Notice of Continuation and Expansion of a Disease Management Demonstration Project for TRICARE Standard Beneficiaries, 11089-11090 [E9-5626]

Agencies

• Office of the Secretary
• DEPARTMENT OF DEFENSE

[Federal Register Volume 74, Number 49 (Monday, March 16, 2009)]
[Notices]
[Pages 11089-11090]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E9-5626]


=======================================================================
-----------------------------------------------------------------------

DEPARTMENT OF DEFENSE

Office of the Secretary


Notice of Continuation and Expansion of a Disease Management 
Demonstration Project for TRICARE Standard Beneficiaries

AGENCY: Department of Defense.

ACTION: Notice of demonstration project.

-----------------------------------------------------------------------

SUMMARY: This notice is to advise interested parties of the 
continuation and expansion of a Military Health System (MHS) 
demonstration project entitled ``Disease Management Demonstration 
Project for TRICARE Standard Beneficiaries''. The original 
demonstration notice was published on June 13, 2007 (72 FR 32628-32629) 
and described a demonstration project to provide disease management 
(DM) services to TRICARE Standard beneficiaries in addition to the 
TRICARE Prime beneficiaries who were already entitled to such services. 
TRICARE began the demonstration project in March 2007 for Standard 
beneficiaries and this demonstration project has enabled the MHS to 
provide uniform policies and practices on disease and chronic care 
management throughout the TRICARE network. Additionally, the 
demonstration has helped determine the effectiveness of DM programs in 
improving the health status of beneficiaries with targeted

[[Page 11090]]

chronic diseases or conditions, and any associated cost savings. The 
TRICARE Management Activity (TMA) chose a phased approach to determine 
the efficacy and cost effectiveness of its disease management 
demonstration, beginning with beneficiaries identified with the disease 
states of asthma, congestive heart failure, and diabetes. TMA now 
intends to expand the disease management services to TRICARE Standard 
beneficiaries with the additional disease states of cancer, Chronic 
Obstructive Pulmonary Disease (COPD), and anxiety and depression 
disorders as well as continue the original disease states of asthma, 
congestive heart failure, and diabetes. This expansion and continuation 
of the DM demonstration project will be conducted under the authority 
provided in 10 U.S.C. 1092.

DATES: The expansion of the demonstration will be effective April 1, 
2009 and will continue for a period of 2 years until March 31, 2011. 
The terms and conditions of the original demonstration notice will 
continue.

FOR FURTHER INFORMATION CONTACT: Dr. Barry Cohen, Director of 
Healthcare Operations--TRICARE Management Activity, 5111 Leesburg Pike, 
Suite 810, Falls Church, VA 22041-3206; telephone (703) 681-4029.

SUPPLEMENTARY INFORMATION:

A. Background

    For additional information on the TRICARE demonstration project for 
DM, please see 72 FR 32628-32629. The demonstration notice focused on 
explaining the differences between the DM benefits available to TRICARE 
Standard and TRICARE Prime beneficiaries and the manner in which DM 
services had been provided prior to the demonstration. The prior notice 
explained that for purposes of the demonstration, the Department of 
Defense (DoD) would waive, for these DM services provided to Standard 
beneficiaries, the provisions of 10 U.S.C. 1079(a)(13) and 32 CFR 
199.4(g)(39) that expressly exclude clinical preventive services for 
TRICARE Standard beneficiaries. The prior notice also explained the 
enrollment process and cap on DM costs.

B. Description of Expansion of Demonstration Project

    Under this demonstration, DoD has waived, for disease management 
services provided to TRICARE Standard beneficiaries, the provisions of 
10 U.S.C. 1079(a)(13) and 32 CFR 199.4(g)(39) that expressly exclude 
clinical preventive services for TRICARE Standard beneficiaries in the 
current benefit. The Military Health System (MHS) has enrolled TRICARE 
Standard beneficiaries in its DM programs. DM services provided to 
Standard beneficiaries have included, but have not been limited to: 
Clinical preventive examinations, patient education and counseling 
services, and periodic screening exams. MHS DM program costs have been 
capped not to exceed the amount approved by the contracting officer. 
The DM program costs are total costs of DM services provided to both 
Prime and Standard beneficiaries. Only those beneficiaries identified 
by the TRICARE Management Activity (TMA) for disease management of 
asthma, congestive heart failure, and diabetes have been included in 
the current program. TMA is now expanding the demonstration by 
including the additional disease states of cancer, COPD, and anxiety 
and depression disorders. Beneficiaries identified by TMA are included 
in the DM program unless they choose to opt out. This action directly 
reduces variation across the system and results in improved consistency 
and quality for beneficiaries with targeted chronic illness, regardless 
of TRICARE classification. Furthermore, including TRICARE Standard 
beneficiaries in current DM efforts informs the MHS about total 
potential savings and return on investment (ROI) associated with DM, a 
stated requirement of the John Warner National Defense Authorization 
Act for Fiscal Year 2007. Continuing to provide the current three, and 
adding the additional three diseases to the system-wide DM program, 
will improve the quality of care of our beneficiaries. By educating 
patients about their disease and helping them manage their symptoms, 
many of the complications of these diseases can be avoided, possibly 
slowing the progression of their chronic disease, thus resulting in 
significant cost savings.

C. Implementation

    The expansion of the demonstration will be effective on April 1, 
2009. The terms and conditions of the original demonstration as 
provided in the Notice in 72 FR 32368-32369 will continue on that date.

D. Evaluation

    An independent evaluation of the demonstration will be conducted. 
The evaluation will be designed to use a combination of administrative 
and survey measures of health care outcomes (clinical, utilization, 
financial, and humanistic measures) to provide analyses and comment on 
meeting its goal of providing uniform disease management policies and 
practices across the MHS.

    Dated: March 9, 2009.
Patricia L. Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. E9-5626 Filed 3-13-09; 8:45 am]
BILLING CODE 5001-06-P