TRICARE Program; TRICARE Prime Remote for Active Duty Family Members and TRICARE Prime Enrollment Period, 50347-50349 [E6-13719]
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Federal Register / Vol. 71, No. 165 / Friday, August 25, 2006 / Rules and Regulations
Dated: August 9, 2006.
Emil W. Henry, Jr.,
Assistant Secretary of the Treasury.
[FR Doc. E6–14180 Filed 8–24–06; 8:45 am]
be ineligible for later payment if the
Program Trigger is reached.
III. Procedural Requirements
Executive Order 12866, ‘‘Regulatory
Planning and Review’’
BILLING CODE 4811–37–P
This final rule is a significant
regulatory action and has been reviewed
by the Office of Management and
Budget under the terms of Executive
Order 12866.
Regulatory Flexibility Act
Pursuant to the Regulatory Flexibility
Act, 5 U.S.C. 601 et seq., it is hereby
certified that the final rule will not have
a significant economic impact on a
substantial number of small entities.
The final rule implements changes
prescribed or authorized by the
Extension Act. The Act itself requires all
insurers receiving direct earned
premium for any type of property and
casualty insurance, as defined in the
Extension Act, to participate in the
Program. This includes all insurers
regardless of size or sophistication. The
Extension Act also defines property and
casualty insurance to mean commercial
lines of insurance without any reference
to size or scope of the insurer or the
insured. The disclosure and ‘‘make
available’’ requirements are required by
the Act. The rule allows all insurers,
whether large or small, to use existing
systems and business practices to
demonstrate compliance. Treasury is
required to pay the Federal share of
compensation to insurers for insured
losses subject to the new Program
Trigger provisions in the Act. The
requirement that insurers seek advance
approval of certain settlements is now
required by the Act. Any economic
impact associated with the final rule
flows from the Extension Act and not
the final rule. However, the Act and the
Program are intended to provide
benefits to the U.S. economy and all
businesses, including small businesses,
by providing a federal reinsurance
backstop to commercial property and
casualty insurance policyholders and
spreading the risk of insured losses
resulting from an act of terrorism.
Accordingly, a regulatory flexibility
analysis is not required.
List of Subjects in 31 CFR Part 50
Terrorism risk insurance.
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Authority and Issuance
For the reasons set forth above, the
interim final rule revising subparts A, B,
C, F, and I of 31 CFR part 50, which was
published at 71 FR 27564 on May 11,
2006, is adopted as a final rule without
change.
I
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DEPARTMENT OF DEFENSE
Office of the Secretary
[DoD–2006–OS–0182; 0720–AA97]
32 CFR Part 199
TRICARE Program; TRICARE Prime
Remote for Active Duty Family
Members and TRICARE Prime
Enrollment Period
Office of the Secretary, DoD.
Final rule.
AGENCY:
ACTION:
SUMMARY: This final rule implements 10
U.S.C. 1079(p), as added by section
722(b) of the Floyd D. Spence National
Defense Authorization Act for Fiscal
Year 2001. The rule provides coverage
for medical care for active duty family
members who reside with an active duty
member of the Uniformed Services
assigned to remote areas and eligible for
the program known as TRICARE Prime
Remote. Active duty family members
who enroll in TRICARE Prime Remote
for Active Duty Family Members
(TPRADFM) will enjoy benefits
generally comparable to TRICARE Prime
enrollees including access standards,
benefit coverage, and cost-shares.
This final rule also implements
Section 702 of the NDAA for FY 2003,
which establishes circumstances under
which dependents of Reserve
Components and National Guard
members called to active duty in
support of contingency operations may
enroll in TRICARE Prime Remote for
Active Duty Family Members, and
dependents of TRICARE Prime Remote
service members may remain enrolled
when the service member receives
orders for an unaccompanied follow-on
assignment.
Finally, this final rule establishes
circumstances under which eligible
beneficiaries may enroll in TRICARE
Prime for a period of less than 1 year.
DATES: Effective Date: This rule is
effective October 24, 2006.
ADDRESSES: TRICARE Management
Activity (TMA), Program Requirements
Division, 16401 East Centretech
Parkway, Aurora, CO 80011–9066.
FOR FURTHER INFORMATION CONTACT: John
J.M. Leininger, Program Requirements
Division, TMA, (303) 676–3613 for
questions on the TPRADFM portion of
this rule. Ann Fazzini, Medical Benefits
PO 00000
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50347
and Reimbursement Systems, TMA,
(303) 676–3803 for questions on the
TRICARE Prime Enrollment Period
portion of this rule.
SUPPLEMENTARY INFORMATION:
I. Summary of Final Rule Provisions
On October 30, 2000, the Floyd D.
Spence National Defense Authorization
Act (NDAA) for Fiscal Year 2001, Public
Law 106–398 was signed into law. This
final rule implements section 722(b) of
this Act, which amended section 1079
of Title 10, United States Code, by
adding subsection (p). It requires a
TRICARE Prime-like benefit for active
duty family members residing with their
active duty Uniformed Services sponsor
eligible for TRICARE Prime Remote, as
defined by section 1074(c)(3) of Title 10,
United States Code. The reader should
refer to the interim final rule that was
published on February 6, 2002 (67 FR
5477).
This final rule implements Section
702 of the NDAA for FY 2003, which
amended section 1079 of Title 10,
United States Code, by adding
subsection (3) to subsection (p) which
establishes circumstances under which
dependents of Reserve Components and
National Guard members called to
active duty in support of contingency
operations may enroll in TRICARE
Prime Remote for Active Duty Family
Members, and dependents of TRICARE
Prime Remote service members may
remain enrolled when the service
member receives orders for an
unaccompanied follow-on assignment.
The reader should refer to the interim
final rule that was published on July 31,
2003 [68 FR 44882] and was effective
September 29, 2003.
This final rule also establishes
circumstances under which eligible
beneficiaries may enroll in TRICARE
Prime for a period of less than one year.
Enrollment in TRICARE Prime normally
must be for a period of one year. Section
199.17(v), provides for the
establishment of administrative
requirements and procedures to ensure
reasonable implementation and
operation of the TRICARE program.
Under this authority, an exception to
the one-year enrollment requirement
has been provided for Reservists and
members of the National Guard who are
called or ordered to active duty for a
period of 179 days or more. A second
exception has been established for those
beneficiaries who are eligible to enroll
in Prime but have less than one year of
TRICARE eligibility remaining. For
example, the dependents of an active
duty member may enroll in Prime even
though the member has less than one
year of active duty remaining, and the
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50348
Federal Register / Vol. 71, No. 165 / Friday, August 25, 2006 / Rules and Regulations
member will not be eligible for
retirement at the end of the member’s
active duty service. Refer to the interim
final rule that was published on July 31,
2003, (68 FR 44882) and was effective
September 29, 2003, for more detailed
information regarding this change.
Authority: 5 U.S.C. 301; 10 U.S.C. Chapter
55.
II. Public Comments
We provided a 60-day comment
period on the interim final rules. We
received no public comments on any of
the provisions cited in this rule.
*
III. Changes in the Final Rule
The only change made to the final
rule from the interim final rule was in
199.16 (e)(3) Enrollment. For clarity, we
changed ‘‘If an eligible active duty
member does not enroll in the TRICARE
Prime Remote program’’ to ‘‘Until the
active duty service member enrolls in
the TRICARE Prime Remote program’’.
cprice-sewell on PROD1PC66 with RULES
IV. Regulatory Procedures
Executive Order 12866 requires that a
regulatory impact analysis be performed
on any economically significant rule.
An economically significant rule is
defined as one that would result in the
annual effect on the national economy
of $100 million or more, or have other
substantial impact. 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 regulations which would
have a significant impact on a
substantial number of small entities.
This final rule is not a major rule
under the Congressional Review Act,
because its economic impact will be less
than $100 million. The changes set forth
in this final rule are revisions to existing
regulation. The changes made in this
final rule involve an expansion of
TRICARE benefits. In addition, this final
rule will have minor impact and will
not significantly affect a substantial
number of small entities. In light of the
above, no regulatory impact analysis is
required.
This final rule will not impose
additional information collection
requirements on the public under the
Paperwork Reduction Act of 1995 (44
U.S.C. Chapter 55).
List of Subjects in 32 CFR Part 199
Claims, Dental health, Health care,
Health insurance, Individuals with
disabilities, Military personnel.
I Accordingly, 32 CFR part 199 is
amended as follows:
PART 199—[AMENDED]
1. The authority citation for part 199
continues to read as follows:
I
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Jkt 208001
2. Section 199.16 is amended by
revising paragraphs (d) introductory text
and (d)(2), to read as follows:
I
§ 199.16 Supplemental Health Care
Program for active duty members.
*
*
*
*
(d) Special rules and procedure. As
exceptions to the general rule in
paragraph (c) of this section, the special
rules and procedures in this section
shall govern payment and
administration of claims under the
supplemental care program. These
special rules and procedures are subject
to the TRICARE Prime Remote program
for active duty service members set forth
in paragraph (e) of this section and the
waiver authority of paragraph (f) of this
section.
*
*
*
*
*
(2) Preauthorization by the Uniformed
Services of each service is required for
the supplemental care program except
for services in cases of medical
emergency (for which the definition in
Sec. 199.2 shall apply) or in cases
governed by the TRICARE Prime
Remote program for active duty service
members set forth in paragraph (e) of
this section. It is the responsibility of
the active duty members to obtain
preauthorization for each service. With
respect to each emergency inpatient
admission, after such time as the
emergency condition is addressed,
authorization for any proposed
continued stay must be obtained within
two working days of admission.
*
*
*
*
*
I 3. Section 199.17 is amended by
revising paragraphs (g) and (o)(2) to read
as follows:
§ 199.17
TRICARE program.
*
*
*
*
*
(g) TRICARE Prime Remote for Active
Duty Family Members. (1) In general. In
geographic areas in which TRICARE
Prime is not offered and in which
eligible family members reside, there is
offered under 10 U.S.C. 1079(p)
TRICARE Prime Remote for Active Duty
Family Members as an enrollment
option. TRICARE Prime Remote for
Active Duty Family Members
(TPRADFM) will generally follow the
rules and procedures of TRICARE
Prime, except as provided in this
paragraph (g) and otherwise except to
the extent the Director, TRICARE
Management Activity determines them
to be infeasible because of the remote
area.
(2) Active duty family member. For
purposes of this paragraph (g), the term
PO 00000
Frm 00030
Fmt 4700
Sfmt 4700
‘‘active duty family member’’ means one
of the following dependents of an active
duty member of the Uniformed Services:
Spouse, child, or unmarried child
placed in the legal custody of the active
duty member as a result of an order of
a court of competent jurisdiction for a
period of at least 12 consecutive
months.
(3) Eligibility.
(i) An active duty family member is
eligible for TRICARE Prime Remote for
Active Duty Family Members if he or
she is eligible for CHAMPUS, and, on or
after December 2, 2003 meets the
criteria of either (g)(3)(i)(A) and (B), or
(g)(3)(i)(C):
(A) The family member’s active duty
sponsor has been assigned permanent
duty as a recruiter; as an instructor at an
educational institution, an administrator
of a program, or to provide
administrative services in support of a
program of instruction for the Reserve
Officers’ Training Corps; as a full-time
adviser to a unit of a reserve component;
or any other permanent duty designated
by the Director, TRICARE Management
Activity that the Director determines is
more than 50 miles, or approximately
one hour driving time, from the nearest
military treatment facility that is
adequate to provide care.
(B) The family members and active
duty sponsor, pursuant to the
assignment of duty described in
paragraph (g)(3)(i)(A) of this section,
reside at a location designated by the
Director, TRICARE Management
Activity, that the Director determines is
more than 50 miles, or approximately
one hour driving time, from the nearest
military medical treatment facility
adequate to provide care.
(C) The family member, having
resided together with the active duty
sponsor while the sponsor served in an
assignment described in (g)(3)(i)(A),
continues to reside at the same location
after the sponsor relocates without the
family member pursuant to orders for a
permanent change of duty station, and
the orders do not authorize dependents
to accompany the sponsor to the new
duty station at the expense of the United
States.
(ii) A family member who is a
dependent of a reserve component
member is eligible for TRICARE Prime
Remote for Active Duty Family
Members if he or she is eligible for
CHAMPUS and meets all of the
following additional criteria:
(A) The reserve component member
has been ordered to active duty for a
period of more than 30 days.
(B) The family member resides with
the member.
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Federal Register / Vol. 71, No. 165 / Friday, August 25, 2006 / Rules and Regulations
(C) The Director, TRICARE
Management Activity, determines the
residence of the reserve component
member is more than 50 miles, or
approximately one hour driving time,
from the nearest military medical
treatment facility that is adequate to
provide care.
(D) ‘‘Resides with’’ is defined as the
TRICARE Prime Remote residence
address at which the family resides with
the activated reservist upon activation.
(4) Enrollment. TRICARE Prime
Remote for Active Duty Family
Members requires enrollment under
procedures set forth in paragraph (o) of
this section or as otherwise established
by the Executive Director, TRICARE
Management Activity.
(5) Health care management
requirements under TRICARE Prime
Remote for Active Duty Family
Members. The additional health care
management requirements applicable to
Prime enrollees under paragraph (n) of
this section are applicable under
TRICARE Prime Remote for Active Duty
Family Members unless the Executive
Director, TRICARE Management
Activity determines they are infeasible
because of the particular remote
location. Enrollees will be given notice
of the applicable management
requirements in their remote location.
(6) Cost sharing. Beneficiary cost
sharing requirements under TRICARE
Prime Remote for Active Duty Family
Members are the same as those under
TRICARE Prime under paragraph (m) of
this section, except that the higher
point-of-service option cost sharing and
deductible shall not apply to routine
primary health care services in cases in
which, because of the remote location,
the beneficiary is not assigned a primary
care manager or the Executive Director,
TRICARE Management Activity
determines that care from a TRICARE
network provider is not available within
the TRICARE access standards under
paragraph (p)(5) of this section. The
higher point-of-service option cost
sharing and deductible shall apply to
specialty health care services received
by any TRICARE Prime Remote for
Active Duty Family Members enrollee
unless an appropriate referral/
preauthorization is obtained as required
by section (n) under TRICARE Prime. In
the case of pharmacy services under
Sec. 199.21, where the Director,
TRICARE Management Activity
determines that no TRICARE network
retail pharmacy has been established
within a reasonable distance of the
residence of the TRICARE Prime Remote
for Active Duty Family Members
enrollee, cost sharing applicable to
TRICARE network retail pharmacies
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15:27 Aug 24, 2006
Jkt 208001
will be applicable to all CHAMPUS
eligible pharmacies in the remote area.
*
*
*
*
*
(o) * * *
(1) * * *
(2) Enrollment period.
(i) Beneficiaries who select the
TRICARE Prime option or the TRICARE
Prime Remote for Active Duty Family
Members option remain enrolled for 12
month increments until: They take
action to disenroll; they are no longer
eligible for enrollment in TRICARE
Prime or TRICARE Prime Remote for
Active Duty Family Members; or they
are disenrolled for failure to pay
required enrollment fees. For those who
remain eligible for TRICARE Prime
enrollment, no later than 15 days before
the expiration date of an enrollment, the
sponsor will be sent a written
notification of the pending expiration
and renewal of the TRICARE Prime
enrollment. TRICARE Prime
enrollments shall be automatically
renewed upon the expiration of the
enrollment unless the renewal is
declined by the sponsor. Termination of
enrollment for failure to pay enrollment
fees is addressed in paragraph (o)(3) of
this section.
(ii) Exceptions to the 12-month
enrollment period.
(A) Beneficiaries who are eligible to
enroll in TRICARE Prime but have less
than one year of TRICARE eligibility
remaining.
(B) The dependents of a Reservist who
is called or ordered to active duty or of
a member of the National Guard who is
called or ordered to full-time federal
National Guard duty for a period of
more than 30 days.
*
*
*
*
*
Dated: August 15, 2006.
L. M. Bynum,
Alternate OSD Federal Register Liaison
Officer, Department of Defense.
[FR Doc. E6–13719 Filed 8–24–06; 8:45 am]
BILLING CODE 5001–06–P
DEPARTMENT OF HOMELAND
SECURITY
Coast Guard
33 CFR Part 117
[CGD05–06–087]
RIN 1625–AA09
Drawbridge Operation Regulations;
Potomac River, Between Maryland and
Virginia
AGENCY:
PO 00000
Coast Guard, DHS.
Frm 00031
Fmt 4700
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50349
Notice of temporary deviation
from regulations.
ACTION:
SUMMARY: The Commander, Fifth Coast
Guard District, has approved a
temporary deviation from the
regulations governing the operation of
the new Woodrow Wilson Memorial (I–
95) Bridge, mile 103.8, across Potomac
River between Alexandria, Virginia and
Oxon Hill, Maryland. This deviation
allows the new drawbridge to remain
closed-to-navigation each day from 10
A.M. to 2 P.M. beginning on August 26,
2006 until and including October 24,
2006, to facilitate completion of the
Outer Loop portion for the new
Woodrow Wilson Bridge construction
project.
This deviation is effective from
10 a.m. on August 26, 2006, until 2 p.m.
on October 24, 2006.
ADDRESSES: Materials referred to in this
document are available for inspection or
copying at Commander (dpb), Fifth
Coast Guard District, Federal Building,
1st Floor, 431 Crawford Street,
Portsmouth, VA 23704–5004 between 8
a.m. and 4 p.m., Monday through
Friday, except Federal holidays. The
telephone number is (757) 398–6222.
Commander (dqb), Fifth Coast Guard
District maintains the public docket for
this temporary deviation.
FOR FURTHER INFORMATION CONTACT:
Waverly W. Gregory, Jr., Bridge
Administrator, Fifth Coast Guard
District, at (757) 398–6222.
SUPPLEMENTARY INFORMATION: In June
2006, the southernmost portion of the
bascule spans for the new Woodrow
Wilson Memorial Bridge, at mile 103.8,
across Potomac River between
Alexandria, Virginia and Oxon Hill,
Maryland was publicly placed into
service, switching I–95 Northbound
traffic onto the new Outer Loop portion
of the bridge. The newly-constructed
portion of bridge will be required to
open for vessels in accordance with the
current drawbridge operating
regulations set out in 33 CFR 117.255(c).
While the drawbridge is operational,
coordinators for the construction of the
new Woodrow Wilson Bridge Project
indicated that the bascule span s not yet
fully commissioned and the work
continues through the rigorous testing
phase. Opening the new bascule span
for a vessel at this time would take
approximately 45 minutes in a best case
scenario. This has the potential to have
a significant impact upon I–95 traffic,
especially during the 10 a.m. to 2 p.m,
bridge-opening time frame currently
available for commercial vessels, in
accordance with 33 CFR 117.255(c).
DATES:
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]]>Agencies
[Federal Register Volume 71, Number 165 (Friday, August 25, 2006)]
[Rules and Regulations]
[Pages 50347-50349]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E6-13719]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF DEFENSE
Office of the Secretary
[DoD-2006-OS-0182; 0720-AA97]
32 CFR Part 199
TRICARE Program; TRICARE Prime Remote for Active Duty Family
Members and TRICARE Prime Enrollment Period
AGENCY: Office of the Secretary, DoD.
ACTION: Final rule.
-----------------------------------------------------------------------
SUMMARY: This final rule implements 10 U.S.C. 1079(p), as added by
section 722(b) of the Floyd D. Spence National Defense Authorization
Act for Fiscal Year 2001. The rule provides coverage for medical care
for active duty family members who reside with an active duty member of
the Uniformed Services assigned to remote areas and eligible for the
program known as TRICARE Prime Remote. Active duty family members who
enroll in TRICARE Prime Remote for Active Duty Family Members (TPRADFM)
will enjoy benefits generally comparable to TRICARE Prime enrollees
including access standards, benefit coverage, and cost-shares.
This final rule also implements Section 702 of the NDAA for FY
2003, which establishes circumstances under which dependents of Reserve
Components and National Guard members called to active duty in support
of contingency operations may enroll in TRICARE Prime Remote for Active
Duty Family Members, and dependents of TRICARE Prime Remote service
members may remain enrolled when the service member receives orders for
an unaccompanied follow-on assignment.
Finally, this final rule establishes circumstances under which
eligible beneficiaries may enroll in TRICARE Prime for a period of less
than 1 year.
DATES: Effective Date: This rule is effective October 24, 2006.
ADDRESSES: TRICARE Management Activity (TMA), Program Requirements
Division, 16401 East Centretech Parkway, Aurora, CO 80011-9066.
FOR FURTHER INFORMATION CONTACT: John J.M. Leininger, Program
Requirements Division, TMA, (303) 676-3613 for questions on the TPRADFM
portion of this rule. Ann Fazzini, Medical Benefits and Reimbursement
Systems, TMA, (303) 676-3803 for questions on the TRICARE Prime
Enrollment Period portion of this rule.
SUPPLEMENTARY INFORMATION:
I. Summary of Final Rule Provisions
On October 30, 2000, the Floyd D. Spence National Defense
Authorization Act (NDAA) for Fiscal Year 2001, Public Law 106-398 was
signed into law. This final rule implements section 722(b) of this Act,
which amended section 1079 of Title 10, United States Code, by adding
subsection (p). It requires a TRICARE Prime-like benefit for active
duty family members residing with their active duty Uniformed Services
sponsor eligible for TRICARE Prime Remote, as defined by section
1074(c)(3) of Title 10, United States Code. The reader should refer to
the interim final rule that was published on February 6, 2002 (67 FR
5477).
This final rule implements Section 702 of the NDAA for FY 2003,
which amended section 1079 of Title 10, United States Code, by adding
subsection (3) to subsection (p) which establishes circumstances under
which dependents of Reserve Components and National Guard members
called to active duty in support of contingency operations may enroll
in TRICARE Prime Remote for Active Duty Family Members, and dependents
of TRICARE Prime Remote service members may remain enrolled when the
service member receives orders for an unaccompanied follow-on
assignment. The reader should refer to the interim final rule that was
published on July 31, 2003 [68 FR 44882] and was effective September
29, 2003.
This final rule also establishes circumstances under which eligible
beneficiaries may enroll in TRICARE Prime for a period of less than one
year. Enrollment in TRICARE Prime normally must be for a period of one
year. Section 199.17(v), provides for the establishment of
administrative requirements and procedures to ensure reasonable
implementation and operation of the TRICARE program. Under this
authority, an exception to the one-year enrollment requirement has been
provided for Reservists and members of the National Guard who are
called or ordered to active duty for a period of 179 days or more. A
second exception has been established for those beneficiaries who are
eligible to enroll in Prime but have less than one year of TRICARE
eligibility remaining. For example, the dependents of an active duty
member may enroll in Prime even though the member has less than one
year of active duty remaining, and the
[[Page 50348]]
member will not be eligible for retirement at the end of the member's
active duty service. Refer to the interim final rule that was published
on July 31, 2003, (68 FR 44882) and was effective September 29, 2003,
for more detailed information regarding this change.
II. Public Comments
We provided a 60-day comment period on the interim final rules. We
received no public comments on any of the provisions cited in this
rule.
III. Changes in the Final Rule
The only change made to the final rule from the interim final rule
was in 199.16 (e)(3) Enrollment. For clarity, we changed ``If an
eligible active duty member does not enroll in the TRICARE Prime Remote
program'' to ``Until the active duty service member enrolls in the
TRICARE Prime Remote program''.
IV. Regulatory Procedures
Executive Order 12866 requires that a regulatory impact analysis be
performed on any economically significant rule. An economically
significant rule is defined as one that would result in the annual
effect on the national economy of $100 million or more, or have other
substantial impact. 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 regulations
which would have a significant impact on a substantial number of small
entities.
This final rule is not a major rule under the Congressional Review
Act, because its economic impact will be less than $100 million. The
changes set forth in this final rule are revisions to existing
regulation. The changes made in this final rule involve an expansion of
TRICARE benefits. In addition, this final rule will have minor impact
and will not significantly affect a substantial number of small
entities. In light of the above, no regulatory impact analysis is
required.
This final rule will not impose additional information collection
requirements on the public under the Paperwork Reduction Act of 1995
(44 U.S.C. Chapter 55).
List of Subjects in 32 CFR Part 199
Claims, Dental health, Health care, Health insurance, Individuals
with disabilities, Military personnel.
0
Accordingly, 32 CFR part 199 is amended as follows:
PART 199--[AMENDED]
0
1. The authority citation for part 199 continues to read as follows:
Authority: 5 U.S.C. 301; 10 U.S.C. Chapter 55.
0
2. Section 199.16 is amended by revising paragraphs (d) introductory
text and (d)(2), to read as follows:
Sec. 199.16 Supplemental Health Care Program for active duty members.
* * * * *
(d) Special rules and procedure. As exceptions to the general rule
in paragraph (c) of this section, the special rules and procedures in
this section shall govern payment and administration of claims under
the supplemental care program. These special rules and procedures are
subject to the TRICARE Prime Remote program for active duty service
members set forth in paragraph (e) of this section and the waiver
authority of paragraph (f) of this section.
* * * * *
(2) Preauthorization by the Uniformed Services of each service is
required for the supplemental care program except for services in cases
of medical emergency (for which the definition in Sec. 199.2 shall
apply) or in cases governed by the TRICARE Prime Remote program for
active duty service members set forth in paragraph (e) of this section.
It is the responsibility of the active duty members to obtain
preauthorization for each service. With respect to each emergency
inpatient admission, after such time as the emergency condition is
addressed, authorization for any proposed continued stay must be
obtained within two working days of admission.
* * * * *
0
3. Section 199.17 is amended by revising paragraphs (g) and (o)(2) to
read as follows:
Sec. 199.17 TRICARE program.
* * * * *
(g) TRICARE Prime Remote for Active Duty Family Members. (1) In
general. In geographic areas in which TRICARE Prime is not offered and
in which eligible family members reside, there is offered under 10
U.S.C. 1079(p) TRICARE Prime Remote for Active Duty Family Members as
an enrollment option. TRICARE Prime Remote for Active Duty Family
Members (TPRADFM) will generally follow the rules and procedures of
TRICARE Prime, except as provided in this paragraph (g) and otherwise
except to the extent the Director, TRICARE Management Activity
determines them to be infeasible because of the remote area.
(2) Active duty family member. For purposes of this paragraph (g),
the term ``active duty family member'' means one of the following
dependents of an active duty member of the Uniformed Services: Spouse,
child, or unmarried child placed in the legal custody of the active
duty member as a result of an order of a court of competent
jurisdiction for a period of at least 12 consecutive months.
(3) Eligibility.
(i) An active duty family member is eligible for TRICARE Prime
Remote for Active Duty Family Members if he or she is eligible for
CHAMPUS, and, on or after December 2, 2003 meets the criteria of either
(g)(3)(i)(A) and (B), or (g)(3)(i)(C):
(A) The family member's active duty sponsor has been assigned
permanent duty as a recruiter; as an instructor at an educational
institution, an administrator of a program, or to provide
administrative services in support of a program of instruction for the
Reserve Officers' Training Corps; as a full-time adviser to a unit of a
reserve component; or any other permanent duty designated by the
Director, TRICARE Management Activity that the Director determines is
more than 50 miles, or approximately one hour driving time, from the
nearest military treatment facility that is adequate to provide care.
(B) The family members and active duty sponsor, pursuant to the
assignment of duty described in paragraph (g)(3)(i)(A) of this section,
reside at a location designated by the Director, TRICARE Management
Activity, that the Director determines is more than 50 miles, or
approximately one hour driving time, from the nearest military medical
treatment facility adequate to provide care.
(C) The family member, having resided together with the active duty
sponsor while the sponsor served in an assignment described in
(g)(3)(i)(A), continues to reside at the same location after the
sponsor relocates without the family member pursuant to orders for a
permanent change of duty station, and the orders do not authorize
dependents to accompany the sponsor to the new duty station at the
expense of the United States.
(ii) A family member who is a dependent of a reserve component
member is eligible for TRICARE Prime Remote for Active Duty Family
Members if he or she is eligible for CHAMPUS and meets all of the
following additional criteria:
(A) The reserve component member has been ordered to active duty
for a period of more than 30 days.
(B) The family member resides with the member.
[[Page 50349]]
(C) The Director, TRICARE Management Activity, determines the
residence of the reserve component member is more than 50 miles, or
approximately one hour driving time, from the nearest military medical
treatment facility that is adequate to provide care.
(D) ``Resides with'' is defined as the TRICARE Prime Remote
residence address at which the family resides with the activated
reservist upon activation.
(4) Enrollment. TRICARE Prime Remote for Active Duty Family Members
requires enrollment under procedures set forth in paragraph (o) of this
section or as otherwise established by the Executive Director, TRICARE
Management Activity.
(5) Health care management requirements under TRICARE Prime Remote
for Active Duty Family Members. The additional health care management
requirements applicable to Prime enrollees under paragraph (n) of this
section are applicable under TRICARE Prime Remote for Active Duty
Family Members unless the Executive Director, TRICARE Management
Activity determines they are infeasible because of the particular
remote location. Enrollees will be given notice of the applicable
management requirements in their remote location.
(6) Cost sharing. Beneficiary cost sharing requirements under
TRICARE Prime Remote for Active Duty Family Members are the same as
those under TRICARE Prime under paragraph (m) of this section, except
that the higher point-of-service option cost sharing and deductible
shall not apply to routine primary health care services in cases in
which, because of the remote location, the beneficiary is not assigned
a primary care manager or the Executive Director, TRICARE Management
Activity determines that care from a TRICARE network provider is not
available within the TRICARE access standards under paragraph (p)(5) of
this section. The higher point-of-service option cost sharing and
deductible shall apply to specialty health care services received by
any TRICARE Prime Remote for Active Duty Family Members enrollee unless
an appropriate referral/preauthorization is obtained as required by
section (n) under TRICARE Prime. In the case of pharmacy services under
Sec. 199.21, where the Director, TRICARE Management Activity determines
that no TRICARE network retail pharmacy has been established within a
reasonable distance of the residence of the TRICARE Prime Remote for
Active Duty Family Members enrollee, cost sharing applicable to TRICARE
network retail pharmacies will be applicable to all CHAMPUS eligible
pharmacies in the remote area.
* * * * *
(o) * * *
(1) * * *
(2) Enrollment period.
(i) Beneficiaries who select the TRICARE Prime option or the
TRICARE Prime Remote for Active Duty Family Members option remain
enrolled for 12 month increments until: They take action to disenroll;
they are no longer eligible for enrollment in TRICARE Prime or TRICARE
Prime Remote for Active Duty Family Members; or they are disenrolled
for failure to pay required enrollment fees. For those who remain
eligible for TRICARE Prime enrollment, no later than 15 days before the
expiration date of an enrollment, the sponsor will be sent a written
notification of the pending expiration and renewal of the TRICARE Prime
enrollment. TRICARE Prime enrollments shall be automatically renewed
upon the expiration of the enrollment unless the renewal is declined by
the sponsor. Termination of enrollment for failure to pay enrollment
fees is addressed in paragraph (o)(3) of this section.
(ii) Exceptions to the 12-month enrollment period.
(A) Beneficiaries who are eligible to enroll in TRICARE Prime but
have less than one year of TRICARE eligibility remaining.
(B) The dependents of a Reservist who is called or ordered to
active duty or of a member of the National Guard who is called or
ordered to full-time federal National Guard duty for a period of more
than 30 days.
* * * * *
Dated: August 15, 2006.
L. M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. E6-13719 Filed 8-24-06; 8:45 am]
BILLING CODE 5001-06-P
