[Code of Federal Regulations]
[Title 32, Volume 5]
[Revised as of July 1, 2005]
From the U.S. Government Printing Office via GPO Access
[CITE: 32CFR732.17]

[Page 355-357]
 
                       TITLE 32--NATIONAL DEFENSE
 
                   CHAPTER VI--DEPARTMENT OF THE NAVY
 
PART 732_NONNAVAL MEDICAL AND DENTAL CARE--Table of Contents
 
         Subpart B_Medical and Dental Care From Nonnaval Sources
 
Sec. 732.17  Nonemergency care requirements.

    Members are cautioned not to obtain nonemergency care from civilian 
sources without prior approval from the cognizant adjudication authority 
in Sec. 732.20. Obtaining nonemergency care, other than as specified 
herein, without documented prior approval may result in denial by the 
Government of responsibility for claims arising from such care.
    (a) Individual prior approval. (1) Submit requests for prior 
approval of nonemergency care (medical, dental, or maternity) from non-
Federal sources to the adjudication authority (Sec. 732.20) serving the 
geographic area where care is to be obtained. When the requirements of 
Sec. 732.14(d)(2) are met and spectacles have been obtained, request 
after-the-fact approval per this paragraph.
    (2) Submit requests on a NAVMED 6320/10. Statement of Civilian 
Medical/Dental Care, with blocks 1 through 7 and 19 through 25 
completed. Assistance in completing the NAVMED 6320/10 can be obtained 
from the health benefits advisor (HBA) at the nearest USMTF.
    (3) Upon receipt, the adjudication authority will review the request 
and, if necessary, forward it to the appropriate chief of service with 
an explanation of non-Federal care regulations pertaining to the 
request. The chief of service will respond to the request within 24 
hours. The adjudication authority will then complete blocks 26 and 27, 
and return the original of the approved/disapproved NAVMED 6320/10 to 
the member.
    (b) Blanket prior approval. (1) Recruiting offices and other 
activities far removed from USMTFs, uniformed services dental treatment 
facilities (USDTFs), designated USTFs, and VA facilities may request 
blanket approval for civilian medical and dental care of assigned active 
duty personnel. Letter requests should be submitted to the adjudication 
authority (Sec. 732.20) assigned responsibility for the geographic area 
of the requestor.
    (2) With full realization that such blanket approval is an 
authorization to obligate the Government without individual prior 
approval, adjudication authorities will ensure that:
    (i) Each blanket approval letter specifies a maximum dollar amount 
allowable in each instance of care.
    (ii) The location of the activity receiving blanket approval 
authority is clearly delineated.
    (iii) Travel distance and time required to reach the nearest USMTF, 
USDTF, designated USTF, or VA facility have been considered.
    (iv) Certain conditions are specifically excluded, e.g., psychiatric 
care and elective surgical procedures. These conditions will continue to 
require individual prior approval.
    (v) COMNAVMEDCOM (MEDCOM-333) is made an information addressee on 
each letter of authorization.

[[Page 356]]

    (c) Maternity care. (1) Pregnant active duty members residing 
outside Military Health Services System (MHSS) inpatent catchment areas 
of uniformed services facilities (including USTFs), designated in 
Volumes I, II, and III of MHSS Catchment Area Directories, are permitted 
to choose whether to deliver in a closer civilian hospital or travel to 
a USMTF or USTF for delivery. If the Government is to assume financial 
responsibility for non-Federal maternity care of any member regardless 
of where she resides, the member must obtain individual prior approval 
as outlined in paragraph (a) of this section. Adjudication authorities 
should not approve requests from members residing within an inpatient 
MHSS catchment area unless:
    (i) Capability does not (did not) exist at the USMTF or other 
Federal MTF serving her catchment area.
    (ii) An emergency situation necessitated delivery or other treatment 
in a non-Federal facility (Sec. 732.16(b)).
    (2) Normal delivery at or near the expected delivery date should not 
be considered an emergency for members residing within an MHSS inpatient 
catchment area where delivery was expected to occur and, unless provided 
for in this part, will not be reason for delivery in a civilian facility 
at Government expense.
    (3) When granted leave that spans the period of an imminent 
delivery, the pregnant member should request a copy of her complete 
prenatal care records from the prenatal care physician. The physician 
should note in the record whether the member is clear to travel. If 
receiving prenatel care from a USMTF, the HBA will assist the member in 
obtaining a statement bearing the name of the MTF (may be an OMA) with 
administrative responsibility for the geographic area of her leave 
address, including the telephone number of the head of the patient 
administration department or HBA, if available. If a member is receiving 
prenatal care from other than a USMTF, she should avail herself of the 
services of the nearest HBA to effect the aforestated services. This 
statement should be attached to the approved leave request. In normal 
deliveries, requests for after-the-fact approval should be denied when 
members have not attempted to adhere to the provisions of this part.
    (4) Upon arrival at the designated leave address, members should 
contact the MTF indicated on the statement attached to their leave 
request. The MTF will make a determination whether the member's leave 
address falls within the inpatient catchment area of a USMTF or USTF 
with the capability of providing needed care. If no such USMTF or USTF 
exists, the member will be given the opportunity to choose to deliver in 
a civilian hospital closer to her leave address or travel to the most 
accessible USMTF or USTF with capability for maternity care.
    (5) Upon determination that civilian sources will be used for 
maternity care, the MTF listed on the attachment to the leave papers 
will inform the member that she (or someone acting in her behalf) must 
notify that MTF of the member's admission for delivery or other 
inpatient care so that medical cognizance can be initiated.
    (6) Automatically grant prior or retroactive approval, as the 
situation warrants, to members requiring maternity care while in a 
travel status in the execution of permanent change of station (PCS) 
orders.
    (d) Nonemergency care without prior approval. (1) If it becomes 
known that a member intends to seek medical or dental care (inpatient or 
outpatient) from a non-Federal source and prior approval has not been 
granted for the use of the Nonnaval Medical and Dental Care Program, the 
member must be counseled by, or in the presence of, a Medical Department 
officer. Request that the member sign a statement on an SF 600, 
Chronological Record of Medical Care, or an SF 603 or 603A, Health 
Record, Dental as appropriate, for inclusion in the member's Health 
Record. The statement must specify that counseling has been 
accomplished, and that the member understands the significance of 
receiving unauthorized civilian care. This must be accomplished when 
either personal funds or third party payor (insurance) funds are 
intended to be used to defray the cost of care. Counseling will include:
    (i) Availability of care from a Federal source.

[[Page 357]]

    (ii) The requirement for prior approval if the Government may be 
expected to defray any of the cost of such care.
    (iii) Information regarding possible compromise of disability 
benefits should a therapeutic misadventure occur.
    (iv) Notification that should hospitalization become necessary, or 
other time is lost from the member's place of duty, such lost time may 
be chargeable as ``ordinary leave.''
    (v) Notification that the Government cannot be responsible for out-
of-pocket expenses which may be required by the insurance carrier or 
when the member does not have insurance which covers the cost of 
contemplated care.
    (vi) Direction to report to a uniformed services medical officer 
(preferably Navy) upon completion of treatment for determination of 
member's fitness for continued service.
    (2) If it becomes known that a member has already received non-
Federal medical care without prior authorization, refer the member to a 
uniformed services medical officer (preferably Navy) to determine 
fitness for continued service. At this time, counseling measures 
delineated in paragraph (d)(1)(iii), (iv), and (v) of this section must 
be taken.