[Federal Register Volume 61, Number 215 (Tuesday, November 5, 1996)]
[Proposed Rules]
[Pages 56929-56930]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-28301]


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DEPARTMENT OF DEFENSE

Office of the Secretary

32 CFR Part 199

[DoD 6010.8-R]
RIN-0720-AA73


Civilian Health and Medical Program of the Uniformed Services 
(CHAMPUS); Health Promotion and Disease Prevention Visits and 
Immunizations

AGENCY: Office of the Secretary, DoD.

ACTION: Proposed rule.

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SUMMARY: This proposed rule expands well-baby visits and immunizations 
to dependents under the age of six and improves access to preventive 
benefits for dependents age six and above to include health promotion 
and disease prevention visits in connection with immunizations, pap 
smears and mammograms.

DATES: Written comments will be accepted until January 6, 1997.

ADDRESSES: Forward comments to the Office of Health Services Financing 
Policy, Department of Defense, Room 1B657 Pentagon, Washington, DC 
20301-1200.

FOR FURTHER INFORMATION CONTACT: Cynthia P. Speight, Office of 
Assistant Secretary of Defense (Health Affairs), (703) 697-8975.

SUPPLEMENTARY INFORMATION: On February 10, 1996, P.L. 104-106 was 
signed into law. Section 701 of that law extends coverage of ``well-
baby visits'' and immunizations for an additional three years, from up 
to two years of age to under six years of age. Section 701 also 
provides for additional preventive care services under the Basic 
CHAMPUS Program (see Sec. 199.4) for dependents six years of age or 
older. This rule implements provisions of Public Law 104-106 by 
changing ``well-baby care'' to ``well-child care'' and by providing for 
additional preventive care services for dependents six years of age or 
older. This rule improves availability of immunizations and other 
preventive services, particularly for children. While these services 
have previously been available in military hospitals and clinics, 
access has depended on proximity to military medical treatment 
facilities with available space and services. Access, therefore, has 
not been uniformly attainable for all beneficiaries.
    These proposed preventive services and immunizations are based on 
recommendations of the U.S. Preventive Services Task Force which set 
national health goals in their report Healthy People 2000. Broad goals 
set by Healthy People 2000 included an increase in the span of healthy 
life for Americans, reduction in health disparities among Americans, 
and access to preventive services for all Americans. This rule 
strengthens existing programs within the Department and contributes 
significantly to national efforts toward meeting these goals.

Regulatory Procedures

    Executive Order 12866 requires that a regulatory impact analysis be 
performed on any significant regulatory action, defined as one which 
would have an annual effect on the economy of $100 million or more, or 
have other significant effects.
    The Regulatory Flexibility Act requires that each federal agency 
prepare a regulatory flexibility analysis when the agency issues 
regulations which would have a significant impact on a substantial 
number of small entities. This proposed rule is not a significant 
regulatory action under E.O. 12866, nor would it have a significant 
impact on small entities. In addition, this proposed rule does not 
impose new information collection requirements for purposes of the 
Paperwork Reduction Act of 1980 (44 U.S.C. 3501-3511). This is a 
proposed rule. All public comments are invited.

[[Page 56930]]

List of Subjects in 32 CFR Part 199

    Claims, Handicapped, Health insurance, Military personnel.

PART 199--[AMENDED]

    Accordingly, 32 CFR Part 199 is amended as follows:
    1. The authority citation for part 199 continues to read as 
follows:

    Authority: 5 U.S.C. 301; and 10 U.S.C. Chapter 55.

    2. Section 199.2(b) is proposed to be amended by revising the 
definition for ``well-baby care'' as follows:


Sec. 199.2  Definitions.

* * * * *
    (b) * * *
    Well-child care. A specific program of periodic health screening, 
developmental assessment, and routine immunization for children under 
six years of age.
* * * * *
    3. Section 199.4 is proposed to be amended by revising the heading 
of paragraph (c)(2), paragraphs (c)(2) (xiii), (c)(2)(xvi), (c)(3)(xi), 
(g)(37), and (g)(47).


Sec. 199.4  Basic program benefits.

* * * * *
    (c) * * *
    (2) Covered services of physicians and other authorized 
professional providers.
* * * * *
    (xiii) Well-child care.
* * * * *
    (xvi) Routine eye examinations. Coverage for routine eye 
examinations is limited to dependents of active duty members, to one 
examination per calendar year per person, and to services rendered on 
or after October 1, 1984, except as provided under paragraph (c)(3)(xi) 
of this section.
    (3) * * *
* * * * *
    (xi) Well-child care. Benefits routinely are payable for well-child 
care from birth to under six years of age. These periodic health 
examinations are designed for prevention, early detection and treatment 
of disease and consist of screening procedures, immunizations and risk 
counseling.
    (A) The following services are payable when required as a part of 
the specific well-child care program and when rendered by the attending 
pediatrician, family physician, or a pediatric nurse practitioner.
    (1) New born examination, heredity and metabolic screening, and 
newborn circumcision.
    (2) Periodic health supervision visits intended to promote the 
optimal health for infants and children to include the following 
services:
    (i) History and physical examination.
    (ii) Vision, hearing, and dental screening.
    (iii) Developmental appraisal to include body measurement.
    (iv) Immunizations as recommended by the Centers for Disease 
Control and Prevention (CDC) Advisory Committee on Immunization 
Practices.
    (v) Pediatric blood lead level test.
    (vi) Tuberculosis screening.
    (vii) Blood pressure screening.
    (viii) Measurement of hemoglobin and hematocrit for anemia.
    (ix) Urinalysis.
    (x) Health guidance and counseling.
    (B) Additional services or visits required because of specific 
findings or because the particular circumstances of the individual case 
are covered if medically necessary and otherwise authorized for 
benefits under CHAMPUS.
    (C) The Director, OCHAMPUS will determine when such services are 
separately reimbursable apart from the health supervision visit.
* * * * *
    (g) * * *
* * * * *
    (37) Preventive care. Preventive care, such as routine, annual, or 
employment-requested physical examinations; routine screening 
procedures; except that the following are not excluded:
    (i) Well-child care.
    (ii) Immunizations for individuals age six and older, as 
recommended by the Centers for Disease Control and Prevention Advisory 
Committee on Immunization Practices.
    (iii) Rabies shots.
    (iv) Tetanus shot following an accidental injury.
    (v) Rh immune globulin.
    (vi) Genetic tests as specified in paragraph (e)(3)(ii) of this 
section.
    (vii) Immunizations and physical examinations provided when 
required in the case of dependents of active duty military personnel 
who are traveling outside the United States as a result of an active 
member's duty assignment and such travel is being performed under 
orders issued by a Uniformed Service.
    (viii) Screening mammography for asymptomatic women 40 years of age 
and older when provided under the terms and conditions contained in the 
guidelines adopted by the Director, OCHAMPUS.
    (ix) Cancer screening papanicolaou (PAP) test for women who are or 
have been sexually active, and women 18 years of age and older when 
provided under the terms and conditions contained in the guidelines 
adopted by the Director, OCHAMPUS.
    (x) Other cancer screenings authorized by 10 U.S.C. 1079.
    (xi) Health promotion and disease prevention visits (which may 
include all of the services provided pursuant to Sec. 199.18(b)(2)) may 
be provided in connection with immunizations and cancer screening 
examinations authorized by paragraphs (g)(37)(ii) or (g)(37) (viii) 
through (x).
* * * * *
    (47) Eye and hearing examinations. Eye and hearing examinations 
except as specifically provided in paragraphs (c)(2)(xvi) and 
(c)(3)(xi) of this section, or except when rendered in connection with 
medical or surgical treatment of a covered illness or injury.
* * * * *
    Dated: October 30, 1996.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 96-28301 Filed 11-4-96; 8:45 am]
BILLING CODE 5000-04-M