TRICARE; Reserve and Guard Family Member Benefits, 46808-46809 [E8-18597]

Agencies

• Office of the Secretary
• DEPARTMENT OF DEFENSE

[Federal Register Volume 73, Number 156 (Tuesday, August 12, 2008)]
[Rules and Regulations]
[Pages 46808-46809]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E8-18597]



[[Page 46808]]

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DEPARTMENT OF DEFENSE

Office of the Secretary

[DoD-2006-OS-0091; RIN 0720-AB00]

32 CFR Part 199


TRICARE; Reserve and Guard Family Member Benefits

AGENCY: Office of the Secretary, DoD.

ACTION: Final rule.

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SUMMARY: This final rule implements sections 704 and 705 of the Ronald 
W. Reagan National Defense Authorization Act for Fiscal Year 2005. 
These provisions 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 gives 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/$100 for families of 
members in pay grades E-4 and below). The second provision gives 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 inpatient and outpatient health services received from a 
provider that does not participate (accept assignment) with TRICARE. 
These provisions 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: Effective Date: August 12, 2008.

FOR FURTHER INFORMATION CONTACT: Jody W. Donehoo, TRICARE Policy and 
Operations, TRICARE Management Activity, telephone (703) 681-0039.

SUPPLEMENTARY INFORMATION: 

I. Introduction and Background

    A. 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.
    On June 19, 2007, the Department published a notice (72 FR 33742) 
to extend the demonstration through October 31, 2008.
    On April 18, 2008, the Department published a notice (73 FR 21120) 
to extend the demonstration through October 31, 2009.
    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 is implementing this discretionary 
authority.
    B. Public Comments. The proposed rule was published in the Federal 
Register on August 22, 2006 (71 FR 48864). We received no public 
comments. The final rule is consistent with the proposed rule, with the 
exception of two technical corrections. In the proposed rule, the 
family deductible for E-4s and below was stated as $150. That amount is 
incorrect. Under 10 U.S.C. 1079(b)(3), the family deductible for 
dependents of E-4s and below is $100. The correct amount is reflected 
in this final rule.
    Also, in the proposed rule, the allowable charge authorized for 
non-participating providers was described incorrectly. The proposed 
rule used the phrase ``the lower of the billed amount or the applicable 
balance billing limit under paragraph (j)(l)(i)(C) of this section, 
less the applicable beneficiary cost share.'' The correct phrase to 
describe the allowable charge authorized for non-participating 
providers is ``the CMAC level as established in paragraph (j)(l)(i)(B) 
of this section plus any balance billing amount up to the balance 
billing limit as referred to in paragraph (j)(l)(i)(C) of this 
section.'' This phrase, which is more consistent with the statutory 
language, is used in this final rule.

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/$100 for E-4s and below) each fiscal year. Exercise of 
the authority to waive this annual deductible appropriately limits 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 
authority contained in this program allows 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 inpatient and outpatient care received from a 
provider that does not participate (accept assignment) under TRICARE. 
This helps Reserve and Guard family members to be able to continue to 
see civilian providers with whom they have established relations and 
promotes access and clinically appropriate continuity of care.

III. Regulatory Procedures

    Executive Order 12866 requires certain regulatory assessments for 
any significant regulatory action that results 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

[[Page 46809]]

analysis when the agency issues a regulation that has significant 
impact on a substantial number of small entities. This final rule does 
not have an annual effect on the economy of $100 million or more. 
According to an independent government cost estimate, the annual cost 
for both of these provisions will be less than $30 million.
    This rule, however, does address a novel policy issue 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 have a significant impact on a substantial 
number of small entities for purposes of the RFA.
    This rule does not contain a Federal mandate that may result in the 
expenditure by State, local and tribunal governments, in aggregate, or 
by the private sector, of $100 million or more in any one year.
    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 final rule under Executive 
Order 13132 and it does not have policies that have federalism 
implications that 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.


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 199.4 is 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 fulltime 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 is defined in 
paragraphs (b)(2)(ii)(A) through (F) and (b)(2)(ii)(H)(1), (2), and (4) 
of Sec.  199.3.
* * * * *

0
3. Section 199.14 is 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 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 non-participating providers 
the allowable charge to be the CMAC level as established in paragraph 
(j)(l)(i)(B) of this section plus any balance billing amount up to the 
balance billing limit as referred to in paragraph (j)(l)(i)(C) of this 
section.
* * * * *

    Dated: August 6, 2008.
Patricia L. Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. E8-18597 Filed 8-11-08; 8:45 am]
BILLING CODE 5001-06-P