[Federal Register Volume 59, Number 170 (Friday, September 2, 1994)]
[Notices]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-21705]


[[Page Unknown]]

[Federal Register: September 2, 1994]


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DEPARTMENT OF DEFENSE
 

Civilian Health and Medical Program of the Uniformed Services 
(CHAMPUS); Demonstration Project in Europe

AGENCY: Office of the Secretary, DoD.

ACTION: Notice of a CHAMPUS demonstration project to be implemented in 
Europe.

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SUMMARY: Military force reductions in Europe have resulted in 
diminished military medical services for many areas, particularly those 
where the active duty end strength has fallen below levels which would 
support a military health clinic. Service members and their families, 
particularly those in remote areas, have experienced significant access 
problems in areas where military medical services have either been 
substantially reduced or eliminated. Although some military families 
currently use civilian providers, differences in U.S. and local 
national billing practices have resulted in payment delays which are 
unacceptable to host nation providers. Because local systems are not 
conducive to calculation and collection of beneficiary deductibles and 
cost shares, these payments by beneficiaries are often overlooked or 
substantially delayed and have become a source of major dissatisfaction 
among local providers. As a result, some local providers have indicated 
they are no longer willing to accept CHAMPUS patients while others have 
begun to require payment for services in advance. This demonstration is 
proposed for the purpose of testing whether special agreements with 
host nation medical providers and elimination of CHAMPUS deductible and 
cost shares can enhance beneficiary access to required care. Although 
earlier demonstration proposals for Europe limited participation to 
medically remote or underserved areas, payment issues which have become 
barriers to access affect all active duty families in Europe who must 
seek care in host nation hospitals and clinics. For this reason, the 
demonstration is proposed for the entire region. Demonstration 
participants will include family members of all active duty personnel 
in the uniformed services located in countries served by OCHAMPUS 
EUROPE. Under Title 10, U.S. Code, Section 1092, the Department is 
authorized to test different methods of financing delivery of health 
care services under CHAMPUS.

DATES: Beginning 1 October 1994, active duty family members in 
countries served by OCHAMPUS EUROPE who cannot obtain required services 
in military hospitals and clinics may obtain those services from 
civilian providers without paying cost shares and deductibles normally 
required under standard CHAMPUS. CHAMPUS eligible beneficiaries other 
than active duty family members are not eligible for participation. 
Standard CHAMPUS is still available for individuals who do not qualify 
under this program.

FOR FURTHER INFORMATION CONTACT:
CDR Deborah Kamin, Office of the Assistant Secretary of Defense (Health 
Affairs), (703) 697-8975.

SUPPLEMENTARY INFORMATION: Under this CHAMPUS demonstration, active 
duty family members who are unable to access services in a military 
medical treatment facility (MTF) may obtain both inpatient and 
outpatient services through local national medical facilities. Where 
possible, written agreements will be executed between these local 
national medical facilities and elements of the uniformed services in 
areas served by OCHAMPUS EUROPE. Care received under this demonstration 
project would require neither the cost share nor the deductible 
normally collected for inpatient and outpatient services under standard 
CHAMPUS.
    While the primary demonstration component, elimination of CHAMPUS 
cost shares and deductibles, applies to all active duty families, 
development of referral networks and agreements with host nation 
providers will be phased, with earliest attention directed at remote or 
underserved areas which have experienced significant reduction or 
elimination of military medical services. Initial development of 
referral networks and agreements will occur in Germany.
    Demonstration participation will be restricted to active duty 
dependents. Active duty service members will be included in provider 
agreements; separate procedures and funding will be used to account and 
process payment for care rendered to active duty personnel as required 
by current regulation. The Office of the Assistant Secretary of Defense 
(Health Affairs) will act as executive agent for purposes of this 
demonstration and will assume overall responsibility for demonstration 
policy, implementation, and monitoring.

DURATION: This demonstration will operate for one year with two 
additional option years. Continuation of the program will depend on a 
program evaluation conducted toward the end of the first year of 
operation.
    It is our hypothesis that specific agreements with local national 
providers will clarify relationships and forge stronger links between 
U.S. and host nation providers. These links will become more critical 
as troop withdrawals continue to affect U.S. military medical presence 
and capabilities in Europe. Elimination of the beneficiary cost share 
and deductible should ease a major source of conflict with respect to 
payment of host nation providers, thereby improving access to care for 
our beneficiaries. A decreasing military presence in Europe can be 
likened to a shrinking ``market power'' and, hence, less capability for 
area commanders to negotiate favorable arrangements and/or access to 
local civilian medical services. Formal agreements which clarify DoD's 
commitment to payment procedures and deadlines and a streamlined 
administrative process without copayments and deductibles should 
provide positive incentive for local facilities to accept CHAMPUS 
beneficiaries.

EXCLUSIONS TO THE EUROPE DEMONSTRATION PROJECT: Participation in this 
demonstration is limited to active duty dependents.
    All current CHAMPUS rules, unless this notice specifically provides 
otherwise, will continue to apply. This notice reflects the changes 
under this demonstration which is expected to start 1 October 1994.

    Dated: August 29, 1994.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 94-21705 Filed 9-1-94; 8:45 am]
BILLING CODE 5000-04-M