TRICARE; Reimbursement for Travel for Specialty Care Under Exceptional Circumstances, 2290-2291 [2011-622]

Agencies

• Office of the Secretary
• DEPARTMENT OF DEFENSE

[Federal Register Volume 76, Number 9 (Thursday, January 13, 2011)]
[Proposed Rules]
[Pages 2290-2291]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-622]


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DEPARTMENT OF DEFENSE

Office of the Secretary

32 CFR Part 199

[DOD-2010-HA-0094; RIN 0720-AB42]


TRICARE; Reimbursement for Travel for Specialty Care Under 
Exceptional Circumstances

AGENCY: Office of the Secretary, DoD.

ACTION: Proposed rule.

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SUMMARY: This proposed rule implements section 634 of the National 
Defense Authorization Act for Fiscal Year 2010 which amends Section 
1074i of title 10, United States Code, to permit reimbursement for 
reasonable travel expenses for active duty members of the uniformed 
Services and their dependents, and accompaniment, to a specialty care 
provider under such exceptional circumstances as the Secretary of 
Defense may proscribe. The Department of Defense through its military 
treatment facilities and its robust managed care program, TRICARE 
Prime, is able to fulfill the medical needs of the majority of its 
active duty members and their families. However, in some locations 
where active duty members and their families live due to the duty 
assignment of the member, the medical resources in the military 
treatment facilities and the managed care networks may not meet all of 
the specialty care needs of these members and their families within 
normal access standards. Reimbursement of reasonable travel expenses 
for required specialty care that is more than 100 miles from the 
primary care manager's office is currently a benefit under paragraph 
(a) of section 1074i, title 10, United States Code for any covered 
beneficiary enrolled in the TRICARE Prime program, including the active 
duty members and their dependents. However this proposed rule extends a 
travel reimbursement for active duty members of the armed forces and 
their families who, because of an exceptional circumstance involving 
the duty assignment of the active duty member of the armed forces, are 
required to travel less than 100 miles but more than 60 minutes in 
drive time to access needed specialty care. This travel reimbursement 
benefit is limited to those active duty members and their dependents, 
and accompaniment, enrolled in Prime or TRICARE Prime Remote. The 
Director, TRICARE Management Activity, shall issue procedures and 
guidelines under which authorization for reimbursement of travel 
expenses will be issued after verification that the member, family 
member, and/or accompaniment, must travel less than 100 miles but more 
than 60 minutes drive time from the military treatment facility or 
their primary care manager's office to receive required specialty care.

DATES: Comments must be received on or before March 14, 2011.

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.
     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 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: TRICARE Policy and Operations, TRICARE 
Management Activity, 5111 Leesburg Pike, Suite 810, Falls Church, VA 
22041.

SUPPLEMENTARY INFORMATION:

I. Introduction and Background

    The TRICARE benefit was directed by Congress in section 1097 of the 
National Defense Authorization Act for Fiscal Year 1995. For further 
information on TRICARE, the reader may refer to the final rule 
regarding TRICARE published in the Federal Register on October 5, 1995.

Travel for Specialty Care

    Managed care support contractors are required to establish adequate 
networks throughout regions to complement military treatment facilities 
and support TRICARE Prime and Extra. However, there are many active 
duty members of the uniformed Services and their families who are 
required by the member's duty assignment to live in certain more remote 
areas where there are insufficient numbers or types of specialty or 
subspecialty providers to provide care within normal drive-time access 
standards notwithstanding the due diligence of the contractors in 
developing the network around the military treatment facilities or 
their diligence in finding network providers for those members or 
families enrolled in TRICARE Prime Remote. Under such exceptional 
circumstances as identified under procedures and guidelines issued by 
the Director, TRICARE Management Activity, reasonable travel expenses 
to obtained specialty care for which the enrollee has been referred may 
be reimbursed. The specific location or identity of these military 
treatment facilities and the specific TRICARE Prime Remote locations 
and the types of specialists or sub-specialists shall be determined in 
accordance with guidelines issued by the Assistant Secretary of Defense 
for Health Affairs. The guidelines shall include identity of the 
specific military treatment facility or TRICARE Prime Remote area, 
validation by either, or both, the facility commander and/or the 
Director of the TRICARE Regional Office that the specialty care 
provider or category of specialty care provider required to provide 
care to the active duty member and their dependents, are not available 
within a 60 minute drive time, but are available within 100 miles of 
the military treatment facility or primary care manager's office. The 
Director of the TRICARE Regional Office shall also verify that the 
Managed Care Support Contractor has used due diligence in attempting to 
enroll the needed specialists who do meet the drive time specialty care 
access standards, into the network. The Director, TRICARE Management 
Activity shall establish and make available a list of military 
treatment facilities and category of specialty providers for which 
these reasonable travel expenses shall be allowed. For members, and 
families, enrolled in TPR the Director shall ensure that adequate 
coordination of care and travel benefits is provided to

[[Page 2291]]

those qualifying members and their families.

II. Regulatory Procedures

Executive Order 12866, ``Regulatory Planning and Review'' and Public 
Law 96-354, ``Regulatory Flexibility Act'' (5 U.S.C. 601)

    Executive Order 12866 requires that a comprehensive regulatory 
impact analysis be performed on any economically significant regulatory 
action, defined as one that would result in an annual effect of $100 
million or more on the national economy or which would have other 
substantial 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 
which would have a significant impact on a substantial number of small 
entities. This proposed rule is not a significant regulatory action and 
will not have a significant impact on a substantial number of small 
entities for purposes of the RFA. Thus this proposed rule is not 
subject to any of these requirements.

Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3511)

    This rule will not impose additional information collection 
requirements on the public.

Executive Order 13132, ``Federalism''

    We have examined the impacts of the 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.

Sec. 202, Public Law 104-4, ``Unfunded Mandates Reform Act''

    This rule does not contain unfunded mandates. It does not contain a 
Federal mandate that may result in the expenditure by State, local and 
Tribal governments, in aggregate, or by the private sector, of $100 
million or more in any one year.

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 199.17 is amended by revising paragraph (n)(2)(vi) to 
read as follows:


Sec.  199.17  TRICARE program

* * * * *
    (n) * * *
    (2) * * *
    (vi) In accordance with guidelines issued by the Assistant 
Secretary of Defense for Health Affairs, reasonable travel expenses may 
be reimbursed for a TRICARE Prime enrollee and, when an adult non-
medical attendant is necessary, for a parent or guardian of the 
enrollee or another member of the enrollee's family who is at least 21 
years of age. Such guidelines shall be consistent with appropriate 
provisions of generally applicable Department of Defense rules and 
procedures governing travel expenses. Reimbursement of reasonable 
travel expenses shall be provided under the following conditions:
    (A) When a Prime enrollee is referred by the primary care manager 
for medically necessary specialty care more than 100 miles away from 
the primary care manager's office.
    (B) When an exceptional circumstance exists involving referral for 
specialty care for an active duty member of the uniformed Services or a 
dependent of an active duty member of the uniformed Services enrolled 
in Prime or in TRICARE Prime Remote. An exceptional circumstance exists 
when the enrollee is referred for medically necessary specialty care 
requiring travel beyond a 60-minute drive time but within 100 miles of 
the military treatment facility or the TRICARE Prime Remote primary 
care manager's office. The Director, TRICARE shall issue guidelines and 
procedures under which authorization of travel expenses will be issued 
based on verification that a specialty care provider or specific 
category of specialty care provider is not available within 60- minute 
drive time but less than 100 miles from a referring military treatment 
facility or TRICARE Prime Remote primary care manager's office. The 
guidelines and procedures shall also include verification that the 
Managed Care Support Contractor has used due diligence in attempting to 
enroll into the network needed specialists who meet the normal drive 
time specialty care access standards or has otherwise identified non-
network providers within the specialty care access standards to whom a 
Prime enrollee may be referred without incurring point of service 
costs. The Director, TRICARE may establish and make available a list of 
military treatment facilities and specialty providers for each for 
which these reasonable travel expenses shall be allowed and shall 
ensure that members and their families enrolled in TRICARE Prime Remote 
obtain assistance in receiving this benefit when appropriate.
* * * * *

    Dated: January 4, 2011.
Patricia L. Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2011-622 Filed 1-12-11; 8:45 am]
BILLING CODE 5001-06-P