TRICARE Final Rule

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Table Of Contents


I. Introduction

II. Overview Of TRICARE

III. Provisions of the TRICARE Final Rule

  1. Establishment of the TRICARE Program (section 199.17(a)).
  2. Triple option (section 199.17(b)).
  3. Eligibility for Enrollment in Prime (section 199.17(c)).
  4. Health benefits under Prime (section 199.17(d)).
  5. Health benefits under Extra (section 199.17(e)).
  6. Health benefits under Standard (section 199.17(f)).
  7. Coordination with other health care programs (section 199.17(g)).
  8. Resource sharing agreements (section 199.17(h)).
  9. Health Care Finder (section 199.17(i)).
  10. General quality assurance, utilization review, and preauthorization requirements (section 199.17(j)).
  11. Pharmacy services, including special services in base realignment and closure sites (section 199.17(k)).
  12. PRIMUS and NAVCARE Clinics (section 199.17(l)).
  13. Consolidated schedule of beneficiary charges (section 199.17(m)).
  14. Additional health care management requirements under Prime (section 199.17(n).
  15. Enrollment Procedures (section 199.17(o)).
  16. Civilian Preferred Provider Networks (section 199.17(p)).
  17. Preferred Provider Network Establishment under Any Qualified Provider Method (section 199.17(q)).
  18. General fraud, abuse, and conflict of interest requirements under TRICARE Program (section 199.17(r)).
  19. Partial Implementation of TRICARE (section 199.17(s)).
  20. Inclusion of Veterans Hospitals in TRICARE Networks (section 199.17(t)).
  21. Cost sharing of care for family members of active duty members in overseas locations (section 199.17(u)).
  22. Administrative procedures (section 199.17(v)).
New Chapter 18-Uniform HMO Benefit Option
  1. In general (section 199.18(a)).
  2. Benefits covered under the Uniform HMO Benefit option (section 199.18(b)).
  3. Deductibles, fees, and cost sharing under the HMO Benefit option (sections 199.18(c) through (f)).
Other Regulatory Changes
  1. Nonavailability Statements (revisions to sections 199.4(a)(9) and 199.15)
  2. Participating Provider Program (revisions to 199.14).
  3. Administrative Linkages of Medical Necessity Determinations and Nonavailability Statement Issuance (revisions to 199.4(a)(9)(vii) and 199.15)
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