[Federal Register: August 12, 2008 (Volume 73, Number 156)]
[Rules and Regulations]
[Page 46808-46809]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr12au08-3]
[[Page 46808]]
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DEPARTMENT OF DEFENSE
Office of the Secretary
[DoD-2006-OS-0091; RIN 0720-AB00]
32 CFR Part 199
TRICARE; Reserve and Guard Family Member Benefits
AGENCY: Office of the Secretary, DoD.
ACTION: Final rule.
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SUMMARY: This final rule implements sections 704 and 705 of the Ronald
W. Reagan National Defense Authorization Act for Fiscal Year 2005.
These provisions apply to eligible family members who become eligible
for TRICARE as a result of their Reserve Component (RC) sponsor
(including those with delayed effective date orders up to 90 days)
being called or ordered to active duty for more than 30 days in support
of a federal/contingency operation and choose to participate in TRICARE
Standard or Extra, rather than enroll in TRICARE Prime. The first
provision gives the Secretary the authority to waive the annual TRICARE
Standard (or Extra) deductible, which is set by law (10 U.S.C. 1079(b))
at $150 per individual and $300 per family ($50/$100 for families of
members in pay grades E-4 and below). The second provision gives the
Secretary the authority to increase TRICARE payments up to 115 percent
of the TRICARE maximum allowable charge, less the applicable patient
cost share if not previously waived under the first provision, for
covered inpatient and outpatient health services received from a
provider that does not participate (accept assignment) with TRICARE.
These provisions help ensure timely access to health care and maintain
clinically appropriate continuity of health care to family members of
Reservists and Guardsmen activated in support of a federal/contingency
operation; limit the out-of-pocket health care expenses for those
family members; and remove potential barriers to health care access by
Guard and Reserve families.
DATES: Effective Date: August 12, 2008.
FOR FURTHER INFORMATION CONTACT: Jody W. Donehoo, TRICARE Policy and
Operations, TRICARE Management Activity, telephone (703) 681-0039.
SUPPLEMENTARY INFORMATION:
I. Introduction and Background
A. On November 5, 2001, the Department of Defense (DoD) published
notice of a nationwide TRICARE Demonstration Project (66 FR 55928-
55930). This demonstration was conducted under the authority of 10
U.S.C. 1092. In this demonstration project, DoD addressed unreasonable
impediments to the continuity of health care encountered by certain
family members of Reservists and National Guard called to active duty
in support of a federal contingency operation for more than 30 days.
On November 12, 2003, DoD published a notice (68 FR 64087) to
extend through October 31, 2004, the demonstration project which was
scheduled to end on November 1, 2003.
On October 1, 2004, the DoD published another notice (69 FR 58895)
extending the demonstration project, previously scheduled to end on
October 31, 2004, to October 31, 2005.
On October 12, 2005, DoD published a notice (70 FR 59320) to extend
the demonstration project, previously scheduled to end on October 31,
2005, to October 31, 2007.
On June 19, 2007, the Department published a notice (72 FR 33742)
to extend the demonstration through October 31, 2008.
On April 18, 2008, the Department published a notice (73 FR 21120)
to extend the demonstration through October 31, 2009.
The continued deployment of RC members in support of Operation
Noble Eagle/Operation Enduring Freedom and Operation Iraqi Freedom
warrants making permanent the Secretary's authority to exercise certain
components of this demonstration project. Sections 704 and 705 of the
Ronald W. Reagan National Defense Authorization Act for Fiscal Year
2005 provide DoD authority to make two components of the demonstration
project permanent and amend section 1095d(a) and section 1079(h) of
Title 10, United States Code, as appropriate. In accordance with these
two statutory provisions, DoD is implementing this discretionary
authority.
B. Public Comments. The proposed rule was published in the Federal
Register on August 22, 2006 (71 FR 48864). We received no public
comments. The final rule is consistent with the proposed rule, with the
exception of two technical corrections. In the proposed rule, the
family deductible for E-4s and below was stated as $150. That amount is
incorrect. Under 10 U.S.C. 1079(b)(3), the family deductible for
dependents of E-4s and below is $100. The correct amount is reflected
in this final rule.
Also, in the proposed rule, the allowable charge authorized for
non-participating providers was described incorrectly. The proposed
rule used the phrase ``the lower of the billed amount or the applicable
balance billing limit under paragraph (j)(l)(i)(C) of this section,
less the applicable beneficiary cost share.'' The correct phrase to
describe the allowable charge authorized for non-participating
providers is ``the CMAC level as established in paragraph (j)(l)(i)(B)
of this section plus any balance billing amount up to the balance
billing limit as referred to in paragraph (j)(l)(i)(C) of this
section.'' This phrase, which is more consistent with the statutory
language, is used in this final rule.
II. Permanent Benefits Offered To Reserve Component Families
A. Waiver of deductible (paragraph 199.4(f)(2)(i)(H)). Eligible
family members of RC sponsors called or ordered to active duty for more
than 30 days in support of a federal contingency operation, who choose
to participate in TRICARE Standard, may not be responsible for paying
the annual TRICARE Standard deductible. By law, the TRICARE Standard
deductible for active duty family members is $150 per individual, $300
per family ($50/$100 for E-4s and below) each fiscal year. Exercise of
the authority to waive this annual deductible appropriately limits out-
of-pocket expenses for many Reserve and Guard family members, in
consideration of the fact that many may have already paid annual
deductibles under their civilian health plan.
B. Increased payment to providers (paragraph 199.14(j)). Executive
authority contained in this program allows an increase in TRICARE
payments up to 115 percent of the TRICARE maximum allowable charge,
less the applicable patient cost share if not previously waived under
the first provision, for inpatient and outpatient care received from a
provider that does not participate (accept assignment) under TRICARE.
This helps Reserve and Guard family members to be able to continue to
see civilian providers with whom they have established relations and
promotes access and clinically appropriate continuity of care.
III. Regulatory Procedures
Executive Order 12866 requires certain regulatory assessments for
any significant regulatory action that results in an annual effect on
the economy of $100 million or more. The Congressional Review Act
establishes certain procedures for major rules, defined as those with
similar major impacts. The Regulatory Flexibility Act (RFA) requires
that each Federal agency prepare, and make available for public
comment, a regulatory flexibility
[[Page 46809]]
analysis when the agency issues a regulation that has significant
impact on a substantial number of small entities. This final rule does
not have an annual effect on the economy of $100 million or more.
According to an independent government cost estimate, the annual cost
for both of these provisions will be less than $30 million.
This rule, however, does address a novel policy issue relating to
waiving the deductibles for one category of family member beneficiaries
and not others, as well as allowing providers who treat this same group
of beneficiaries to receive reimbursement at a higher rate than
providers who treat similar beneficiaries. Thus this rule has been
reviewed by the Office of Management and Budget under E.O. 12866.
This rule will not have a significant impact on a substantial
number of small entities for purposes of the RFA.
This rule does not contain a Federal mandate that may result in the
expenditure by State, local and tribunal governments, in aggregate, or
by the private sector, of $100 million or more in any one year.
This rule will not impose additional information collection
requirements on the public under the Paperwork Reduction Act of 1995
(44 U.S.C. 3501-3511).
We have examined the impact(s) of the final rule under Executive
Order 13132 and it does not have policies that have federalism
implications that have substantial direct effects on the States, on the
relationship between the national government and the States, or on the
distribution of power and responsibilities among the various levels of
government, therefore, consultation with State and local officials is
not required.
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 199.4 is amended by revising paragraph (f)(2)(i)(H) to read
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 or a National Guard member who is called or
ordered to fulltime federal National Guard duty for a period of more
than 30 days 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 is defined in
paragraphs (b)(2)(ii)(A) through (F) and (b)(2)(ii)(H)(1), (2), and (4)
of Sec. 199.3.
* * * * *
0
3. Section 199.14 is amended by adding paragraph (j)(1)(i)(E) to read
as follows:
Sec. 199.14 Provider reimbursement methods.
* * * * *
(j) * * *
(1) * * *
(i) * * *
(E) Special rule for certain TRICARE Standard Beneficiaries. In the
case of dependent spouse or child, as defined in paragraphs
(b)(2)(ii)(A) through (F) and (b)(2)(ii)(H)(1), (2), and (4) of Sec.
199.3, of a Reserve Component member serving on active duty pursuant to
a call or order to active duty for a period of more than 30 days in
support of a contingency operation under a provision of law referred to
in section 101(a)(13)(B) of title 10, United States Code, the Director,
TRICARE Management Activity, may authorize non-participating providers
the allowable charge to be the CMAC level as established in paragraph
(j)(l)(i)(B) of this section plus any balance billing amount up to the
balance billing limit as referred to in paragraph (j)(l)(i)(C) of this
section.
* * * * *
Dated: August 6, 2008.
Patricia L. Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. E8-18597 Filed 8-11-08; 8:45 am]
BILLING CODE 5001-06-P