Access to Healthcare Under the TRICARE Program for Beneficiaries of TRICARE Prime, 40680-40681 [2016-14786]
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Federal Register / Vol. 81, No. 120 / Wednesday, June 22, 2016 / Notices
DEPARTMENT OF DEFENSE
Office of the Secretary
Access to Healthcare Under the
TRICARE Program for Beneficiaries of
TRICARE Prime
Office of the Secretary,
Department of Defense.
ACTION: Notice of access to health care
standards for TRICARE Prime
beneficiaries under the TRICARE
Program.
AGENCY:
This notice is to advise
interested parties of the Military Health
System’s access to health care standards
addressed in Title 32, Code of Federal
Regulations (32 CFR), Section 199.17 for
TRICARE Prime beneficiaries under the
TRICARE Program and how the
Secretary of Defense plans to ensure that
beneficiaries under TRICARE Prime
who are seeking an appointment for
health care will obtain an appointment
within established access to health care
standards. Access to health care under
the TRICARE Program for TRICARE
Prime beneficiaries was established in
October 1995 and remains current.
ADDRESSES: Defense Health Agency,
TRICARE Health Plan, 7700 Arlington
Boulevard, Suite 5101, Falls Church,
Virginia 22042–5101.
FOR FURTHER INFORMATION CONTACT: Ms.
Michelle Graves, TRICARE Health Plan,
telephone (703) 681–0039.
SUPPLEMENTARY INFORMATION:
mstockstill on DSK3G9T082PROD with NOTICES
SUMMARY:
A. Background on Access to Health
Care for TRICARE Prime Beneficiaries
Under the TRICARE Program
Section 704 of the National Defense
Authorization Act for Fiscal Year 2016
(NDAA for FY16) requires the Secretary
of Defense to establish and publicize
access to care standards for beneficiaries
enrolled in TRICARE Prime at military
treatment facilities (MTFs) or with
civilian network providers. The
Department has already established
Prime maximum wait times and travel
distances for Prime primary and
specialty care appointments as required
by Section 704 of the NDAA for FY
2016.
Access to care standards for TRICARE
Prime enrollees have been in place since
the start of the TRICARE Prime program
in 1995. TRICARE Prime access
standards were published in a Federal
Register notice on October 5, 1995 (60
FR 52100–52101) and promulgated in
32 CFR 199.17(p)(5)(i–v). These same
standards are also disseminated
throughout the Military Health System
via Assistant Secretary of Defense
(Health Affairs) Memorandum 11–005,
VerDate Sep<11>2014
20:02 Jun 21, 2016
Jkt 238001
‘‘TRICARE Policy for Access to Care,’’
dated February 23, 2011. Finally, these
standards are incorporated by reference
in existing and future TRICARE regional
support contracts. TRICARE Prime
access to health care standards apply
regardless of the location of the
beneficiary’s primary care manager
(military treatment facility or civilian
network).
B. Description of the Health Care
Access Standards for TRICARE Prime
Beneficiaries
The health care access standards
outlined in this notice are set forth in 32
CFR 199.17(p)(5)(i–v). These access
standards remain current and in force
without any amendment to date.
Access standards. Preferred provider
networks will have attributes of size,
composition, mix of providers, and
geographical distribution so that the
networks, coupled with the MTF
capabilities, can adequately address the
health care needs of the enrollees. The
capabilities of the MTF plus preferred
provider network will meet the
following access standards with respect
to the needs of the expected number of
enrollees:
(i) Under normal circumstances,
enrollee travel time may not exceed 30
minutes from home to primary care
delivery site unless a longer time is
necessary because of the absence of
providers (including providers not part
of the network) in the area.
(ii) The wait time for an appointment
for a well-patient visit or a specialty
care referral shall not exceed four
weeks; for a routine visit, the wait time
for an appointment shall not exceed one
week; and for an urgent care visit the
wait time for an appointment shall be
within 24 hours. (The specialty care
time standard does not apply in the case
of a follow-up appointment that for
clinical reasons is specifically stated for
a later period.)
(iii) Emergency services shall be
available and accessible to handle
emergencies (and urgent care visits if
not available from other primary care
providers pursuant to paragraph
(p)(5)(ii) of 32 CFR 199.17), within the
service area 24 hours a day, seven days
a week.
(iv) The network shall include a
sufficient number and mix of board
certified specialists to meet reasonably
the anticipated needs of enrollees.
Travel time for specialty care shall not
exceed one hour under normal
circumstances, unless a longer time is
necessary because of the absence of
providers (including providers not part
of the network) in the area. This
requirement does not apply under the
PO 00000
Frm 00028
Fmt 4703
Sfmt 4703
Specialized Treatment Services
Program.
(v) Office waiting times in nonemergency circumstances shall not
exceed 30 minutes, except when
emergency care is being provided to
patients, and the normal schedule is
disrupted.
C. Description of How the Secretary of
Defense Plans To Ensure That
Beneficiaries Under TRICARE Prime
Who Are Seeking an Appointment for
Health Care Will Obtain an
Appointment Within Established
Access to Health Care Standards
In an effort to ensure TRICARE Prime
beneficiaries obtain an appointment
within access to health care standards at
an MTF, the Military Health System
implemented a first-call resolution
policy in calendar year 2015. This
policy outlines standard processes to
ensure TRICARE Prime beneficiaries are
not asked to call back to the MTFs if no
appointments are available within the
established access to health care
standards. The policy also identifies
responsibilities of MTF Directors,
primary care, specialist care and other
stakeholders identified in the
appointing process to ensure patient
satisfaction for our beneficiaries. The
policy outlines specific procedures to
correctly transfer calls in accordance
with existing access to care standards,
referral management protocols and
proper use of managing clinic schedules
to ensure appointing success the first
time one of our beneficiaries seeks
access. In addition, a Joint Outpatient
Experience Survey will be used to
measure the impact of the first-call
resolution policy from beneficiaries’
perspectives on whether they obtained
an appointment within health care
access standards.
For those TRICARE Prime
beneficiaries seeking an appointment
with a TRICARE Prime civilian network
provider, if the beneficiary cannot be
scheduled for a visit in the MTF or
TRICARE Prime network within the
access to care standards, the beneficiary
will be authorized an out-of-network
provider visit with no point-of-service
charge. The TRICARE Reimbursement
Manual will be revised to reflect the
above statement. In addition, as stated
in the TRICARE Operations Manual
(TOM Chapter 1, Section 3, Paragraph
1.0), ‘‘Contractors are charged with
providing or arranging for delivery of
quality, timely health care services and
have the responsibility for providing the
timely and accurate processing of all
claims received into their custody,
whether for network or non-network
care.’’
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Federal Register / Vol. 81, No. 120 / Wednesday, June 22, 2016 / Notices
D. Communications
The Defense Health Agency will post
the TRICARE Prime access to care
standards on the TRICARE.mil Web site
and execute a strategic communication
plan to educate beneficiaries enrolled in
TRICARE Prime about the access to care
standards.
Dated: June 17, 2016.
Aaron Siegel,
Alternate OSD Federal Register Liaison
Officer, Department of Defense.
[FR Doc. 2016–14786 Filed 6–21–16; 8:45 am]
BILLING CODE 5001–06–P
DEPARTMENT OF DEFENSE
Department of the Army, Corps of
Engineers
Public Notice of Intent for Studies and
Initial Scoping Meeting for Gulf
Intracoastal Waterway Brazos River
Floodgates and Colorado River Locks
Feasibility Study
Department of the Army, U.S.
Army Corps of Engineers, DoD.
ACTION: Notice of intent and public
scoping meeting.
AGENCY:
This notice provides a
summary of the ongoing feasibility
study activities for the Gulf Intracoastal
Waterway (GIWW) Brazos River
Floodgates (BRFG) and Colorado River
Locks (CRL) Feasibility Study and
solicit public input regarding the study.
The objective of the feasibility study is
to investigate and recommend solutions
to improve traffic safety and navigation
efficiencies at the confluence of the
GIWW with the BRFG and CRL. The
GIWW BRFG/CRL Feasibility Study will
identify and evaluate possible structural
and navigation alternatives to reduce
traffic accidents and navigation delays.
The non-Federal sponsor for the project
is the Texas Department of
Transportation (TXDOT).
DATES: The Galveston District will hold
the Initial Public Scoping Meeting for
the Feasibility Phase of the study on
July 12, 2016 from 6:00–8:00 p.m.
ADDRESSES: The meeting will be held at
the West Columbia Civic Center, 516 E.
Brazos Ave. (State Highway 35), West
Columbia, TX 77486.
FOR FURTHER INFORMATION CONTACT:
Franchelle Craft, (409) 766–3187.
SUPPLEMENTARY INFORMATION:
Study Background. In 2000, the
Galveston District completed a
reconnaissance study to assess the
feasibility of modifying the
configurations of the BRFG and CRL to
reduce traffic accidents and delays. The
mstockstill on DSK3G9T082PROD with NOTICES
SUMMARY:
VerDate Sep<11>2014
20:02 Jun 21, 2016
Jkt 238001
study resulted in the determination that
there was Federal interest in continuing
to the feasibility phase of the study.
Funding for the feasibility phase of the
study was approved in Fiscal Year 2016.
Recognizing the hydrologic connectivity
of the GIWW system, the decision was
made to conduct the assessment of the
BRFG and CRL separately and combine
the results into one integrated feasibility
report.
Navigation along the GIWW is
constrained at the confluence with the
BRFG and the CRL resulting in the
following conditions:
• Inadequate channel and crossing
widths for modern vessels;
• Outdated floodgate construction
and width in the floodgate chambers at
the Brazos River;
• Outdated lock construction at the
Colorado River leading to mechanical
failure;
• Shutdown of operations during
high water periods presenting a
significant security concern;
• Increased hydrology (river flows
due to flood events) impacting
navigation traffic;
• Increased operations and
maintenance costs to prevent marine
buildup on mechanical elements of the
structures;
• Increased sedimentation at the
mouth of the rivers;
• Shoreline erosion.
The Feasibility Study will assess the
conditions identified above and develop
specific measures/alternatives that can
be combined or used as standalone
actions to address the problems at each
location.
Study Process. During the feasibility
phase, detailed engineering, hydrology,
economic analysis, and environmental
studies are performed. The goal of the
feasibility phase is to find the most costeffective solution that responds to the
problems identified above while
protecting the Nation’s environment.
The final feasibility report documents
the study results and findings, the
selection process of the recommended
alternative, and the costs and benefits of
the recommended plan. The feasibility
study ends when the report is submitted
to Congress for authorization.
Study Status. The Feasibility study
will reevaluate the proposed
alternatives identified in the 2000
Reconnaissance Study to determine the
feasibility of undertaking modifications
to the Brazos and Colorado river
crossings, as well as identify changes to
the floodgate and lock structures at each
location that are economically and
environmentally justified. There is a
need to reduce navigation impacts and
costly waterborne traffic delays that are
PO 00000
Frm 00029
Fmt 4703
Sfmt 9990
40681
a result of aging infrastructure and
inadequate channel dimensions for
modern vessels. Alternatives to be
evaluated in the feasibility phase
include:
• Moving the gates away from the
river;
• Widening the gates;
• Reconfiguring the guide wall to
lessen the angle to the GIWW;
• Straightening the crossing at the
Brazos and Colorado Rivers;
• Lock modifications (construction of
new locks);
• Removal of floodgates; and/or;
• Some combination of these and
other measures.
Meeting. The Galveston District will
hold the Initial Public Scoping Meeting
for the Feasibility Phase on July 12,
2016 from 6:00–8:00 p.m. at the West
Columbia Civic Center. The purpose of
the meeting will be to inform the
community about the proposed
navigation modification project, present
how the study will be conducted, solicit
public input regarding the initial scope
of potential issues/alternatives to be
addressed, and identify those issues/
alternatives that should be analyzed
further, or eliminated, based on their
significance and effects on the
environment. The information from the
public meeting will be used in the
development of an Environmental
Impact Statement in compliance with
the National Environmental Policy Act
(NEPA) requirements. This notice serves
as an invitation for the public to attend.
The public will be provided an
opportunity for questions and
comments.
We are soliciting comments/concerns
on the opportunities to improve
navigation along the GIWW at the
Brazos and Colorado Rivers, the
identification of resources that may
occur within the study area, and other
social, economic, and environmental
concerns.
All interested parties are invited to
provide input to this study. Please send
your comments or questions regarding
this notice or mailing list updates to
USACE SWG, 2000 Ft. Point Rd.,
Galveston, TX 77550. Written input can
also be submitted and is requested by
August 11, 2016. If we can provide
further information, contact the project
manager, Ms. Franchelle Craft, by phone
at (409) 766–3187 or by email at
franchelle.e.craft@usace.army.mil.
Eric W. Verwers,
Director, Regional Planning and
Environmental Center.
[FR Doc. 2016–14694 Filed 6–21–16; 8:45 am]
BILLING CODE 3720–58–P
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]]>Agencies
[Federal Register Volume 81, Number 120 (Wednesday, June 22, 2016)]
[Notices]
[Pages 40680-40681]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-14786]
[[Page 40680]]
-----------------------------------------------------------------------
DEPARTMENT OF DEFENSE
Office of the Secretary
Access to Healthcare Under the TRICARE Program for Beneficiaries
of TRICARE Prime
AGENCY: Office of the Secretary, Department of Defense.
ACTION: Notice of access to health care standards for TRICARE Prime
beneficiaries under the TRICARE Program.
-----------------------------------------------------------------------
SUMMARY: This notice is to advise interested parties of the Military
Health System's access to health care standards addressed in Title 32,
Code of Federal Regulations (32 CFR), Section 199.17 for TRICARE Prime
beneficiaries under the TRICARE Program and how the Secretary of
Defense plans to ensure that beneficiaries under TRICARE Prime who are
seeking an appointment for health care will obtain an appointment
within established access to health care standards. Access to health
care under the TRICARE Program for TRICARE Prime beneficiaries was
established in October 1995 and remains current.
ADDRESSES: Defense Health Agency, TRICARE Health Plan, 7700 Arlington
Boulevard, Suite 5101, Falls Church, Virginia 22042-5101.
FOR FURTHER INFORMATION CONTACT: Ms. Michelle Graves, TRICARE Health
Plan, telephone (703) 681-0039.
SUPPLEMENTARY INFORMATION:
A. Background on Access to Health Care for TRICARE Prime Beneficiaries
Under the TRICARE Program
Section 704 of the National Defense Authorization Act for Fiscal
Year 2016 (NDAA for FY16) requires the Secretary of Defense to
establish and publicize access to care standards for beneficiaries
enrolled in TRICARE Prime at military treatment facilities (MTFs) or
with civilian network providers. The Department has already established
Prime maximum wait times and travel distances for Prime primary and
specialty care appointments as required by Section 704 of the NDAA for
FY 2016.
Access to care standards for TRICARE Prime enrollees have been in
place since the start of the TRICARE Prime program in 1995. TRICARE
Prime access standards were published in a Federal Register notice on
October 5, 1995 (60 FR 52100-52101) and promulgated in 32 CFR
199.17(p)(5)(i-v). These same standards are also disseminated
throughout the Military Health System via Assistant Secretary of
Defense (Health Affairs) Memorandum 11-005, ``TRICARE Policy for Access
to Care,'' dated February 23, 2011. Finally, these standards are
incorporated by reference in existing and future TRICARE regional
support contracts. TRICARE Prime access to health care standards apply
regardless of the location of the beneficiary's primary care manager
(military treatment facility or civilian network).
B. Description of the Health Care Access Standards for TRICARE Prime
Beneficiaries
The health care access standards outlined in this notice are set
forth in 32 CFR 199.17(p)(5)(i-v). These access standards remain
current and in force without any amendment to date.
Access standards. Preferred provider networks will have attributes
of size, composition, mix of providers, and geographical distribution
so that the networks, coupled with the MTF capabilities, can adequately
address the health care needs of the enrollees. The capabilities of the
MTF plus preferred provider network will meet the following access
standards with respect to the needs of the expected number of
enrollees:
(i) Under normal circumstances, enrollee travel time may not exceed
30 minutes from home to primary care delivery site unless a longer time
is necessary because of the absence of providers (including providers
not part of the network) in the area.
(ii) The wait time for an appointment for a well-patient visit or a
specialty care referral shall not exceed four weeks; for a routine
visit, the wait time for an appointment shall not exceed one week; and
for an urgent care visit the wait time for an appointment shall be
within 24 hours. (The specialty care time standard does not apply in
the case of a follow-up appointment that for clinical reasons is
specifically stated for a later period.)
(iii) Emergency services shall be available and accessible to
handle emergencies (and urgent care visits if not available from other
primary care providers pursuant to paragraph (p)(5)(ii) of 32 CFR
199.17), within the service area 24 hours a day, seven days a week.
(iv) The network shall include a sufficient number and mix of board
certified specialists to meet reasonably the anticipated needs of
enrollees. Travel time for specialty care shall not exceed one hour
under normal circumstances, unless a longer time is necessary because
of the absence of providers (including providers not part of the
network) in the area. This requirement does not apply under the
Specialized Treatment Services Program.
(v) Office waiting times in non-emergency circumstances shall not
exceed 30 minutes, except when emergency care is being provided to
patients, and the normal schedule is disrupted.
C. Description of How the Secretary of Defense Plans To Ensure That
Beneficiaries Under TRICARE Prime Who Are Seeking an Appointment for
Health Care Will Obtain an Appointment Within Established Access to
Health Care Standards
In an effort to ensure TRICARE Prime beneficiaries obtain an
appointment within access to health care standards at an MTF, the
Military Health System implemented a first-call resolution policy in
calendar year 2015. This policy outlines standard processes to ensure
TRICARE Prime beneficiaries are not asked to call back to the MTFs if
no appointments are available within the established access to health
care standards. The policy also identifies responsibilities of MTF
Directors, primary care, specialist care and other stakeholders
identified in the appointing process to ensure patient satisfaction for
our beneficiaries. The policy outlines specific procedures to correctly
transfer calls in accordance with existing access to care standards,
referral management protocols and proper use of managing clinic
schedules to ensure appointing success the first time one of our
beneficiaries seeks access. In addition, a Joint Outpatient Experience
Survey will be used to measure the impact of the first-call resolution
policy from beneficiaries' perspectives on whether they obtained an
appointment within health care access standards.
For those TRICARE Prime beneficiaries seeking an appointment with a
TRICARE Prime civilian network provider, if the beneficiary cannot be
scheduled for a visit in the MTF or TRICARE Prime network within the
access to care standards, the beneficiary will be authorized an out-of-
network provider visit with no point-of-service charge. The TRICARE
Reimbursement Manual will be revised to reflect the above statement. In
addition, as stated in the TRICARE Operations Manual (TOM Chapter 1,
Section 3, Paragraph 1.0), ``Contractors are charged with providing or
arranging for delivery of quality, timely health care services and have
the responsibility for providing the timely and accurate processing of
all claims received into their custody, whether for network or non-
network care.''
[[Page 40681]]
D. Communications
The Defense Health Agency will post the TRICARE Prime access to
care standards on the TRICARE.mil Web site and execute a strategic
communication plan to educate beneficiaries enrolled in TRICARE Prime
about the access to care standards.
Dated: June 17, 2016.
Aaron Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2016-14786 Filed 6-21-16; 8:45 am]
BILLING CODE 5001-06-P
