[Federal Register Volume 76, Number 9 (Thursday, January 13, 2011)]
[Proposed Rules]
[Pages 2290-2291]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-622]
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DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 199
[DOD-2010-HA-0094; RIN 0720-AB42]
TRICARE; Reimbursement for Travel for Specialty Care Under
Exceptional Circumstances
AGENCY: Office of the Secretary, DoD.
ACTION: Proposed rule.
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SUMMARY: This proposed rule implements section 634 of the National
Defense Authorization Act for Fiscal Year 2010 which amends Section
1074i of title 10, United States Code, to permit reimbursement for
reasonable travel expenses for active duty members of the uniformed
Services and their dependents, and accompaniment, to a specialty care
provider under such exceptional circumstances as the Secretary of
Defense may proscribe. The Department of Defense through its military
treatment facilities and its robust managed care program, TRICARE
Prime, is able to fulfill the medical needs of the majority of its
active duty members and their families. However, in some locations
where active duty members and their families live due to the duty
assignment of the member, the medical resources in the military
treatment facilities and the managed care networks may not meet all of
the specialty care needs of these members and their families within
normal access standards. Reimbursement of reasonable travel expenses
for required specialty care that is more than 100 miles from the
primary care manager's office is currently a benefit under paragraph
(a) of section 1074i, title 10, United States Code for any covered
beneficiary enrolled in the TRICARE Prime program, including the active
duty members and their dependents. However this proposed rule extends a
travel reimbursement for active duty members of the armed forces and
their families who, because of an exceptional circumstance involving
the duty assignment of the active duty member of the armed forces, are
required to travel less than 100 miles but more than 60 minutes in
drive time to access needed specialty care. This travel reimbursement
benefit is limited to those active duty members and their dependents,
and accompaniment, enrolled in Prime or TRICARE Prime Remote. The
Director, TRICARE Management Activity, shall issue procedures and
guidelines under which authorization for reimbursement of travel
expenses will be issued after verification that the member, family
member, and/or accompaniment, must travel less than 100 miles but more
than 60 minutes drive time from the military treatment facility or
their primary care manager's office to receive required specialty care.
DATES: Comments must be received on or before March 14, 2011.
ADDRESSES: You may submit comments, identified by docket number and/or
RIN number and title, by any of the following methods:
Federal eRulemaking Portal: http://www.regulations.gov.
Follow the instructions for submitting comments.
Mail: Federal Docket Management System Office, 1160
Defense Pentagon, Washington, DC 20301-1160.
Instructions: All submissions received must include the agency name
and docket number or Regulatory Information Number (RIN) for this
Federal Register document. The general policy for comments and other
submissions from members of the public is to make these submissions
available for viewing on the Internet at http://regulations.gov as they
are received without change, including any personal identifiers or
contact information.
FOR FURTHER INFORMATION CONTACT: TRICARE Policy and Operations, TRICARE
Management Activity, 5111 Leesburg Pike, Suite 810, Falls Church, VA
22041.
SUPPLEMENTARY INFORMATION:
I. Introduction and Background
The TRICARE benefit was directed by Congress in section 1097 of the
National Defense Authorization Act for Fiscal Year 1995. For further
information on TRICARE, the reader may refer to the final rule
regarding TRICARE published in the Federal Register on October 5, 1995.
Travel for Specialty Care
Managed care support contractors are required to establish adequate
networks throughout regions to complement military treatment facilities
and support TRICARE Prime and Extra. However, there are many active
duty members of the uniformed Services and their families who are
required by the member's duty assignment to live in certain more remote
areas where there are insufficient numbers or types of specialty or
subspecialty providers to provide care within normal drive-time access
standards notwithstanding the due diligence of the contractors in
developing the network around the military treatment facilities or
their diligence in finding network providers for those members or
families enrolled in TRICARE Prime Remote. Under such exceptional
circumstances as identified under procedures and guidelines issued by
the Director, TRICARE Management Activity, reasonable travel expenses
to obtained specialty care for which the enrollee has been referred may
be reimbursed. The specific location or identity of these military
treatment facilities and the specific TRICARE Prime Remote locations
and the types of specialists or sub-specialists shall be determined in
accordance with guidelines issued by the Assistant Secretary of Defense
for Health Affairs. The guidelines shall include identity of the
specific military treatment facility or TRICARE Prime Remote area,
validation by either, or both, the facility commander and/or the
Director of the TRICARE Regional Office that the specialty care
provider or category of specialty care provider required to provide
care to the active duty member and their dependents, are not available
within a 60 minute drive time, but are available within 100 miles of
the military treatment facility or primary care manager's office. The
Director of the TRICARE Regional Office shall also verify that the
Managed Care Support Contractor has used due diligence in attempting to
enroll the needed specialists who do meet the drive time specialty care
access standards, into the network. The Director, TRICARE Management
Activity shall establish and make available a list of military
treatment facilities and category of specialty providers for which
these reasonable travel expenses shall be allowed. For members, and
families, enrolled in TPR the Director shall ensure that adequate
coordination of care and travel benefits is provided to
[[Page 2291]]
those qualifying members and their families.
II. Regulatory Procedures
Executive Order 12866, ``Regulatory Planning and Review'' and Public
Law 96-354, ``Regulatory Flexibility Act'' (5 U.S.C. 601)
Executive Order 12866 requires that a comprehensive regulatory
impact analysis be performed on any economically significant regulatory
action, defined as one that would result in an annual effect of $100
million or more on the national economy or which would have other
substantial impacts. 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 a regulation
which would have a significant impact on a substantial number of small
entities. This proposed rule is not a significant regulatory action and
will not have a significant impact on a substantial number of small
entities for purposes of the RFA. Thus this proposed rule is not
subject to any of these requirements.
Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3511)
This rule will not impose additional information collection
requirements on the public.
Executive Order 13132, ``Federalism''
We have examined the impacts of the rule under Executive Order
13132 and it does not have policies that have federalism implications
that would 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.
Sec. 202, Public Law 104-4, ``Unfunded Mandates Reform Act''
This rule does not contain unfunded mandates. It does not contain a
Federal mandate that may result in the expenditure by State, local and
Tribal governments, in aggregate, or by the private sector, of $100
million or more in any one year.
List of Subjects in 32 CFR Part 199
Claims, Dental health, Health care, Health insurance, Individuals
with disabilities, Military personnel.
Accordingly, 32 CFR part 199 is proposed to be amended as follows:
PART 199--[AMENDED]
1. The authority citation for part 199 continues to read as
follows:
Authority: 5 U.S.C. 301; 10 U.S.C. chapter 55.
2. Section 199.17 is amended by revising paragraph (n)(2)(vi) to
read as follows:
Sec. 199.17 TRICARE program
* * * * *
(n) * * *
(2) * * *
(vi) In accordance with guidelines issued by the Assistant
Secretary of Defense for Health Affairs, reasonable travel expenses may
be reimbursed for a TRICARE Prime enrollee and, when an adult non-
medical attendant is necessary, for a parent or guardian of the
enrollee or another member of the enrollee's family who is at least 21
years of age. Such guidelines shall be consistent with appropriate
provisions of generally applicable Department of Defense rules and
procedures governing travel expenses. Reimbursement of reasonable
travel expenses shall be provided under the following conditions:
(A) When a Prime enrollee is referred by the primary care manager
for medically necessary specialty care more than 100 miles away from
the primary care manager's office.
(B) When an exceptional circumstance exists involving referral for
specialty care for an active duty member of the uniformed Services or a
dependent of an active duty member of the uniformed Services enrolled
in Prime or in TRICARE Prime Remote. An exceptional circumstance exists
when the enrollee is referred for medically necessary specialty care
requiring travel beyond a 60-minute drive time but within 100 miles of
the military treatment facility or the TRICARE Prime Remote primary
care manager's office. The Director, TRICARE shall issue guidelines and
procedures under which authorization of travel expenses will be issued
based on verification that a specialty care provider or specific
category of specialty care provider is not available within 60- minute
drive time but less than 100 miles from a referring military treatment
facility or TRICARE Prime Remote primary care manager's office. The
guidelines and procedures shall also include verification that the
Managed Care Support Contractor has used due diligence in attempting to
enroll into the network needed specialists who meet the normal drive
time specialty care access standards or has otherwise identified non-
network providers within the specialty care access standards to whom a
Prime enrollee may be referred without incurring point of service
costs. The Director, TRICARE may establish and make available a list of
military treatment facilities and specialty providers for each for
which these reasonable travel expenses shall be allowed and shall
ensure that members and their families enrolled in TRICARE Prime Remote
obtain assistance in receiving this benefit when appropriate.
* * * * *
Dated: January 4, 2011.
Patricia L. Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2011-622 Filed 1-12-11; 8:45 am]
BILLING CODE 5001-06-P