Access to Healthcare Under the TRICARE Program for Beneficiaries of TRICARE Prime, 40680-40681 [2016-14786]

Download as PDF 40680 Federal Register / Vol. 81, No. 120 / Wednesday, June 22, 2016 / Notices DEPARTMENT OF DEFENSE Office of the Secretary Access to Healthcare Under the TRICARE Program for Beneficiaries of TRICARE Prime Office of the Secretary, Department of Defense. ACTION: Notice of access to health care standards for TRICARE Prime beneficiaries under the TRICARE Program. AGENCY: This notice is to advise interested parties of the Military Health System’s access to health care standards addressed in Title 32, Code of Federal Regulations (32 CFR), Section 199.17 for TRICARE Prime beneficiaries under the TRICARE Program and how the Secretary of Defense plans to ensure that beneficiaries under TRICARE Prime who are seeking an appointment for health care will obtain an appointment within established access to health care standards. Access to health care under the TRICARE Program for TRICARE Prime beneficiaries was established in October 1995 and remains current. ADDRESSES: Defense Health Agency, TRICARE Health Plan, 7700 Arlington Boulevard, Suite 5101, Falls Church, Virginia 22042–5101. FOR FURTHER INFORMATION CONTACT: Ms. Michelle Graves, TRICARE Health Plan, telephone (703) 681–0039. SUPPLEMENTARY INFORMATION: mstockstill on DSK3G9T082PROD with NOTICES SUMMARY: A. Background on Access to Health Care for TRICARE Prime Beneficiaries Under the TRICARE Program Section 704 of the National Defense Authorization Act for Fiscal Year 2016 (NDAA for FY16) requires the Secretary of Defense to establish and publicize access to care standards for beneficiaries enrolled in TRICARE Prime at military treatment facilities (MTFs) or with civilian network providers. The Department has already established Prime maximum wait times and travel distances for Prime primary and specialty care appointments as required by Section 704 of the NDAA for FY 2016. Access to care standards for TRICARE Prime enrollees have been in place since the start of the TRICARE Prime program in 1995. TRICARE Prime access standards were published in a Federal Register notice on October 5, 1995 (60 FR 52100–52101) and promulgated in 32 CFR 199.17(p)(5)(i–v). These same standards are also disseminated throughout the Military Health System via Assistant Secretary of Defense (Health Affairs) Memorandum 11–005, VerDate Sep<11>2014 20:02 Jun 21, 2016 Jkt 238001 ‘‘TRICARE Policy for Access to Care,’’ dated February 23, 2011. Finally, these standards are incorporated by reference in existing and future TRICARE regional support contracts. TRICARE Prime access to health care standards apply regardless of the location of the beneficiary’s primary care manager (military treatment facility or civilian network). B. Description of the Health Care Access Standards for TRICARE Prime Beneficiaries The health care access standards outlined in this notice are set forth in 32 CFR 199.17(p)(5)(i–v). These access standards remain current and in force without any amendment to date. Access standards. Preferred provider networks will have attributes of size, composition, mix of providers, and geographical distribution so that the networks, coupled with the MTF capabilities, can adequately address the health care needs of the enrollees. The capabilities of the MTF plus preferred provider network will meet the following access standards with respect to the needs of the expected number of enrollees: (i) Under normal circumstances, enrollee travel time may not exceed 30 minutes from home to primary care delivery site unless a longer time is necessary because of the absence of providers (including providers not part of the network) in the area. (ii) The wait time for an appointment for a well-patient visit or a specialty care referral shall not exceed four weeks; for a routine visit, the wait time for an appointment shall not exceed one week; and for an urgent care visit the wait time for an appointment shall be within 24 hours. (The specialty care time standard does not apply in the case of a follow-up appointment that for clinical reasons is specifically stated for a later period.) (iii) Emergency services shall be available and accessible to handle emergencies (and urgent care visits if not available from other primary care providers pursuant to paragraph (p)(5)(ii) of 32 CFR 199.17), within the service area 24 hours a day, seven days a week. (iv) The network shall include a sufficient number and mix of board certified specialists to meet reasonably the anticipated needs of enrollees. Travel time for specialty care shall not exceed one hour under normal circumstances, unless a longer time is necessary because of the absence of providers (including providers not part of the network) in the area. This requirement does not apply under the PO 00000 Frm 00028 Fmt 4703 Sfmt 4703 Specialized Treatment Services Program. (v) Office waiting times in nonemergency circumstances shall not exceed 30 minutes, except when emergency care is being provided to patients, and the normal schedule is disrupted. C. Description of How the Secretary of Defense Plans To Ensure That Beneficiaries Under TRICARE Prime Who Are Seeking an Appointment for Health Care Will Obtain an Appointment Within Established Access to Health Care Standards In an effort to ensure TRICARE Prime beneficiaries obtain an appointment within access to health care standards at an MTF, the Military Health System implemented a first-call resolution policy in calendar year 2015. This policy outlines standard processes to ensure TRICARE Prime beneficiaries are not asked to call back to the MTFs if no appointments are available within the established access to health care standards. The policy also identifies responsibilities of MTF Directors, primary care, specialist care and other stakeholders identified in the appointing process to ensure patient satisfaction for our beneficiaries. The policy outlines specific procedures to correctly transfer calls in accordance with existing access to care standards, referral management protocols and proper use of managing clinic schedules to ensure appointing success the first time one of our beneficiaries seeks access. In addition, a Joint Outpatient Experience Survey will be used to measure the impact of the first-call resolution policy from beneficiaries’ perspectives on whether they obtained an appointment within health care access standards. For those TRICARE Prime beneficiaries seeking an appointment with a TRICARE Prime civilian network provider, if the beneficiary cannot be scheduled for a visit in the MTF or TRICARE Prime network within the access to care standards, the beneficiary will be authorized an out-of-network provider visit with no point-of-service charge. The TRICARE Reimbursement Manual will be revised to reflect the above statement. In addition, as stated in the TRICARE Operations Manual (TOM Chapter 1, Section 3, Paragraph 1.0), ‘‘Contractors are charged with providing or arranging for delivery of quality, timely health care services and have the responsibility for providing the timely and accurate processing of all claims received into their custody, whether for network or non-network care.’’ E:\FR\FM\22JNN1.SGM 22JNN1 Federal Register / Vol. 81, No. 120 / Wednesday, June 22, 2016 / Notices D. Communications The Defense Health Agency will post the TRICARE Prime access to care standards on the TRICARE.mil Web site and execute a strategic communication plan to educate beneficiaries enrolled in TRICARE Prime about the access to care standards. Dated: June 17, 2016. Aaron Siegel, Alternate OSD Federal Register Liaison Officer, Department of Defense. [FR Doc. 2016–14786 Filed 6–21–16; 8:45 am] BILLING CODE 5001–06–P DEPARTMENT OF DEFENSE Department of the Army, Corps of Engineers Public Notice of Intent for Studies and Initial Scoping Meeting for Gulf Intracoastal Waterway Brazos River Floodgates and Colorado River Locks Feasibility Study Department of the Army, U.S. Army Corps of Engineers, DoD. ACTION: Notice of intent and public scoping meeting. AGENCY: This notice provides a summary of the ongoing feasibility study activities for the Gulf Intracoastal Waterway (GIWW) Brazos River Floodgates (BRFG) and Colorado River Locks (CRL) Feasibility Study and solicit public input regarding the study. The objective of the feasibility study is to investigate and recommend solutions to improve traffic safety and navigation efficiencies at the confluence of the GIWW with the BRFG and CRL. The GIWW BRFG/CRL Feasibility Study will identify and evaluate possible structural and navigation alternatives to reduce traffic accidents and navigation delays. The non-Federal sponsor for the project is the Texas Department of Transportation (TXDOT). DATES: The Galveston District will hold the Initial Public Scoping Meeting for the Feasibility Phase of the study on July 12, 2016 from 6:00–8:00 p.m. ADDRESSES: The meeting will be held at the West Columbia Civic Center, 516 E. Brazos Ave. (State Highway 35), West Columbia, TX 77486. FOR FURTHER INFORMATION CONTACT: Franchelle Craft, (409) 766–3187. SUPPLEMENTARY INFORMATION: Study Background. In 2000, the Galveston District completed a reconnaissance study to assess the feasibility of modifying the configurations of the BRFG and CRL to reduce traffic accidents and delays. The mstockstill on DSK3G9T082PROD with NOTICES SUMMARY: VerDate Sep<11>2014 20:02 Jun 21, 2016 Jkt 238001 study resulted in the determination that there was Federal interest in continuing to the feasibility phase of the study. Funding for the feasibility phase of the study was approved in Fiscal Year 2016. Recognizing the hydrologic connectivity of the GIWW system, the decision was made to conduct the assessment of the BRFG and CRL separately and combine the results into one integrated feasibility report. Navigation along the GIWW is constrained at the confluence with the BRFG and the CRL resulting in the following conditions: • Inadequate channel and crossing widths for modern vessels; • Outdated floodgate construction and width in the floodgate chambers at the Brazos River; • Outdated lock construction at the Colorado River leading to mechanical failure; • Shutdown of operations during high water periods presenting a significant security concern; • Increased hydrology (river flows due to flood events) impacting navigation traffic; • Increased operations and maintenance costs to prevent marine buildup on mechanical elements of the structures; • Increased sedimentation at the mouth of the rivers; • Shoreline erosion. The Feasibility Study will assess the conditions identified above and develop specific measures/alternatives that can be combined or used as standalone actions to address the problems at each location. Study Process. During the feasibility phase, detailed engineering, hydrology, economic analysis, and environmental studies are performed. The goal of the feasibility phase is to find the most costeffective solution that responds to the problems identified above while protecting the Nation’s environment. The final feasibility report documents the study results and findings, the selection process of the recommended alternative, and the costs and benefits of the recommended plan. The feasibility study ends when the report is submitted to Congress for authorization. Study Status. The Feasibility study will reevaluate the proposed alternatives identified in the 2000 Reconnaissance Study to determine the feasibility of undertaking modifications to the Brazos and Colorado river crossings, as well as identify changes to the floodgate and lock structures at each location that are economically and environmentally justified. There is a need to reduce navigation impacts and costly waterborne traffic delays that are PO 00000 Frm 00029 Fmt 4703 Sfmt 9990 40681 a result of aging infrastructure and inadequate channel dimensions for modern vessels. Alternatives to be evaluated in the feasibility phase include: • Moving the gates away from the river; • Widening the gates; • Reconfiguring the guide wall to lessen the angle to the GIWW; • Straightening the crossing at the Brazos and Colorado Rivers; • Lock modifications (construction of new locks); • Removal of floodgates; and/or; • Some combination of these and other measures. Meeting. The Galveston District will hold the Initial Public Scoping Meeting for the Feasibility Phase on July 12, 2016 from 6:00–8:00 p.m. at the West Columbia Civic Center. The purpose of the meeting will be to inform the community about the proposed navigation modification project, present how the study will be conducted, solicit public input regarding the initial scope of potential issues/alternatives to be addressed, and identify those issues/ alternatives that should be analyzed further, or eliminated, based on their significance and effects on the environment. The information from the public meeting will be used in the development of an Environmental Impact Statement in compliance with the National Environmental Policy Act (NEPA) requirements. This notice serves as an invitation for the public to attend. The public will be provided an opportunity for questions and comments. We are soliciting comments/concerns on the opportunities to improve navigation along the GIWW at the Brazos and Colorado Rivers, the identification of resources that may occur within the study area, and other social, economic, and environmental concerns. All interested parties are invited to provide input to this study. Please send your comments or questions regarding this notice or mailing list updates to USACE SWG, 2000 Ft. Point Rd., Galveston, TX 77550. Written input can also be submitted and is requested by August 11, 2016. If we can provide further information, contact the project manager, Ms. Franchelle Craft, by phone at (409) 766–3187 or by email at franchelle.e.craft@usace.army.mil. Eric W. Verwers, Director, Regional Planning and Environmental Center. [FR Doc. 2016–14694 Filed 6–21–16; 8:45 am] BILLING CODE 3720–58–P E:\FR\FM\22JNN1.SGM 22JNN1

Agencies

[Federal Register Volume 81, Number 120 (Wednesday, June 22, 2016)]
[Notices]
[Pages 40680-40681]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-14786]



[[Page 40680]]

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DEPARTMENT OF DEFENSE

Office of the Secretary


Access to Healthcare Under the TRICARE Program for Beneficiaries 
of TRICARE Prime

AGENCY: Office of the Secretary, Department of Defense.

ACTION: Notice of access to health care standards for TRICARE Prime 
beneficiaries under the TRICARE Program.

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

SUMMARY: This notice is to advise interested parties of the Military 
Health System's access to health care standards addressed in Title 32, 
Code of Federal Regulations (32 CFR), Section 199.17 for TRICARE Prime 
beneficiaries under the TRICARE Program and how the Secretary of 
Defense plans to ensure that beneficiaries under TRICARE Prime who are 
seeking an appointment for health care will obtain an appointment 
within established access to health care standards. Access to health 
care under the TRICARE Program for TRICARE Prime beneficiaries was 
established in October 1995 and remains current.

ADDRESSES: Defense Health Agency, TRICARE Health Plan, 7700 Arlington 
Boulevard, Suite 5101, Falls Church, Virginia 22042-5101.

FOR FURTHER INFORMATION CONTACT: Ms. Michelle Graves, TRICARE Health 
Plan, telephone (703) 681-0039.

SUPPLEMENTARY INFORMATION: 

A. Background on Access to Health Care for TRICARE Prime Beneficiaries 
Under the TRICARE Program

    Section 704 of the National Defense Authorization Act for Fiscal 
Year 2016 (NDAA for FY16) requires the Secretary of Defense to 
establish and publicize access to care standards for beneficiaries 
enrolled in TRICARE Prime at military treatment facilities (MTFs) or 
with civilian network providers. The Department has already established 
Prime maximum wait times and travel distances for Prime primary and 
specialty care appointments as required by Section 704 of the NDAA for 
FY 2016.
    Access to care standards for TRICARE Prime enrollees have been in 
place since the start of the TRICARE Prime program in 1995. TRICARE 
Prime access standards were published in a Federal Register notice on 
October 5, 1995 (60 FR 52100-52101) and promulgated in 32 CFR 
199.17(p)(5)(i-v). These same standards are also disseminated 
throughout the Military Health System via Assistant Secretary of 
Defense (Health Affairs) Memorandum 11-005, ``TRICARE Policy for Access 
to Care,'' dated February 23, 2011. Finally, these standards are 
incorporated by reference in existing and future TRICARE regional 
support contracts. TRICARE Prime access to health care standards apply 
regardless of the location of the beneficiary's primary care manager 
(military treatment facility or civilian network).

B. Description of the Health Care Access Standards for TRICARE Prime 
Beneficiaries

    The health care access standards outlined in this notice are set 
forth in 32 CFR 199.17(p)(5)(i-v). These access standards remain 
current and in force without any amendment to date.
    Access standards. Preferred provider networks will have attributes 
of size, composition, mix of providers, and geographical distribution 
so that the networks, coupled with the MTF capabilities, can adequately 
address the health care needs of the enrollees. The capabilities of the 
MTF plus preferred provider network will meet the following access 
standards with respect to the needs of the expected number of 
enrollees:
    (i) Under normal circumstances, enrollee travel time may not exceed 
30 minutes from home to primary care delivery site unless a longer time 
is necessary because of the absence of providers (including providers 
not part of the network) in the area.
    (ii) The wait time for an appointment for a well-patient visit or a 
specialty care referral shall not exceed four weeks; for a routine 
visit, the wait time for an appointment shall not exceed one week; and 
for an urgent care visit the wait time for an appointment shall be 
within 24 hours. (The specialty care time standard does not apply in 
the case of a follow-up appointment that for clinical reasons is 
specifically stated for a later period.)
    (iii) Emergency services shall be available and accessible to 
handle emergencies (and urgent care visits if not available from other 
primary care providers pursuant to paragraph (p)(5)(ii) of 32 CFR 
199.17), within the service area 24 hours a day, seven days a week.
    (iv) The network shall include a sufficient number and mix of board 
certified specialists to meet reasonably the anticipated needs of 
enrollees. Travel time for specialty care shall not exceed one hour 
under normal circumstances, unless a longer time is necessary because 
of the absence of providers (including providers not part of the 
network) in the area. This requirement does not apply under the 
Specialized Treatment Services Program.
    (v) Office waiting times in non-emergency circumstances shall not 
exceed 30 minutes, except when emergency care is being provided to 
patients, and the normal schedule is disrupted.

C. Description of How the Secretary of Defense Plans To Ensure That 
Beneficiaries Under TRICARE Prime Who Are Seeking an Appointment for 
Health Care Will Obtain an Appointment Within Established Access to 
Health Care Standards

    In an effort to ensure TRICARE Prime beneficiaries obtain an 
appointment within access to health care standards at an MTF, the 
Military Health System implemented a first-call resolution policy in 
calendar year 2015. This policy outlines standard processes to ensure 
TRICARE Prime beneficiaries are not asked to call back to the MTFs if 
no appointments are available within the established access to health 
care standards. The policy also identifies responsibilities of MTF 
Directors, primary care, specialist care and other stakeholders 
identified in the appointing process to ensure patient satisfaction for 
our beneficiaries. The policy outlines specific procedures to correctly 
transfer calls in accordance with existing access to care standards, 
referral management protocols and proper use of managing clinic 
schedules to ensure appointing success the first time one of our 
beneficiaries seeks access. In addition, a Joint Outpatient Experience 
Survey will be used to measure the impact of the first-call resolution 
policy from beneficiaries' perspectives on whether they obtained an 
appointment within health care access standards.
    For those TRICARE Prime beneficiaries seeking an appointment with a 
TRICARE Prime civilian network provider, if the beneficiary cannot be 
scheduled for a visit in the MTF or TRICARE Prime network within the 
access to care standards, the beneficiary will be authorized an out-of-
network provider visit with no point-of-service charge. The TRICARE 
Reimbursement Manual will be revised to reflect the above statement. In 
addition, as stated in the TRICARE Operations Manual (TOM Chapter 1, 
Section 3, Paragraph 1.0), ``Contractors are charged with providing or 
arranging for delivery of quality, timely health care services and have 
the responsibility for providing the timely and accurate processing of 
all claims received into their custody, whether for network or non-
network care.''

[[Page 40681]]

D. Communications

    The Defense Health Agency will post the TRICARE Prime access to 
care standards on the TRICARE.mil Web site and execute a strategic 
communication plan to educate beneficiaries enrolled in TRICARE Prime 
about the access to care standards.

    Dated: June 17, 2016.
Aaron Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2016-14786 Filed 6-21-16; 8:45 am]
 BILLING CODE 5001-06-P