[Federal Register Volume 62, Number 121 (Tuesday, June 24, 1997)]
[Proposed Rules]
[Pages 34032-34035]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-16406]


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DEPARTMENT OF DEFENSE

Office of the Secretary

32 CFR Part 199

[DoD 6010.8-R]
RIN 0720-AA38


Civilian Health and Medical Program of the Uniformed Services 
(CHAMPUS); TRICARE Retiree Dental Program

AGENCY: Office of the Secretary, DoD.

ACTION: Proposed rule.

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SUMMARY: This proposed rule establishes the TRICARE Retiree Dental 
Program (TRDP) to provide dental care to military members entitled to 
retired pay and eligible family members and their dependents. The rule 
details operation of the program and seeks comments on our plan to 
implement the TRDP.

DATES: Comments must be received on or before July 24, 1997.

ADDRESSES: 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 the Assistant Secretary of Defense 
(Health Affairs), (703) 697-8975.

SUPPLEMENTARY INFORMATION:

I. Overview of the Proposed Rule

    Implementation of the TRICARE Retire Dental Program (TRDP) was 
directed by Congress in section 703 of the National Defense 
Authorization Act for Fiscal year 1997, Pub. L. 104-201, which amended 
title 10, United States Code, by adding section 1076c. This law 
directed the implementation of a dental program for: (1) Members of the 
Armed Forces who are entitled to retired pay, (2) Members of the 
Retired Reserve under the age of 60, (3) Eligible dependents of (1) or 
(2) who are covered by the enrollment of the member, and (4) The 
unremarried surviving spouse and eligible child dependents of a 
deceased member who dies while in status described in (1) or (2), or 
the unremarried surviving spouse and eligible child dependents who 
receive a surviving spouse annuity.
    Included in the program are the 50 United States and the District 
of Columbia, Canada, Puerto Rico, Guam and the U.S. Virgin Islands. 
Enrollment in the program is voluntary and members enrolled in the 
dental plan will be responsible for paying the full cost of the 
premiums. The premium payment may be collected pursuant to procedures 
established by the Assistant Secretary of Defense (Health Affairs). 
Dental coverage under the TRDP will provide basic dental care, to 
include diagnostic services, preventive services, basic restorative 
services (including endodontics), surgical services, and emergency oral 
examinations.
    Under this approach, where possible, members entitled to retired 
pay and eligible family members and their dependents may make use of 
participating dental providers in their areas and may benefit from 
reduced out-of-pocket costs and provider submission of claims and 
acceptance of contractor allowances and arrangements. TRDP eligibles 
will obtain information concerning the program and the application 
process from the contractor.
    This proposed rule adopts the statutory preemption authority of 10 
U.S.C., section 1103. This statute broadly authorizes preemption of 
state laws in connection with DoD contracts for medical and dental 
care. We have made the judgment that preemption is necessary and 
appropriate to assure the operation of a consistent, effective, and 
efficient federal program. In addition, the enacting legislation for 
the TRICARE Retiree Dental Program directs the Department of Defense to 
implement this program by October 1, 1997. Absent preemption of certain 
State and local laws on insurance regulation and other matters, 
competition would be severely limited and the process substantially 
delayed.

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 (RFA) 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.
    Pursuant to the Paperwork Reduction Act of 1995, the reporting and 
recordkeeping of this proposed rule have been submitted to the OMB for 
review under 3507(d) of the Act.
    In compliance with section 3506(c)(2)(A) of the Paperwork Reduction 
Act of 1995, the Office of the Assistant Secretary of Defense for 
Health Affairs announces a proposed information collection and seeks 
public comment on the provision thereof. Comments are invited on: (a) 
Whether the proposed collection is necessary for the proper performance 
of the functions of the agency, including whether the information shall 
have practical utility; (b) the accuracy of the agency's estimate of 
the burden of the proposed information collection; (c) ways to enhance 
quality, utility, and clarity of the information to be collected; and 
(d) ways to minimize the burden of the information collection on 
respondents, including through the use of automated collection 
techniques or other forms of information technology.
    The collection of information is necessary to enroll military 
members entitled to retired pay and eligible dependents in the TRICARE 
Retiree Dental Program. The application will allow the Department of 
Defense to identify enrollment applicants, evaluate their eligibility 
for the enrollment, and determine other health insurance coverage which 
an applicant may have.
    Affected Public: Eligible family members and their dependents.
    Annual Burden Hours: 71,640.
    Number of Respondents: 286,570.
    Responses Per Respondent: 1.
    Average Burden Per Response: 15 minutes.
    Frequency: Once, at time of initial application.
    Respondents are military members entitled to retired pay and 
eligible family members and their dependents who are seeking enrollment 
in the TRICARE Retiree Dental Program. The enrollment application will 
allow the Department to collect the information necessary to properly 
identify the program's applicants and to determine their eligibility 
for enrollment in the TRICARE Retiree Dental Program. In completing and 
signing a TRICARE Retiree Dental Program enrollment form, applicants 
will acknowledge that they understand the benefits offered under

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the program and the rules they must follow to continue their 
participation in the program. Initial enrollment will be for a period 
of 12 months followed by month-to-month enrollment as long as the 
enrollee chooses to continue enrollment.
    Comments on these requirements should be submitted to the Office of 
Information and Regulatory Affairs, OMB, 715 17th Street NW., 
Washington, DC 20503, marked ``Attention Desk Officer for Department of 
Defense.'' Copies should be sent to the Office of the Assistant 
Secretary of Defense (Health Affairs), 1B657 The Pentagon, Washington, 
DC 20301, ATTN: Cynthia Speight. When the Department of Defense 
promulgates the Final Rule, the Department will respond to comments by 
OMB or the public regarding the information collection provisions and 
recordkeeping requirements of the rule.
    This is a proposed rule. The Department is making an exception to 
the normal 60 day public comment period due to the statutory 
requirement for implementation by October 1, 1997. Public comments are 
invited. All comments will be considered. A discussion of the major 
issues received by public comments will be included with issuance of 
the final rule, anticipated approximately 90 days after the end of the 
comment period.

List of Subjects in 32 CFR Part 199

    Claims, Handicapped, Health insurance, and Military personnel.

    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; 10 U.S.C., Chapter 55.

    2. Part 199 is proposed to be amended by adding Sec. 199.22, as 
follows:


Sec. 199.22  TRICARE Retiree Dental Program (TRDP).

    (a) Purpose. The TRDP is a premium based indemnity dental insurance 
coverage program that will be available to retired members of the Armed 
Forces, their dependents, and certain other beneficiaries, as specified 
in paragraph (d) of this section. The TRDP is authorized by 10 U.S.C. 
1076c.
    (b) General provisions. (1) Benefits are limited to diagnostic 
services, preventive services, basic restorative services (including 
endodontics), surgical services, and emergency oral examinations, as 
specified in paragraph (f) of this section.
    (2) Premium costs for this coverage will be paid by the enrollee.
    (3) The program is applicable to authorized providers in the 50 
United States and the District of Columbia, Canada, Puerto Rico, Guam 
and the U.S. Virgin Islands.
    (4) Except as otherwise provided in this section or by the 
Assistant Secretary of Defense (Health Affairs) or designee, the TRDP 
is administered in a manner similar to the Active Duty Dependents 
Dental Plan under Sec. 199.13.
    (5) The TRDP shall be administered through a contract.
    (c) Definitions. Except as may be specifically provided in this 
section, to the extent terms defined in Secs. 199.2 and 199.13(b) are 
relevant to the administration of the TRICARE Retiree Dental Program, 
the definitions contained in those sections shall apply to the TRDP as 
they do to CHAMPUS and the TRICARE active duty dependents dental plan.
    (d) Eligibility and enrollment.--(1) Eligibility. Enrollment in the 
TRICARE Retiree Dental Program is open to:
    (i) Members of the Armed Forces who are entitled to retired pay,
    (ii) Members of the Retired Reserve under the age of 60,
    (iii) Eligible dependents of paragraph (d)(1)(i) or (ii) of this 
section who are covered by the enrollment of the member, and
    (iv) The unremarried surviving spouse and eligible child dependents 
of a deceased member who dies while in status described in paragraph 
(d)(1) (i) or (ii) of this section, or the unremarried surviving spouse 
and eligible child dependents who receive a surviving spouse annuity.
    (2) Notification of eligibility. The contractor will notify persons 
eligible to receive dental benefits under the TRICARE Retiree Dental 
Program.
    (3) Election of coverage. Following this notification, interested 
members entitled to retired pay and eligible family members and their 
dependents may elect to enroll. In order to obtain dental coverage, 
written election by the eligible beneficiary must be made.
    (4) Enrollment. Enrollment in the TRICARE Retiree Dental Program is 
voluntary and will be accomplished by submission of an application to 
the TRDP contractor. Initial enrollment shall be for a period of 12 
months followed by month-to-month enrollment as long as the enrollee 
chooses to continue enrollment.
    (5) Period of coverage. TRICARE Retiree Dental Program coverage is 
terminated when the member's entitlement to retired pay is terminated, 
the member's status as a member of the Retired Reserve is terminated, a 
dependent child loses eligible child dependent status, or in the case 
of remarriage of the surviving spouse.
    (6) Continuation of dependents' enrollment upon death of enrollee. 
Coverage of a dependent in the TRDP under an enrollment of a member or 
surviving spouse who dies during the period of enrollment shall 
continue until the end of that period and may be renewed by (or for) 
the dependent, so long as the premium paid is sufficient to cover 
continuation of the dependent's enrollment. The Secretary may terminate 
coverage of the dependent when the premiums paid are no longer 
sufficient to cover continuation of the enrollment.
    (e) Premium payments. Persons enrolled in the dental plan will be 
responsible for paying the full cost of the premiums in order to obtain 
the dental insurance.
    (1) Premium payment method. The premium payment may be collected 
pursuant to procedures established by the Assistant Secretary of 
Defense (Health Affairs) or designee.
    (2) Effects of failure to make premium payments. Failure to make 
monthly renewal premium payments will result in the enrollee's 
disenrollment from the TRDP and subject to a lock-out period of 12 
months. Following this period of time, persons eligible will be able to 
reenroll if they so choose.
    (3) Member's payment of premiums. The cost of the TRDP monthly 
premium will be paid by the enrollee. Interested beneficiaries may 
contact the dental contractor/insurer to obtain the enrollee premium 
cost.
    (f) Plan benefits. The TRDP will provide basic dental care, to 
include diagnostic services, preventive services, basic restorative 
services (including endodontics), surgical services, and emergency oral 
examinations. The following is the TRDP covered dental benefit (using 
the American Dental Association, The Council on Dental Care Program's 
Code On Dental Procedures and Nomenclature):
    (i) Diagnostic: Periodic oral examination (00120); Comprehensive 
oral examination (limited to one exam per year in the same dental 
office) (00150), Intraoral-complete series (including bitewings) 
(00210); Intraoral-periapical-first film (00220); Intraoral-periapial-
each additional film (00230); Intraoral-occlusal film (00240); 
Bitewings-single film (00270); Bitewings-two films (00272); Bitewings-
four films (00274); Panoramic film (00330); Caries susceptibility 
tests, by report (00425); Pulp vitality tests (00460).
    (ii) Preventive: Prophylaxis-adult (limit-once per year) (01110); 
Prophylaxis-child (01120); Topical application of fluoride (excluding

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prophylaxis)-child (01203); Topical application of fluoride (excluding 
prophylaxis)-adult, by report, once per year (01204); Sealant-per tooth 
(01351); Space maintainer-fixed-unilateral (01510); Space maintainer-
fixed-bilateral (01515); Space maintainer-removable-unilateral (01520); 
Space maintainer-removable-bilateral (01525); Recementation of space 
maintainer (01550).
    (iii) Restorative: Amalgam-one surface, primary (02110); Amalgam-
two surfaces, primary (02120); Amalgam-three surfaces, primary (02130); 
Amalgam-four or more surfaces, primary (02131); Amalgam-three surfaces, 
permanent (02160); Amalgam-four or more surfaces, permanent (02161); 
Resin-one surface, anterior (02330); Resin-two surfaces, anterior 
(02331); Resin-three surfaces, anterior (02332); Resin-four or more 
surfaces or involving incisal angle (anterior) (02335); Recement inlay 
(02910); Recement crown (02920); Prefabricated stainless steel crown-
primary tooth (02930); Prefabricated stainless steel crown-permanent 
tooth (02931); Prefabricated resin crown (02932); Prefabricated 
stainless steel crown with resin window (02933); Pin retention-per 
tooth, in addition to restoration (02951); Temporary crown (fractured 
tooth) (02970).
    (iv) Endodontic: Pulp cap-indirect (excluding final restoration 
(03120); Therapeutic pulpotomy (excluding final restoration) (03220); 
Anterior root canal (excluding final restoration) (03310); Bicuspid 
root canal (excluding final restoration) (03320); Molar root canal 
(Excluding final restoration) (03330); Retreatment-anterior, by report 
(03346); Retreatment-bicuspid, by report (03347); Retreatment-molar, by 
report (03348); Apexification/recalcification-initial visit (apical 
closure/calcific repair of perforations, root resorption, etc.) 
(03351); Apexification/recalcification-interim medication replacement 
(apical closure/calcific repair of performations, root resorption, 
etc.) (03352); Apexification/recalcification-final visit (includes 
completed root canal therapy-apical closure/calcific repair of 
perforations, root resorption, etc.) (03353); Apicoectomy/Periradicular 
surgery-anterior (03410); Apicoectomy/Periradicular surgery-bicuspid 
(first root) (03421); Apicoectomy/Periradicular surgery-molar (first 
root) (03425); Apicoectomy/Periradicular surgery (each additional root) 
(03426); Retrograde filling-per root (03430); Root amputation-per root 
(03450); Hemisection (including any root removal), not including root 
canal therapy (03920).
    (v) Periodontic: Gingivectomy or gingivoplasty--per quadrant 
(04210); Gingivectomy or gingivoplasty--per tooth (04211); Gingival 
curettage, surgical, per quadrant, by report (04220); Gingival flap 
procedure, including root planing--per quadrant (04240); Mucogingival 
surgery--per quadrant (04250); Osseous surgery (including flap entry 
and closure)--per quadrant (04260); Bone replacement graft--single site 
(including flap entry and closure) (04261); Bone replacement graft--
multiple sites (including flap entry and closure) (04262); Guided 
tissue regeneration (includes the surgery and reentry) (04268); Pedicle 
soft tissue graft procedure (04270); Free soft tissue graft procedure 
(including donor site) (04271); Periodontal scaling and root planing--
per quadrant (04341); Periodontal maintenance procedures (following 
active therapy) (04910); Unscheduled dressing change (by someone other 
than treating dentist) (04920).
    (vi) Oral Surgery: Single tooth (07110); Each additional tooth 
(07120); Root removal--exposed roots (07130); Surgical removal or 
erupted tooth requiring elevation of mucoperiosteal flap and removal of 
bone and/or section of tooth (07210); Removal of impacted tooth--soft 
tissue (07220); Removal of impacted tooth--partially bony (07230); 
Removal of impacted tooth--completely bony (07240); Surgical removal of 
residual tooth roots (cutting procedure) (07250); Oral antral fistula 
closure (07260); Tooth reimplantation and/or stabilization of 
accidentally evulsed or displaced tooth and/or alveolus (07270); 
Surgical exposure of impacted or erupted tooth to aid eruption (07281); 
Biopsy of oral tissue--hard (07285); Biopsy of oral tissue--soft 
(07286); Surgical repositioning of teeth (07290); Alveoloplasty in 
conjunction with extractions--per quadrant (07310); Suture of recent 
small wounds up to 5 cm (07910); Complicated suture--up to 5 cm 
(07911); Complicated suture--greater than 5 cm (07912); Excision of 
pericoronal gingiva (07971).
    (vii) Emergency: Emergency oral examination (00130); Palliative 
(emergency) treatment of dental pain--minor procedures (09110).
    (viii) Drugs: Therapeutic drug injection, by report (09610); Other 
drugs and/or medications, by report (09630).
    (ix) Postsurgical: Treatment of complications (post-surgical) 
unusual circumstances, by report (09930).
    (g) Maximum annual cap. TRDP enrollees will be subject to a maximum 
cap of $1,000.00 of paid allowable charges per enrollee per year, with 
the exception of the diagnostic and preventive services.
    (h) Annual review of rates. TRDP premiums will be determined as 
part of the competitive contracting process. The contractor will 
annually notify those eligible for TRDP of the premium rates.
    (i) Authorized providers. The TRDP enrollee may seek covered 
services from any provider who is fully licensed and approved to 
provide dental care in the state where the provider is located.
    (j) Benefit payment. Enrollees are not required to utilize the 
special network of dental providers established by the TRDP contractor. 
For enrollees who do not use these network providers, however, 
providers shall not balance bill any amount in excess of the maximum 
payment allowable by the TRDP. Enrollees using non-network providers 
may be balance billed such an amount. The maximum payment allowable by 
the TRDP (minus the appropriate cost-share) will be the lesser of:
    (1) billed charges or
    (2) Usual, Customary and Reasonable rates, in which the customary 
rate is calculated at the 85th percentile of billed charges in that 
geographic area, as measured in an undiscounted charge profile in 1995 
or later for that geographic area (as defined by three-digit zip code).
    (k) Appeal and hearing procedures. All levels of appeals and 
grievances established by the Contractor for internal review shall be 
exhausted prior to forwarding to OCHAMPUS for a final review. 
Procedures comparable to those established under Sec. 199.13(h) shall 
apply.
    (l) Preemption of State laws. Pursuant to 10 U.S.C., section 1103, 
any state or local law or regulation pertaining to health or dental 
insurance, prepaid health or dental plans, or other health or dental 
care delivery, administration, and financing methods is preempted and 
does not apply in connection with the TRICARE Retiree Dental Program 
contract. Any such law, or regulation pursuant to such law, is without 
any force or effect, and State or local governments have no legal 
authority to enforce them in relation to the TRICARE Retiree Dental 
Program contract. (However, the Department of Defense may, by contract, 
establish legal obligations on the part of the TRICARE Retiree Dental 
Program contractor to conform with requirements similar to or identical 
to requirements of State or local laws or regulations).
    (m) Administration. The Assistant Secretary of Defense (Health 
Affairs) or designee may establish other rules and

[[Page 34035]]

procedures for the administration of the TRICARE Retiree Dental 
Program.

    Dated: June 18, 1997.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 97-16406 Filed 6-23-97; 8:45 am]
BILLING CODE 5000-04-M