriting provisions
for the cost of civilian health care in the State of Alaska.
EFFECTIVE DATE: Effective with the start date of health care delivery
for the current TRICARE Regions September 9, 10, and 12, 2004 within
the TRICARE Management Activity Health Services and Support Contract
for the Western Region.
ADDRESSES: TRICARE Management Activity (TMA), Regional Operations
Directorate, 5111 Leesburg Pike, Suite 810, Falls Church, VA 22041-
3206.
FOR FURTHER INFORMATION CONTACT: Mr. Michael Talisnik, Office of the
Assistant Secretary of Defense (Health Affairs)--TRICARE Management
Activity, (703) 681-0064.
SUPPLEMENTARY INFORMATION:
A. Background
Alaska is a land of extremes and contradictions. It is the largest
state in the United States, containing one-fifth of all United States
land, yet is one of the least populated. It boasts both the highest
mountain in North America and the longest coastline of any state. There
are just a few major roads providing residents the ability to travel to
the major cities in the state. Other means of transportation are by
boat or plane which places severe hardships on beneficiaries attempting
to access needed healthcare services. It has geography characterized by
harsh ice islands and desert tundra, yet cradles lush meadows and rain
forests. Alaska's citizens are no less diverse.
Alaska's population is just under 627,000. Of these, approximately
71,000 are Military Health System (MHS) beneficiaries. More than half
of these beneficiaries reside in south-central Alaska in the state's
largest city--
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Anchorage. Alaska's Military Treatment Facilities (MTFs) meet a large
percentage of Alaska's beneficiary healthcare needs. The remaining is
referred to local civilian providers or to the lower 48 states.
The TRICARE Western Region health services and support contract,
which includes Alaska, requires the contractor to underwrite the costs
of civilian health care services (also referred to as ``purchased
care'') which is defined as care provided to all Civilian Health and
Medical Program of the Uniformed Services eligible beneficiaries
residing in the Western Region. The following categories of care/
beneficiaries are specifically excluded from the TRICARE Western Region
contract: Outpatient retail and mail order pharmacy; active duty
supplemental care including TRICARE Prime Remote for Service members
only (family members are underwritten by the health services and
support contractor); Continued Health Care Benefits Program; Foreign/
Outside the Continental United States claims; Medicare dual-eligible
TRICARE beneficiaries; and cancer/clinical trials.
The underwriting mechanism of TRICARE Western Region health
services and support contract consists of an underwriting fee which may
be considered to be an underwriting premium associated with the risk
assumed by the contractor. It will be subject to a fee-adjustment
formula which allows for increases or decreases inversely related to
the actual costs. There is potential of creating a negative fee.
Predicated upon the foregoing mechanism, coupled with the
environment in which healthcare services are delivered in Alaska, there
is a concern that if health care is underwritten by the Western Region
health services and support contractor, the contractor may experience
increases in actual costs for healthcare outside the control of the
contractor. This has the potential of creating an unwarranted negative
fee.
Because of this concern, the purpose of this demonstration is to
validate that the Western Region health services and support contractor
can avoid the vagaries of Alaska healthcare and the potential negative
effect that it may have on the contractor's fee, by not underwriting
these healthcare costs for Alaska beneficiaries. Under the
demonstration, the costs will be paid by the government from pass
through funds.
B. Description of Demonstration Project
Under this demonstration, the Western Region health services and
support contractor will not be responsible for the underwriting fee for
healthcare costs for MHS beneficiaries residing in Alaska. The
contractor shall provide all the Services required for Alaska as
specified in the TRICARE Operations Manual, Chapter 23, but will not be
responsible for the underwriting fee associated with providing those
Services under that chapter. All other provisions contained in the
TRICARE Health Services and Support Contract, TRICARE Operations Manual
(6010.51-M), TRICARE Policy Manual (6010.54-M), TRICARE Systems Manual
(7950.1-M), and TRICARE Reimbursement Manual (6010.55-M), shall apply
in Alaska.
I. Implementation
This demonstration will operate for up to five years after the
start of health care delivery for the TRICARE Management Activity
Health Services and Support Contract for the Western Region unless
extended by separate action. Following program evaluation, the
Department of Defense will seek permanent authority to determine
program continuation.
II. Exclusion to the Demonstration Project
Participation in this demonstration is limited to healthcare
provided in the State of Alaska.
III. Evaluation
An independent evaluation of the demonstration will be conducted
under a separate contract.
The evaluation will be designed to use a combination of
administrative and survey measures of health care access to provide
analyses and comment on the effectiveness of the demonstration in
meeting its goal of improving beneficiary access to healthcare by
maximizing the potential pool of healthcare providers in Alaska.
TRICARE beneficiaries will be asked to comment on the quality of
their experiences getting the health care that they need. It is
anticipated that the evaluation will compare the reports of TRICARE
user-beneficiaries in Alaska to those from the TRICARE region under the
administration of TriWest (West) where TriWest is responsible for
provider network development and at risk for health care costs. The
evaluation will begin at the time health care services are delivered
under TriWest administration in both regions.
All analyses will be adjusted to account for demographic
differences between these two geographic domains. It is also
anticipated that analyses will develop measures of access from data
developed in quarterly administration of the TRICARE Beneficiary
Survey. Additional administrative claims based indicators of access to
health care within the two study domains will also be considered.
Dated: May 12, 2004.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 04-11205 Filed 5-17-04; 8:45 am]
BILLING CODE 5001-06-M