[Federal Register Volume 62, Number 143 (Friday, July 25, 1997)]
[Rules and Regulations]
[Pages 39940-39941]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-19559]
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DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 199
[DoD 6010.8-R]
RIN 0720-AA36
Civilian Health and Medical Program of the Uniformed Services
(CHAMPUS); Extension of the Active Duty Dependents Dental Plan to
Overseas Areas
AGENCY: Office of the Secretary, DoD.
ACTION: Interim final rule with request for comments.
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SUMMARY: This interim final rule implements recently enacted statutory
authority for the extension of the Active Duty Dependents Dental Plan
to overseas areas. It provides for adjustments in the program in
overseas areas. This rule details the implementation and operation of
the program which will ensure access to dental care for family members
accompanying their active sponsors while overseas.
DATES: This interim final rule is effective August 25, 1997. Comments
may be submitted on or before September 23, 1997.
ADDRESSES: Forward comments to TRICARE Support Office (TSO)/Office of
the Civilian Health and Medical Program of the Uniformed Services
(OCHAMPUS), Office of Program Development; Aurora, Colorado 80045-6900.
FOR FURTHER INFORMATION CONTACT: Mr. Gunther J. Zimmerman, Office of
the Assistant Secretary of Defense (Health Affairs), (703) 695-3331.
SUPPLEMENTARY INFORMATION:
1. Overview of the Interim Final Rule
Military force reductions in Europe, the Middle East, and the
Pacific have resulted in diminished medical services for many areas,
particularly those where the active duty end strengths have fallen
below levels which would support a military medical facility. Service
members and their families, particularly those in remote areas, have
experienced significant access problems in obtaining dental services at
military facilities. This rule is based on section 703 of the National
Defense Authorization Act for Fiscal Year 1995, Public Law 103-337,
which amended 10 U.S.C. 1076a. This law allows the Department to extend
the Dependent's Dental Plan to overseas areas. Family members enrolled
in the Dependent's Dental Plan will be allowed to receive dental care
from host nation providers and have the dental claims processed by a
dental contractor. Host nation providers who meet accepted dental
practice standards will be identified by the local military dental
treatment facility commander.
Enrolled family members overseas will be eligible to obtain the
same basic dental benefits offered to enrollees in the Active Duty
Dependents' Dental Plan (also referred to as the TRICARE Active Duty
Family Member Dental Plan) in the Continental United States. The
Continental United States is defined as the forty-eight contiguous
states, as well as Alaska, Hawaii, Guam, Puerto Rico, the District of
Columbia, the U.S. Virgin Islands and Canada. Overseas is defined as
those countries not previously mentioned.
This interim final rule will allow dental claims to be paid on a
``billed charge'' basis. In order to participate, beneficiaries must be
enrolled in the Family Member Dental Plan (FMDP). In order to have care
from host nation dentists reimbursed under the FMDP, beneficiaries will
be requested to be referred by a military dental treatment facility
(DTF). This referral will be contingent upon the lack of availability
of the applicable dental services in the DTF. Beneficiaries will
receive evidence of preauthorization. Family members residing with
their active duty sponsor in remote locations where there are no DTFs
will not be required to obtain a Nonavailability Statement (NAS) to
receive care. Countries will be considered remote locations for the
purpose of NAS's when the Department does not have a significant
presence and no fixed dental treatment facilities. Family members in
these countries may obtain care from any host nation provider meeting
accepted U.S. standards. The dental claims processor, upon receiving a
claim without an attached authorization, will review the claim to
determine if it is from a family member in a remote location. Following
this verification, the claim will be processed under the ODP benefit
plan.
Basic dental care encompasses diagnostic and preventive (exams, x-
rays, cleanings, etc), sealants (for children under age 14),
restorative (fillings, crowns, etc), endodontics (root canals, etc.),
periodontics (gum surgery, etc.), oral surgery (extractions, etc.), and
prosthodontics (bridges, dentures, etc.). An annual cap (contract
year--August 1 to July 31) of $1,000 is applicable to basic dental
care. Orthodontics is available, subject to the lifetime maximum of
$1,200 per member. In the event either of these maximum caps (annual
dental or lifetime orthodontics) is insufficient to enable
beneficiaries to obtain the required dental care, the responsible
dental facility has the authority to issue a waiver on behalf of the
beneficiary. This waiver review will be accomplished on a prospective
basis, for dental care required due to extraordinary circumstances
governing the cost of dental services in a particular geographic area.
All requests from DTFs to their Service Dental chiefs for waiver
from the maximum caps will be handled in accordance with procedures
established by the Service Dental Chiefs. Waiver requests should
include the beneficiary's latest Explanation of Benefit (EOB) to
indicate the beneficiary's current value of dental care applicable to
the cap level; information on the proposed treatment; and information
on the costs of dental care in the host nation compared to overall
dental costs in the United States.
II. Rulemaking Procedures
Executive Order 12866 requires certain regulatory assessments for
any ``significant regulatory action,'' defined as one which would
result in an annual effect on the economy of $100 million or more, or
have other substantial impacts.
The Regulatory Flexibility Act (FRA) 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 is not a significant regulatory action under the provisions of
Executive Order 12866, and it would not have a significant impact on a
substantial number of small entities, however, this rule has been
reviewed by OMB.
The interim final rule will not impose additional information
collection requirements on the public under the Paperwork Reduction Act
of 1995 (44 U.S.C. Chapter 55).
The Department is publishing this rule as an interim final rule in
order to implement the program in a timely manner. Regulations
involving military affairs are exempt from the notice and comment
rulemaking procedures of the Administrative Procedures Act. Because
this rule deals exclusively with a
[[Page 39941]]
program for active duty family members accompanying military personnel
in overseas assignments, there is a heightened impact on the conduct of
affairs peculiar to military functions of the government, and a
significant reduced impact on the public. Based on this, it is
appropriate, as an exception to our normal practice of providing an
opportunity for prior public comment on all CHAMPUS regulations, to
issue this rule as an interim final rule, with a subsequent opportunity
for public comment. Public comments are invited. All comments will be
carefully considered. A discussion of the major issues received by
public comments will be included with the issuance of the permanent
final rule, anticipated approximately 90 days after the end of the
comment period.
List of Subjects in 32 CFR Part 199
Administrative practice and procedure, Claims, Fraud, Health care,
Health insurance, Individuals with disabilities, Military personnel.
Accordingly, 32 CFR part 199 is 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 199.13 is amended by adding paragraph (i) to read as
follows:
Sec. 199.13 Active duty dependents dental plan.
* * * * *
(i) Extension of the Active Duty Dependents' Dental Plan to areas
outside the United States. The Assistant Secretary of Defense (Health
Affairs) (ASD(HA)) may, under the authority of 10 U.S.C. 1076a(h),
extend the Active Duty Dependents' Dental Plan to areas other than
those areas specified in paragraph(a)(2)(i) of this section for the
eligible dependents of members of the uniformed services accompanying
the members on permanent assignment to duty in such areas. Action by
the ASD(HA) to extend the program to any such area shall be announced
through the publication of a notice in the Federal Register. In
extending the program outside the United States, the ASD(HA) is
authorized to establish program elements, methods of administration and
payment rates to providers that are different from those in effect
under this section in the United States to the extent the ASD(HA)
determines necessary for the effective and efficient operation of the
plan outside the United States. One such difference is that in areas
other than those areas specified in paragraph (a)(2)(i) of this
section, services under the active duty dependents' dental plan must be
preauthorized by a designated DOD official, who may deny
preauthorization if the needed services are available in a dental
treatment facility of the Department of Defense. Other differences may
occur based on limitations in the availability and capabilities of that
nation's civilian sector providers in certain areas. Another difference
is that a waiver of the annual maximum coverage amount for non-
orthodontic dental benefits or the lifetime maximum coverage amount for
orthodontics is authorized based on extraordinary circumstances
governing the cost of dental services in a particular geographic area.
Otherwise, rules pertaining to services covered under the plan,
beneficiary cost sharing and quality of care standards for providers
shall be comparable to those in effect under this section in the United
States. In addition, all provisions of 10 U.S.C. 1076a shall remain in
effect.
Dated: July 21, 1997.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 97-19559 Filed 7-24-97; 8:45 am]
BILLING CODE 5000-04-M