[Federal Register: March 16, 2009 (Volume 74, Number 49)]
[Notices]
[Page 11089-11090]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr16mr09-40]
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DEPARTMENT OF DEFENSE
Office of the Secretary
Notice of Continuation and Expansion of a Disease Management
Demonstration Project for TRICARE Standard Beneficiaries
AGENCY: Department of Defense.
ACTION: Notice of demonstration project.
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SUMMARY: This notice is to advise interested parties of the
continuation and expansion of a Military Health System (MHS)
demonstration project entitled ``Disease Management Demonstration
Project for TRICARE Standard Beneficiaries''. The original
demonstration notice was published on June 13, 2007 (72 FR 32628-32629)
and described a demonstration project to provide disease management
(DM) services to TRICARE Standard beneficiaries in addition to the
TRICARE Prime beneficiaries who were already entitled to such services.
TRICARE began the demonstration project in March 2007 for Standard
beneficiaries and this demonstration project has enabled the MHS to
provide uniform policies and practices on disease and chronic care
management throughout the TRICARE network. Additionally, the
demonstration has helped determine the effectiveness of DM programs in
improving the health status of beneficiaries with targeted
[[Page 11090]]
chronic diseases or conditions, and any associated cost savings. The
TRICARE Management Activity (TMA) chose a phased approach to determine
the efficacy and cost effectiveness of its disease management
demonstration, beginning with beneficiaries identified with the disease
states of asthma, congestive heart failure, and diabetes. TMA now
intends to expand the disease management services to TRICARE Standard
beneficiaries with the additional disease states of cancer, Chronic
Obstructive Pulmonary Disease (COPD), and anxiety and depression
disorders as well as continue the original disease states of asthma,
congestive heart failure, and diabetes. This expansion and continuation
of the DM demonstration project will be conducted under the authority
provided in 10 U.S.C. 1092.
DATES: The expansion of the demonstration will be effective April 1,
2009 and will continue for a period of 2 years until March 31, 2011.
The terms and conditions of the original demonstration notice will
continue.
FOR FURTHER INFORMATION CONTACT: Dr. Barry Cohen, Director of
Healthcare Operations--TRICARE Management Activity, 5111 Leesburg Pike,
Suite 810, Falls Church, VA 22041-3206; telephone (703) 681-4029.
SUPPLEMENTARY INFORMATION:
A. Background
For additional information on the TRICARE demonstration project for
DM, please see 72 FR 32628-32629. The demonstration notice focused on
explaining the differences between the DM benefits available to TRICARE
Standard and TRICARE Prime beneficiaries and the manner in which DM
services had been provided prior to the demonstration. The prior notice
explained that for purposes of the demonstration, the Department of
Defense (DoD) would waive, for these DM services provided to Standard
beneficiaries, the provisions of 10 U.S.C. 1079(a)(13) and 32 CFR
199.4(g)(39) that expressly exclude clinical preventive services for
TRICARE Standard beneficiaries. The prior notice also explained the
enrollment process and cap on DM costs.
B. Description of Expansion of Demonstration Project
Under this demonstration, DoD has waived, for disease management
services provided to TRICARE Standard beneficiaries, the provisions of
10 U.S.C. 1079(a)(13) and 32 CFR 199.4(g)(39) that expressly exclude
clinical preventive services for TRICARE Standard beneficiaries in the
current benefit. The Military Health System (MHS) has enrolled TRICARE
Standard beneficiaries in its DM programs. DM services provided to
Standard beneficiaries have included, but have not been limited to:
Clinical preventive examinations, patient education and counseling
services, and periodic screening exams. MHS DM program costs have been
capped not to exceed the amount approved by the contracting officer.
The DM program costs are total costs of DM services provided to both
Prime and Standard beneficiaries. Only those beneficiaries identified
by the TRICARE Management Activity (TMA) for disease management of
asthma, congestive heart failure, and diabetes have been included in
the current program. TMA is now expanding the demonstration by
including the additional disease states of cancer, COPD, and anxiety
and depression disorders. Beneficiaries identified by TMA are included
in the DM program unless they choose to opt out. This action directly
reduces variation across the system and results in improved consistency
and quality for beneficiaries with targeted chronic illness, regardless
of TRICARE classification. Furthermore, including TRICARE Standard
beneficiaries in current DM efforts informs the MHS about total
potential savings and return on investment (ROI) associated with DM, a
stated requirement of the John Warner National Defense Authorization
Act for Fiscal Year 2007. Continuing to provide the current three, and
adding the additional three diseases to the system-wide DM program,
will improve the quality of care of our beneficiaries. By educating
patients about their disease and helping them manage their symptoms,
many of the complications of these diseases can be avoided, possibly
slowing the progression of their chronic disease, thus resulting in
significant cost savings.
C. Implementation
The expansion of the demonstration will be effective on April 1,
2009. The terms and conditions of the original demonstration as
provided in the Notice in 72 FR 32368-32369 will continue on that date.
D. Evaluation
An independent evaluation of the demonstration will be conducted.
The evaluation will be designed to use a combination of administrative
and survey measures of health care outcomes (clinical, utilization,
financial, and humanistic measures) to provide analyses and comment on
meeting its goal of providing uniform disease management policies and
practices across the MHS.
Dated: March 9, 2009.
Patricia L. Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. E9-5626 Filed 3-13-09; 8:45 am]
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