[Federal Register Volume 62, Number 172 (Friday, September 5, 1997)]
[Rules and Regulations]
[Pages 46877-46879]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-23521]
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DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 199
[DoD 6010.8-R]
RIN 0720-AA33
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: Final rule.
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SUMMARY: This final 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, mammograms, and colon and prostate cancer screenings.
DATES: This final rule is effective October 6, 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:
A. Provisions of Proposed Rule
On February 10, 1996, Pub.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 Pub.L. 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. This rule improves access by authorizing coverage of
these services by all TRICARE benefit options,
[[Page 46878]]
subject to their respective copay requirements. This rule also
implements provisions of P.L. 104-201 by expanding preventive health
care services covered by TRICARE/CHAMPUS to include colon and prostate
cancer screening.
These preventive services and immunizations are based on
recommendations of the U.S. Preventive Services Task Force which
participated in setting national health goals in the report Healthy
People 2000. Broad goals set by Health 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.
B. Public Comments
The proposed rule was published on November 5, 1996 (61 FR 56929-
56930). We received one public comment. We thank the commenter;
significant items raised by the commenter and our analysis of the
comments are summarized below in the appropriate sections of the
preamble.
1. Screening Mammography. We received a comment expressing
confusion regarding the provision relating to screening mammography for
asymptomatic women 40 years of age and older and its correlation with
the TRICARE/CHAMPUS Policy Manual. The commenter maintains that a
baseline screening mammogram should be obtained by a woman at 35 years.
Response: We agree that high risk women, especially those with
family history of breast cancer in a first degree relative, should
receive a baseline mammogram at 35, and have included this language.
For asymptomatic women routine screening at age 40 is consistent with
nationally recognized guidelines. The TRICARE/CHAMPUS policy manual has
been modified to reflect this policy.
2. Screening Mammography. The commenter pointed out that since
October 1, 1994, the Mammography Quality Standards Act of 1992 (P.L.
102-539) has required mammography facilities to be certified by the
Secretary of the Department of Health and Human Services rather than
the American College of Radiology.
Response: We appreciate the comment and this change will be made in
TRICARE/CHAMPUS policy manual.
3. Cancer Screening Papanicolaou Test--Diagnostic Pap Smear
Coverage. The commenter expressed concern that diagnostic Pap smear
coverage would not be applicable to women under the age of 18.
Response: All diagnostic Pap smears are covered regardless of age.
4. Cancer Screening Papanicolaou Test--Women at Risk. Another
comment we received recommended expanding the list of risk factors that
increase the chances that a women will develop cervical cancer and
necessitate close monitoring of her health status with an annual Pap
smear.
Response: We agree with this recommendation and have modified the
final rule to expand coverage of Pap smears to include women who are at
risk for sexually transmissible disease, women who have or have had
multiple sexual partners (or if their partner has or has multiple
sexual partners), and women who smoke cigarettes.
5. Cancer Screening Papanicolaou--Test--Copayment. We received a
comment expressing opposition to requiring beneficiaries to make
copayments to obtain Pap smears.
Response: For those who enroll in TRICARE Prime, there is no
copayment for Pap smears. Sections 1079(b) and 1086(b) of Title 10,
U.S.C. prevent the Department from waiving copayments for those who
participate in TRICARE Extra or TRICARE Standard.
C. Provisions of Final Rule
This final 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, mammograms, and colon and prostate cancer screenings. Minor
administrative changes have been made as a result of interagency
comments.
We modified the final rule to include physician assistants and
family nurse practitioners in the group of providers who can receive
reimbursement for preventive services as part of the well-child care
program. In addition, we modified the provision pertaining to periodic
health supervision visits under the well-child care program.
Specifically, we defined ``periodic'' according to American Academy of
Pediatrics (AAP) guidelines and included mental health assessment, risk
assessment for lead exposure, and breastfeeding and nutrition
counseling to the services covered under the periodic health
supervision visits.
D. 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 final rule is not a significant
regulatory action under E.O. 12866, nor would it have a significant
impact on small entities. In addition, this final rule does not impose
new information collection requirements for purposes of the Paperwork
Reduction Act of 1980 (44 U.S.C. 3501-3511).
List of Subjects in 32 CFR Part 199
Claims, Handicapped, Health insurance, Military personnel.
PART 199--[AMENDED]
According, 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 amended by removing the definition for
``well-baby care'' and adding the definition for ``well-child care'' in
alphabetical order as follows:
Sec. 199.2 Definitions.
* * * * *
(b) * * *
Well-child care. A specific program of periodic health screening,
developmental assessment, and routine immunization for dependents under
six years of age.
* * * * *
3. Section 199.4 is amended by revising the heading of (c)(2), and
revising paragraphs (c)(2)(xiii), (c)(2)(xvi), (c)(3)(xi), (g)(37), and
(g)(47) to read as follows:
Sec. 199.4 Basic program benefits.
* * * * *
(c) * * *
(2) Covered services of physicians and other authorized profession
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.
[[Page 46879]]
(3) * * *
(xi) Well-child care. Benefits routinely are covered 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 covered when required as a part of
the specific well-child care program and when rendered by the attending
pediatrician, family physician, certified nurse practitioner, or
certified physician assistant.
(1) Newborn examination, heredity and metabolic screening, and
newborn circumcision.
(2) Periodic health supervision visits, in accordance with American
Academy of Pediatrics (AAP) guidelines, intended to promote the optimal
health for infants and children to include the following services:
(i) History and physical examination and mental health assessment.
(ii) Vision, hearing, and dental screening.
(iii) Developmental appraisal to include body measurement.
(iv) Immunizations as recommenced by the Centers for Disease
Control (CDC).
(v) Pediatric risk assessment for lead exposure and 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, including breastfeeding and
nutrition 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 Deputy Assistant Secretary of Defense, Health Services
Financing, 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 CDC.
(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
duty member's 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, and for high risk women 35 years of age and older, when
provided under the terms and conditions contained in the guidelines
adopted by the Deputy Assistant Secretary of Defense, Health Services
Financing.
(ix) Cancer screening Papanicolaou (PAP) test for women who are at
risk for sexually transmissible diseases, women who have or have had
multiple sexual partners (or if their partner has or has had multiple
sexual partners), women who smoke cigarettes, and women 18 years of age
and older when provided under the terms and conditions contained in the
guidelines adopted by the Deputy Assistant Secretary of Defense, Health
Services Financing.
(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) of this section or
(g)(37) (viii) through (x) of this section.
* * * * *
(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: August 29, 1997.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 97-23521 Filed 9-4-97; 8:45 am]
BILLING CODE 5000-04-M