TRICARE Demonstration Project for the Philippines, 20626 [2016-08065]
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Federal Register / Vol. 81, No. 68 / Friday, April 8, 2016 / Notices
the Committee at any time or in
response to the stated agenda of a
planned meeting. Written statements
should be submitted to the Committee’s
Designated Federal Officer. The
Designated Federal Officer’s contact
information is listed in this notice, or it
can be obtained from the General
Services Administration’s FACA
Database: https://www.facadatabase.gov/
committee/
committee.aspx?cid=1663&aid=41.
Written statements that do not pertain to
a scheduled meeting of the TRAC may
be submitted at any time. However, if
individual comments pertain to a
specific topic being discussed at a
planned meeting, then these statements
must be submitted no later than five
business days prior to the meeting in
question. The Designated Federal
Officer will review all submitted written
statements and provide copies to all
TRAC members.
Dated: April 5, 2016.
Aaron Siegel,
Alternate OSD Federal Register Liaison
Officer, Department of Defense.
[FR Doc. 2016–08113 Filed 4–7–16; 8:45 am]
BILLING CODE 5001–06–P
DEPARTMENT OF DEFENSE
Office of the Secretary
TRICARE Demonstration Project for
the Philippines
Office of the Secretary of
Defense (Health Affairs)/TRICARE
Management Activity, Department of
Defense.
ACTION: Notice of an extension of the
TRICARE demonstration project for the
Philippines.
AGENCY:
On Wednesday, September
28, 2011, the Department of Defense
(DoD) published a notice of the
Philippines Demonstration Project
(PDP) (76 FR 60007–60008). This notice
is to advise interested parties of an
extension to a Military Health System
demonstration project entitled
‘‘TRICARE Demonstration Project for
the Philippines.’’ The purpose of this
demonstration is to validate an
alternative approach to providing
healthcare services for those
beneficiaries covered under the
TRICARE Standard option in the
Philippines, controlling costs,
eliminating any balance billing issues,
and ensuring that the billing practices
comply with regulatory requirements.
During the initial two years of the
demonstration project, significant
reductions in providers under Pre-
mstockstill on DSK4VPTVN1PROD with NOTICES
SUMMARY:
VerDate Sep<11>2014
17:48 Apr 07, 2016
Jkt 238001
Payment Review has been observed,
resulting in less fraudulent claim
investigations. In addition, beneficiaries
have been over 93% compliant with
utilizing approved network providers in
the Philippines demonstration areas.
The DHA’s intent is to extend the
demonstration project for an additional
three years in order to determine if the
cost savings to the Government in terms
of the average cost per paid claim along
with the savings on fraudulent claims
can exceed the administrative costs
related to the project while ensuring
Standard beneficiaries are able to access
high quality medical care within
TRICARE access standards.
DATES: Effective Date: Effective
December 31, 2015.
ADDRESSES: Defense Health Agency
(DHA), TRICARE Overseas Program
Office, 16401 East Centretech Parkway,
Aurora, CO 80011.
FOR FURTHER INFORMATION CONTACT:
CAPT Bruno Himmler, Office of the
ASD (HA)—DHA, (303) 676–3728.
SUPPLEMENTARY INFORMATION: TRICARE
has recognized the unique
circumstances existing in the
Philippines which made the provision
of medical care to TRICARE
beneficiaries through the TRICARE
Overseas program operated in other
overseas locations challenging.
TRICARE has experienced dramatic
increases in the amount billed for
healthcare services rendered in the
Philippines from $15 million in 1999 to
$59 million in 2009 while the number
of beneficiaries has remained constant.
Administrative controls such as the
validation of providers, implementation
of a fee reimbursement schedule,
duplicate claims edits and the impact of
the cost-shares and deductibles have
limited actual TRICARE expenditures to
$17 million in 2009 for only
approximately 11,000 beneficiaries.
In addition to these administrative
controls, fraud and abuse activities in
the Philippines have been a growing
concern that necessitated prompt
investigation and actions to reduce the
number of fraudulent or abusive
incidences. Measures were taken to
prevent or reduce the level of fraud and
abuse against TRICARE while
concurrent investigations and
prosecutions were conducted. In April
2008, seventeen individuals were
convicted of defrauding the TRICARE
program of more than $100 million.
As a result, prepayment review of
claims is conducted to identify
excessive charges and aberrant
practices. Prepayment review is a tool
typically used on a limited basis.
Nevertheless, these efforts alone are not
PO 00000
Frm 00021
Fmt 4703
Sfmt 4703
expected to control and eliminate the
rising costs in the Philippines.
Because of this concern, the purpose
of this demonstration is to validate an
alternative approach to providing
healthcare services for those
beneficiaries covered under the
TRICARE Standard option in the
Philippines, controlling costs,
eliminating any balance billing issues,
and ensuring that the billing practices
comply with regulatory requirements.
Initial results have shown some
partial success with the PDP, but
additional data needs to be gathered and
assessed to be able to determine the long
term implications of the PDP. Therefore,
DHA proposes, utilizing the new
overseas contract as the vehicle, to
extend the demonstration for an
additional three years in the Philippines
to validate that use of a well-certified
and limited set of approved providers in
the Philippines will result in a
significant reduction in the level of
claims billing issues, including
beneficiaries being liable for balanced
billing amounts and fraud by providers,
and average cost per claim paid by the
Government, while ensuring
beneficiaries have sufficient access to
high quality care. The demonstration
would continue to be conducted under
10 U.S.C. 1092.
During the next three years, the
Government will look to expand the
demonstration areas to other locations/
cities with a significant Standard
population. Also, the contractor will be
requested to look at including
pharmacies as network providers to
help control costs related to outpatient
prescriptions.
Dated: April 4, 2016.
Aaron Siegel,
Alternate OSD Federal Register Liaison
Officer, Department of Defense.
[FR Doc. 2016–08065 Filed 4–7–16; 8:45 am]
BILLING CODE 5001–06–P
DEPARTMENT OF DEFENSE
Office of the Secretary
Defense Science Board; Notice of
Federal Advisory Committee Meeting
Department of Defense.
Notice of federal advisory
committee meeting.
AGENCY:
ACTION:
The Defense Science Board
will meet in closed session on
Thursday, May 19, 2016, from 8:00 a.m.
to 5:00 p.m. at the Pentagon, Room
3E863, Washington, DC.
DATES: Thursday, May 19, 2016, from
8:00 a.m. to 5:00 p.m.
SUMMARY:
E:\FR\FM\08APN1.SGM
08APN1
]]>Agencies
[Federal Register Volume 81, Number 68 (Friday, April 8, 2016)]
[Notices]
[Page 20626]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-08065]
-----------------------------------------------------------------------
DEPARTMENT OF DEFENSE
Office of the Secretary
TRICARE Demonstration Project for the Philippines
AGENCY: Office of the Secretary of Defense (Health Affairs)/TRICARE
Management Activity, Department of Defense.
ACTION: Notice of an extension of the TRICARE demonstration project for
the Philippines.
-----------------------------------------------------------------------
SUMMARY: On Wednesday, September 28, 2011, the Department of Defense
(DoD) published a notice of the Philippines Demonstration Project (PDP)
(76 FR 60007-60008). This notice is to advise interested parties of an
extension to a Military Health System demonstration project entitled
``TRICARE Demonstration Project for the Philippines.'' The purpose of
this demonstration is to validate an alternative approach to providing
healthcare services for those beneficiaries covered under the TRICARE
Standard option in the Philippines, controlling costs, eliminating any
balance billing issues, and ensuring that the billing practices comply
with regulatory requirements. During the initial two years of the
demonstration project, significant reductions in providers under Pre-
Payment Review has been observed, resulting in less fraudulent claim
investigations. In addition, beneficiaries have been over 93% compliant
with utilizing approved network providers in the Philippines
demonstration areas. The DHA's intent is to extend the demonstration
project for an additional three years in order to determine if the cost
savings to the Government in terms of the average cost per paid claim
along with the savings on fraudulent claims can exceed the
administrative costs related to the project while ensuring Standard
beneficiaries are able to access high quality medical care within
TRICARE access standards.
DATES: Effective Date: Effective December 31, 2015.
ADDRESSES: Defense Health Agency (DHA), TRICARE Overseas Program
Office, 16401 East Centretech Parkway, Aurora, CO 80011.
FOR FURTHER INFORMATION CONTACT: CAPT Bruno Himmler, Office of the ASD
(HA)--DHA, (303) 676-3728.
SUPPLEMENTARY INFORMATION: TRICARE has recognized the unique
circumstances existing in the Philippines which made the provision of
medical care to TRICARE beneficiaries through the TRICARE Overseas
program operated in other overseas locations challenging. TRICARE has
experienced dramatic increases in the amount billed for healthcare
services rendered in the Philippines from $15 million in 1999 to $59
million in 2009 while the number of beneficiaries has remained
constant. Administrative controls such as the validation of providers,
implementation of a fee reimbursement schedule, duplicate claims edits
and the impact of the cost-shares and deductibles have limited actual
TRICARE expenditures to $17 million in 2009 for only approximately
11,000 beneficiaries.
In addition to these administrative controls, fraud and abuse
activities in the Philippines have been a growing concern that
necessitated prompt investigation and actions to reduce the number of
fraudulent or abusive incidences. Measures were taken to prevent or
reduce the level of fraud and abuse against TRICARE while concurrent
investigations and prosecutions were conducted. In April 2008,
seventeen individuals were convicted of defrauding the TRICARE program
of more than $100 million.
As a result, prepayment review of claims is conducted to identify
excessive charges and aberrant practices. Prepayment review is a tool
typically used on a limited basis. Nevertheless, these efforts alone
are not expected to control and eliminate the rising costs in the
Philippines.
Because of this concern, the purpose of this demonstration is to
validate an alternative approach to providing healthcare services for
those beneficiaries covered under the TRICARE Standard option in the
Philippines, controlling costs, eliminating any balance billing issues,
and ensuring that the billing practices comply with regulatory
requirements.
Initial results have shown some partial success with the PDP, but
additional data needs to be gathered and assessed to be able to
determine the long term implications of the PDP. Therefore, DHA
proposes, utilizing the new overseas contract as the vehicle, to extend
the demonstration for an additional three years in the Philippines to
validate that use of a well-certified and limited set of approved
providers in the Philippines will result in a significant reduction in
the level of claims billing issues, including beneficiaries being
liable for balanced billing amounts and fraud by providers, and average
cost per claim paid by the Government, while ensuring beneficiaries
have sufficient access to high quality care. The demonstration would
continue to be conducted under 10 U.S.C. 1092.
During the next three years, the Government will look to expand the
demonstration areas to other locations/cities with a significant
Standard population. Also, the contractor will be requested to look at
including pharmacies as network providers to help control costs related
to outpatient prescriptions.
Dated: April 4, 2016.
Aaron Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2016-08065 Filed 4-7-16; 8:45 am]
BILLING CODE 5001-06-P
