TRICARE; Reserve and Guard Family Member Benefits, 48864-48866 [E6-13720]

Agencies

• Office of the Secretary
• DEPARTMENT OF DEFENSE

[Federal Register Volume 71, Number 162 (Tuesday, August 22, 2006)]
[Proposed Rules]
[Pages 48864-48866]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E6-13720]


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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: https://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 https://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