[Federal Register: August 22, 2006 (Volume 71, Number 162)]
[Proposed Rules]
[Page 48864-48866]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr22au06-12]
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DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 199
[DOD-2006-OS-0091]
RIN 0720-AB00
TRICARE; Reserve and Guard Family Member Benefits
ACTION: Proposed rule.
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SUMMARY: This proposed rule would implement sections 704 and 705 of the
Ronald W. Reagan National Defense Authorization Act for Fiscal Year
2005. These provisions would 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 would provide 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/$150
for families of members in pay grades E-4 and below). The second
provision would provide 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 outpatient health services received
from a provider that does not participate (accept assignment) with
TRICARE. These provisions would 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: Written comments received at the address indicated below by
October 23, 2006.
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.
[[Page 48865]]
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 public 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: LT COL James Whitton, Strategic
Initiatives Division, TRICARE Operations, TRICARE Management Activity,
telephone (703) 681-0039.
SUPPLEMENTARY INFORMATION:
I. Introduction and Background
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. 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 proposes to implement this
discretionary authority.
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/$150 for E-4s and below) each fiscal year. Exercise of
the authority to waive this annual deductible would appropriately limit
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
of the authority contained in this program would allow 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 outpatient care received from a provider
that does not participate (acept assignment) under TRICARE. This would
help Reserve and Guard family members be able to continue to see
civilian providers with whom they would ahve established relations and
would promote access and clinically appropriate continuity of care.
III. Regulatory Procedures
Executive Order 12866 requires certain regulatory assessments for
any significant regulatory action that would result 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 analysis when the agency issues a
regulation that would have significant impact on a substantial number
of small entities. This proposed rule would not have an annual effect
on the economy of $100 million or more. An IGCE estimates the annual
cost for both of these provisions at less than $30 million.
This rule, however, does address a novel policy issues 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 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 proposed 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.
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 199.4 is proposed to be 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 full-time 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 as defined in
paragraphs (b)(2)(ii)(A) through (F) and (b)(2)(ii)(H)(1), (2), and (4)
of Sec. 199.3.
* * * * *
[[Page 48866]]
3. Section 199.14 is proposed to be 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 a 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 for non-participating
providers the allowable charge to be the lower of the billed amount or
115% of the applicable balance billing limit under paragraph
(j)(1)(i)(C) of this section, less the applicable beneficiary cost
share.
* * * * *
August 15, 2006.
L.M. Bynum,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. E6-13720 Filed 8-21-06; 8:45 am]
BILLING CODE 5001-06-P