[Federal Register: August 25, 2006 (Volume 71, Number 165)]
[Rules and Regulations]
[Page 50347-50349]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr25au06-11]
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DEPARTMENT OF DEFENSE
Office of the Secretary
[DoD-2006-OS-0182; 0720-AA97]
32 CFR Part 199
TRICARE Program; TRICARE Prime Remote for Active Duty Family
Members and TRICARE Prime Enrollment Period
AGENCY: Office of the Secretary, DoD.
ACTION: Final rule.
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SUMMARY: This final rule implements 10 U.S.C. 1079(p), as added by
section 722(b) of the Floyd D. Spence National Defense Authorization
Act for Fiscal Year 2001. The rule provides coverage for medical care
for active duty family members who reside with an active duty member of
the Uniformed Services assigned to remote areas and eligible for the
program known as TRICARE Prime Remote. Active duty family members who
enroll in TRICARE Prime Remote for Active Duty Family Members (TPRADFM)
will enjoy benefits generally comparable to TRICARE Prime enrollees
including access standards, benefit coverage, and cost-shares.
This final rule also implements Section 702 of the NDAA for FY
2003, which establishes circumstances under which dependents of Reserve
Components 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 may remain enrolled when the service member receives orders for
an unaccompanied follow-on assignment.
Finally, this final rule establishes circumstances under which
eligible beneficiaries may enroll in TRICARE Prime for a period of less
than 1 year.
DATES: Effective Date: This rule is effective October 24, 2006.
ADDRESSES: TRICARE Management Activity (TMA), Program Requirements
Division, 16401 East Centretech Parkway, Aurora, CO 80011-9066.
FOR FURTHER INFORMATION CONTACT: John J.M. Leininger, Program
Requirements Division, TMA, (303) 676-3613 for questions on the TPRADFM
portion of this rule. Ann Fazzini, Medical Benefits and Reimbursement
Systems, TMA, (303) 676-3803 for questions on the TRICARE Prime
Enrollment Period portion of this rule.
SUPPLEMENTARY INFORMATION:
I. Summary of Final Rule Provisions
On October 30, 2000, the Floyd D. Spence National Defense
Authorization Act (NDAA) for Fiscal Year 2001, Public Law 106-398 was
signed into law. This final rule implements section 722(b) of this Act,
which amended section 1079 of Title 10, United States Code, by adding
subsection (p). It requires a TRICARE Prime-like benefit for active
duty family members residing with their active duty Uniformed Services
sponsor eligible for TRICARE Prime Remote, as defined by section
1074(c)(3) of Title 10, United States Code. The reader should refer to
the interim final rule that was published on February 6, 2002 (67 FR
5477).
This final rule implements Section 702 of the NDAA for FY 2003,
which amended section 1079 of Title 10, United States Code, by adding
subsection (3) to subsection (p) which establishes circumstances under
which dependents of Reserve Components 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 may remain enrolled when the
service member receives orders for an unaccompanied follow-on
assignment. The reader should refer to the interim final rule that was
published on July 31, 2003 [68 FR 44882] and was effective September
29, 2003.
This final rule also establishes circumstances under which eligible
beneficiaries may enroll in TRICARE Prime for a period of less than one
year. Enrollment in TRICARE Prime normally must be for a period of one
year. Section 199.17(v), provides for the establishment of
administrative requirements and procedures to ensure reasonable
implementation and operation of the TRICARE program. Under this
authority, an exception to the one-year enrollment requirement has been
provided for Reservists and members of the National Guard who are
called or ordered to active duty for a period of 179 days or more. A
second exception has been established for those beneficiaries who are
eligible to enroll in Prime but have less than one year of TRICARE
eligibility remaining. For example, the dependents of an active duty
member may enroll in Prime even though the member has less than one
year of active duty remaining, and the
[[Page 50348]]
member will not be eligible for retirement at the end of the member's
active duty service. Refer to the interim final rule that was published
on July 31, 2003, (68 FR 44882) and was effective September 29, 2003,
for more detailed information regarding this change.
II. Public Comments
We provided a 60-day comment period on the interim final rules. We
received no public comments on any of the provisions cited in this
rule.
III. Changes in the Final Rule
The only change made to the final rule from the interim final rule
was in 199.16 (e)(3) Enrollment. For clarity, we changed ``If an
eligible active duty member does not enroll in the TRICARE Prime Remote
program'' to ``Until the active duty service member enrolls in the
TRICARE Prime Remote program''.
IV. Regulatory Procedures
Executive Order 12866 requires that a regulatory impact analysis be
performed on any economically significant rule. An economically
significant 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 final rule is not a major rule under the Congressional Review
Act, because its economic impact will be less than $100 million. The
changes set forth in this final rule are revisions to existing
regulation. The changes made in this final rule involve an expansion of
TRICARE benefits. In addition, this 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 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, Dental health, Health care, Health insurance, Individuals
with disabilities, Military personnel.
0
Accordingly, 32 CFR part 199 is amended as follows:
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 199.16 is amended by revising paragraphs (d) introductory
text and (d)(2), to read as follows:
Sec. 199.16 Supplemental Health Care Program for active duty members.
* * * * *
(d) Special rules and procedure. As exceptions to the general rule
in paragraph (c) of this section, the special rules and procedures in
this section shall govern payment and administration of claims under
the supplemental care program. These special rules and procedures are
subject to the TRICARE Prime Remote program for active duty service
members set forth in paragraph (e) of this section and the waiver
authority of paragraph (f) of this section.
* * * * *
(2) Preauthorization by the Uniformed Services of each service is
required for the supplemental care program except for services in cases
of medical emergency (for which the definition in Sec. 199.2 shall
apply) or in cases governed by the TRICARE Prime Remote program for
active duty service members set forth in paragraph (e) of this section.
It is the responsibility of the active duty members to obtain
preauthorization for each service. With respect to each emergency
inpatient admission, after such time as the emergency condition is
addressed, authorization for any proposed continued stay must be
obtained within two working days of admission.
* * * * *
0
3. Section 199.17 is amended by revising paragraphs (g) and (o)(2) to
read as follows:
Sec. 199.17 TRICARE program.
* * * * *
(g) TRICARE Prime Remote for Active Duty Family Members. (1) In
general. In geographic areas in which TRICARE Prime is not offered and
in which eligible family members reside, there is offered under 10
U.S.C. 1079(p) TRICARE Prime Remote for Active Duty Family Members as
an enrollment option. TRICARE Prime Remote for Active Duty Family
Members (TPRADFM) will generally follow the rules and procedures of
TRICARE Prime, except as provided in this paragraph (g) and otherwise
except to the extent the Director, TRICARE Management Activity
determines them to be infeasible because of the remote area.
(2) Active duty family member. For purposes of this paragraph (g),
the term ``active duty family member'' means one of the following
dependents of an active duty member of the Uniformed Services: Spouse,
child, or unmarried child placed in the legal custody of the active
duty member as a result of an order of a court of competent
jurisdiction for a period of at least 12 consecutive months.
(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 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 medical
treatment facility 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.
[[Page 50349]]
(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 address at which the family resides with the activated
reservist upon activation.
(4) Enrollment. TRICARE Prime Remote for Active Duty Family Members
requires enrollment under procedures set forth in paragraph (o) of this
section or as otherwise established by the Executive Director, TRICARE
Management Activity.
(5) Health care management requirements under TRICARE Prime Remote
for Active Duty Family Members. The additional health care management
requirements applicable to Prime enrollees under paragraph (n) of this
section are applicable under TRICARE Prime Remote for Active Duty
Family Members unless the Executive Director, TRICARE Management
Activity determines they are infeasible because of the particular
remote location. Enrollees will be given notice of the applicable
management requirements in their remote location.
(6) Cost sharing. Beneficiary cost sharing requirements under
TRICARE Prime Remote for Active Duty Family Members are the same as
those under TRICARE Prime under paragraph (m) of this section, except
that the higher point-of-service option cost sharing and deductible
shall not apply to routine primary health care services in cases in
which, because of the remote location, the beneficiary is not assigned
a primary care manager or the Executive Director, TRICARE Management
Activity determines that care from a TRICARE network provider is not
available within the TRICARE access standards under paragraph (p)(5) of
this section. The higher point-of-service option cost sharing and
deductible shall apply to specialty health care services received by
any TRICARE Prime Remote for Active Duty Family Members enrollee unless
an appropriate referral/preauthorization is obtained as required by
section (n) under TRICARE Prime. In the case of pharmacy services under
Sec. 199.21, where the Director, TRICARE Management Activity determines
that no TRICARE network retail pharmacy has been established within a
reasonable distance of the residence of the TRICARE Prime Remote for
Active Duty Family Members enrollee, cost sharing applicable to TRICARE
network retail pharmacies will be applicable to all CHAMPUS eligible
pharmacies in the remote area.
* * * * *
(o) * * *
(1) * * *
(2) Enrollment period.
(i) Beneficiaries who select the TRICARE Prime option or the
TRICARE Prime Remote for Active Duty Family Members option remain
enrolled for 12 month 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. 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: August 15, 2006.
L. M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. E6-13719 Filed 8-24-06; 8:45 am]
BILLING CODE 5001-06-P