[Federal Register Volume 59, Number 2 (Tuesday, January 4, 1994)]
[Notices]
[Page 297]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-57]


[[Page Unknown]]

[Federal Register: January 4, 1994]


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DEPARTMENT OF DEFENSE

Office of the Secretary

 

Civilian Health and Medical Program of the Uniformed Services 
(CHAMPUS)

AGENCY: Office of the Secretary, DoD.

ACTION: Notice of the TRICARE Demonstration Project in California and 
Hawaii.

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SUMMARY: Notice was previously given in the Federal Register (53 FR 
23783-23784) of June 24, 1988, that a demonstration project, called the 
CHAMPUS Reform Initiative (CRI), would be conducted by contract under 
the provisions of chapter 55, title 10, section 1092, to test a 
different method for financing and delivering health services under the 
Civilian Health and Medical Program of the Uniformed Services 
(CHAMPUS). Delivery of services under that contract began August 1, 
1988, for all beneficiaries who reside in the states of California and 
Hawaii, and is scheduled to end January 31, 1994. The TRICARE 
demonstration project in California and Hawaii is a continuation of the 
CRI demonstration project and includes five option periods, the 
execution of which would result in five years of service delivery under 
the new contract. An evaluation of the significant new features of the 
demonstration will be conducted. The objectives of the demonstration 
are to enhance beneficiary access and continuity of care, contain 
health care costs, and improve coordination between the military and 
civilian components of the Military Health Services System (MHSS).

DATES: February 1, 1994, for CHAMPUS beneficiaries in California and 
Hawaii.

FOR FURTHER INFORMATION CONTACT:
Richard E. Bellamy, Chief, Coordinated Care Branch, OCHAMPUS, Aurora, 
CO, 80045-6900, telephone (303) 361-1336.

SUPPLEMENTARY INFORMATION: The Federal Register Notice referenced above 
described in detail the CRI demonstration project, which includes a 
choice for beneficiaries of three benefit options; CHAMPUS Prime, a 
health maintenance organization (HMO) benefit; CHAMPUS Extra, a 
preferred provider organization (PPO) benefit; and standard CHAMPUS, an 
indemnity benefit. The benefit options under this TRICARE demonstration 
(called TRICARE Prime, TRICARE Extra, and TRICARE Standard) are the 
same as those described in the Federal Register Notice for the CRI 
demonstration. There are only five significant differences for 
beneficiaries and providers between the CRI demonstration project and 
the TRICARE demonstration project in California and Hawaii:

--The new contractor is Aetna Government Health Plans. Aetna 
subcontracts with Hawaii Medical Service Association (HMSA) for the 
provision of health care in Hawaii, and with Blue Cross and Blue Shield 
of South Carolina (operating under the name of Palmetto Government 
Benefits Administrators) for claims processing services.
--Beneficiaries with a civilian Primary Care Manager (PCM) will need a 
referral in order to obtain covered services at a Military Treatment 
Facility (MTF) or a PRIMUS/NAVCARE clinic (except for emergency 
services, or for pharmacy services obtained at an MTF).
--MTF Commanders may consider the availability of health care from 
civilian network providers, in addition to availability from MTF 
providers, in determining whether to issue a Nonavailability Statement 
(NAS) to beneficiaries. Standard NAS procedures for beneficiaries 
apply.
--The CHAMPUS home health care demonstration (as outlined in the 
CHAMPUS Operations Manual, Part Two, Chapter 20, Addendum B) is 
included in this demonstration.
--Beneficiaries who receive care from network providers in the states 
of California and Hawaii, but who are not residents of those states, 
obtain the TRICARE Extra benefits (payments based on discounted 
provider rates and reduced coinsurance).

Duration

    It is expected that the demonstration status of this program will 
end upon promulgation of final regulations, expected in 1994, which 
will provide permanent authority for implementation of managed care 
enrollment programs by the Department. In any event, the effect of this 
Notice shall expire September 30, 1994.

    Dated: December 27, 1993.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 94-57 Filed 1-3-94; 8:45 am]
BILLING CODE 5000-04-M