[Federal Register Volume 62, Number 165 (Tuesday, August 26, 1997)]
[Proposed Rules]
[Pages 45196-45197]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-22631]


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DEPARTMENT OF DEFENSE

Office of the Secretary

32 CFR Part 199

RIN 0720-AA41


Civilian Health and Medical Program of the Uniformed Services 
(CHAMPUS); Exception to the CHAMPUS Dual Compensation/Conflict of 
Interest Provisions

AGENCY: Office of the Secretary, DoD.

ACTION: Proposed Rule.

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SUMMARY: This proposed rule provides an exception to the CHAMPUS dual 
compensation/conflict of interest provisions. This exception is for 
part-time physician employees of government agencies.

DATES:  Comments must be submitted on or before October 27, 1997.

ADDRESSES: Forward comments to the Office of the Civilian Health and 
Medical Program of the Uniformed Services (OCHAMPUS), Program 
Development Branch, Aurora, CO 80045-6900.

FOR FURTHER INFORMATION CONTACT: Stephen E. Isaacson, Program 
Development Branch, OCHAMPUS, telephone (303) 361-1172.

SUPPLEMENTARY INFORMATION:  This proposed rule provides for an 
exception to the CHAMPUS dual compensation/conflict of interest 
provisions. Currently, any individual who is a civilian employee of the 
United States government cannot be authorized by CHAMPUS as a provider 
of medical services. The justification for this prohibition is twofold. 
First, it is believed that such individuals should not receive 
additional government compensation above their normal pay and 
allowances for providing medical services to CHAMPUS beneficiaries. 
Second, payment for services provided to CHAMPUS beneficiaries poses 
potential or actual conflict of interest situations since there is a 
potential for personal gain by government employees by referring 
patients to their private (i.e., non-government) practice.
    Clearly there could be situations where a government employee 
provides services to a CHAMPUS beneficiary without a conflict of 
interest. However, the number of claims processed by

[[Page 45197]]

CHAMPUS makes reviewing the status of the provider and circumstances of 
the services for each claim administratively unrealistic. Therefore, 
this prohibition has been applied universally to all providers.
    We propose to provide an exception to this prohibition. There are 
situations where government agencies can meet their needs only by 
employing physicians on a part-time basis. For example, an agency may 
need the services of a physician in a certain specialty but cannot 
justify employing the physician on a full-time basis. These part-time 
employees maintain a private practice in which it is reasonable to 
expect that they will encounter CHAMPUS beneficiaries unrelated to 
their government employment. Therefore, we propose to permit these 
individuals to be authorized CHAMPUS providers if they meet three 
conditions. First, they must be employed by the government agency on a 
part-time basis--that is, less than twenty (20) hours per week. We have 
selected 20 hours as the limit, because we want to ensure that these 
physicians are truly part-time employees needed to fill a specific 
requirement. If the agency needs the services of an employee for twenty 
or more hours per week, we believe a full-time employee should be 
utilized. Second, the agency must certify that unique or special 
circumstances detrimental to the delivery of quality health care exist 
that can be overcome only by employing part-time, non-government, 
physicians. Third, the agency and the physician must certify that they 
understand and have taken appropriate measures to avoid violation of 
Standards of Conduct, dual compensation, and conflict of interest 
requirements including protection against referral of patients to the 
employee's private practice.
    Providers must certify on each CHAMPUS claim that he/she is not an 
employee of the government. In those cases where an exception to this 
prohibition has been granted, the provider will be required to certify 
on the CHAMPUS claim that an exception has been granted.
    Exceptions can be granted only to physicians, and no exceptions 
will be granted retroactively. In addition, this exception provision 
applies to part-time physicians employed by all U.S. government 
agencies, such as those employed by the Department of Veterans Affairs 
which probably has the most frequent need for it.
    It is our intention to delegate approval of all exceptions to the 
CHAMPUS fiscal intermediaries and managed care contractors. Therefore, 
requests for exceptions, including the necessary certifications, must 
be sent to the appropriate CHAMPUS FI/Contractor.

Regulatory Procedures

    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.
    This proposed rule is not a significant regulatory action under 
Executive Order 12866. The changes set forth in this proposed rule are 
minor revisions to the existing regulation. Since this proposed rule 
does not impose information collection requirements, it does not need 
to be reviewed by the Executive Office of Management and Budget under 
authority of the Paperwork Reduction Act of 1995 (44 U.S.C., Chapter 
35).

List of Subjects in 32 CFR Part 199

    Claims, Handicapped, Health Insurance, and 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; 10 U.S.C. chapter 55.

    2. Section 199.6 is amended by revising paragraph (a)(3) to read as 
follows:


Sec. 199.6  Authorized providers.

* * * * *
    (a) * * *
    (3) Dual compensation/conflict of interest. 5 U.S.C. 5536 prohibits 
medical personnel who are active duty Uniformed Service members or 
civilian employees of the Government from receiving additional 
Government compensation above their normal pay and allowances for 
medical care furnished. In addition, Uniformed Service members and 
civilian employees of the Government are generally prohibited by law 
and agency regulations and policies from participating in apparent or 
actual conflict of interest situations in which a potential for 
personal gain exists or in which there is an appearance of impropriety 
or incompatibility with the performance of their official duties or 
responsibilities. Active duty Uniformed Service members (including a 
reserve member while on active duty) and civilian employees of the 
United States Government shall not be authorized to be CHAMPUS 
providers except as provided in this paragraph (a)(3). An exception to 
this policy may be made by the Director, OCHAMPUS, on a case-by-case 
basis only for a physician employed by the Government on a part-time 
basis (i.e., less than 20 hours per week) when the employing agency 
requests an exception based on unique or special circumstances 
detrimental to the delivery of quality health care, and the employing 
agency and the physician have certified that they understand and have 
taken appropriate measures to avoid violation of Standards of Conduct, 
dual compensation, and conflict of interest requirements including 
protection against referral of patients to the employee's civilian 
practice. A provider shall certify on each CHAMPUS claim that he/she is 
not an active duty Uniformed Service member or civilian employee of the 
Government. For those physicians who are part-time government employees 
and have been granted an exception, the provider shall certify on each 
CHAMPUS claim that an exception has been granted.
* * * * *
    Dated: August 20, 1997.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 97-22631 Filed 8-25-97; 8:45 am]
BILLING CODE-5000-04-M