[Federal Register Volume 78, Number 51 (Friday, March 15, 2013)]
[Notices]
[Pages 16476-16477]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-06022]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF DEFENSE
Office of the Secretary
Notice for Termination of a Disease Management Demonstration
Project for TRICARE Standard Beneficiaries
AGENCY: Office of the Secretary of Defense, (Health Affairs)/TRICARE
Management Activity, DoD.
ACTION: Notice for termination of a Disease Management Demonstration
Project for TRICARE Standard Beneficiaries.
-----------------------------------------------------------------------
SUMMARY: This notice is to advise interested parties of the termination
of a Military Health System (MHS) demonstration project entitled
``Disease Management Demonstration Project for TRICARE Standard
Beneficiaries.'' The demonstration provided disease management (DM)
services to TRICARE Standard beneficiaries who are not eligible to
receive some DM-like services under the basic benefit regulations.
TRICARE began the demonstration project in March 2007 for Standard
beneficiaries and this demonstration project has enabled the MHS to
evaluate the programs and identify ways to improve the provision of
effective services by detecting strengths and weaknesses of the
programs, as well as evidence of best practices. As the TRICARE
Management Activity (TMA) chose a phased approach, the demonstration
was extended twice, on March 16, 2009 (74 FR 11089-11090), and again on
March 4, 2011 (76 FR 12081-12082), to allow time for all program
evaluations. TMA intends to continue to provide DM services to eligible
TRICARE beneficiaries through strategies based on evidence-based best
practices, beneficiary's needs, plan category, and location of health
care provision.
DATES: Effective date: March 31, 2013.
ADDRESSES: TRICARE Management Activity (TMA), 7700 Arlington Boulevard,
Suite 5101, Falls Church, VA 22042-5101.
FOR FURTHER INFORMATION CONTACT: Robin Marzullo, TRICARE Management
[[Page 16477]]
Activity, Office of the Chief Medical Officer (703) 681-6173.
SUPPLEMENTARY INFORMATION: As a result of Section 734 0f the 2007
National Defense Authorization Act, the MHS implemented uniform
policies and practices for DM throughout the TRICARE network. To
include the Standard beneficiaries, who could not receive many of the
services that are the cornerstone of DM per the Basic Benefit
Regulations, a two year demonstration notice was published June 13 2007
(72 FR 32628-32629). The demonstration project provided for measuring
the effectiveness of the DM programs in improving the health of TRICARE
beneficiaries with chronic conditions. In addition, it allowed the MHS
to identify best practices for improving the care management services
for individuals with chronic conditions. The demonstration was extended
twice. On March 16, 2009 a notice (74 FR 11089-11090) was published
that extended the demonstration through March 31, 2011 and on March 4,
2011 (76 FR 12081-12082) further extended the demonstration through
March 31, 2013. For several years, TRICARE has been evaluating the best
way to provide assistance to people with certain chronic medical
conditions. Based on TRICARE's evaluation of best health care
practices, we found that chronic medical conditions are best managed as
a routine part of good medical practice, and when structured to fit the
individual beneficiary's circumstances and their specific health plan.
Multiple analyses of the DM program were conducted, and in that same
time period other studies for similar programs were piloted nationally
that provided additional insight. The results of these analyses and
literature reviews provided identification of evidence-based best
practices that support the future direction of the MHS disease and
chronic condition management programs. These best practices include
team based--provider directed care, care coordination, self-management
education and transitional care services that target at risk
populations, have access to timely data, close interactions with care
coordinators and primary care physicians, face-to-face contact with
individuals involved in their own care, and supported by practices
predominantly staffed by registered nurses.
Given the focus with the primary care provider in moving forward
with disease and chronic care management, and the lack of a defined
provider for the Standard beneficiaries, TMA has determined that the
best course is for the Standard beneficiaries to receive disease and
chronic care management direction from the provider of their choosing.
TMA envisions the following scenarios related to the distinct
structures of the health care benefit within TRICARE (Direct Care
through the Military Treatment Facilities, Private Sector Care through
contracted and non-contracted network providers, the US Family Health
Plans etc.), chronic care management based on the above mentioned best-
practices will be available to beneficiaries and adapted based on these
factors. The DM services will also take into consideration the
different benefit plans available (Prime, which operates like an HMO
and requires enrollment with a primary care provider, vs. Standard
which functions as a fee-for-service plan), and will modify the chronic
care services provided to best match that plan. For example, Prime
beneficiaries enrolled at an MTF would receive their services through a
Patient-Centered Medical Home (where available). A Prime beneficiary
enrolled to the network would receive DM services provided through the
Managed Care Support Contractor's program. A Standard beneficiary not
enrolled to a primary care provider, would receive disease and chronic
care management from their chosen provider inside or outside the
network, and would have access to disease specific educational
information through the regional contractor Web sites or TRICARE
online. Since the standard beneficiaries are not required to enroll
with a primary care provider, and there is no visibility to the
services they receive outside the network, it is not practicable to
determine if they are receiving the recommended best-practices, and in
turn to measure outcomes and determine effectiveness of care. As a
result, it has been determined that Standard beneficiaries are best
served being care-managed by the provider of their choosing; the
provider being familiar with the Standard beneficiaries gaps in care
and on-going needs.
TMA has developed a strategic plan for the on-going provision of
disease and chronic care management services, based on the evidence-
based best practices noted above, and have determined that the need for
this demonstration has ceased. It is important to note that the end of
this demonstration does not change the basic benefit for the Standard
beneficiaries; they will continue to have access to all the services
identified in 32 CFR 199.4.
Dated: March 12, 2013.
Aaron Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2013-06022 Filed 3-14-13; 8:45 am]
BILLING CODE 5001-06-P