[Federal Register Volume 63, Number 97 (Wednesday, May 20, 1998)]
[Rules and Regulations]
[Pages 27677-27679]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-13377]


=======================================================================
-----------------------------------------------------------------------

DEPARTMENT OF DEFENSE

Office of the Secretary

32 Part 199

RIN 0720-AA43
[DoD 6010.8-R]


Civilian Health and Medical Program of the Uniformed Services 
(CHAMPUS); Waiver of Collection of Payments Due From Certain Persons 
Unaware of Loss of CHAMPUS Eligibility

AGENCY: Office of the Secretary, DoD.

ACTION: Final rule.

-----------------------------------------------------------------------

SUMMARY: This final rule authorizes the waiver of collection of 
payments due from individuals who lost their CHAMPUS eligibility when 
they became eligible for Medicare Part A, due to disability or end 
stage renal disease.

EFFECTIVE DATE: This final rule is effective June 19, 1998.

ADDRESSES: TRICARE Management Activity, 1B657 Pentagon, Washington, DC 
20301-1200.

FOR FURTHER INFORMATION CONTACT: Cynthia P. Speight, TRICARE Management 
Activity, (703) 697-8975.

SUPPLEMENTARY INFORMATION:

I. Overview of the Final Rule

    Formerly, under Title 10 United States Code, Section 1086(d), a 
beneficiary lost eligibility for CHAMPUS when he or she became eligible 
for Medicare Part A, including when eligibility was due to disability 
or

[[Page 27678]]

end stage renal disease. Payments made after the beneficiary attained 
eligibility for Medicare Part A were erroneous payments and subject to 
collection under the Federal Claims Collection Act. In 1991, Congress 
amended 10 U.S.C. 1086(d) to provide that those persons eligible for 
Medicare by reason of disability or end stage renal disease who are 
enrolled in the supplementary medical insurance program under Medicare 
Part B retain eligibility for CHAMPUS, secondary to Medicare coverage. 
Section 743 of the National Defense Authorization Act for Fiscal Year 
1996, Pub. L. 104-106, provides authority, effective February 10, 1996, 
to waive the collection of erroneous civilian health care benefits from 
a person under age 65 who lost eligibility for civilian care due to 
eligibility for Medicare as a result of disability or end stage renal 
disease. The period of this waiver authority begins January 1, 1967, 
and ends on the later of July 1, 1996, or the termination date of any 
special enrollment Medicare period established by law for such person.
    Since most payments made under CHAMPUS are paid directly to 
participating providers of care, and not to the beneficiary, the rule 
also provides for the waiver of collection of such payments made to 
participating providers. These providers are paid based on a 
contractual agreement of benefits by the beneficiaries. If the claim 
for these benefits cannot be paid due to ineligibility of the 
beneficiary, the beneficiary indebtedness to the provider would remain. 
Thus, the authority to relieve disabled CHAMPUS beneficiaries from the 
indebtedness arising from these erroneous payments does not depend upon 
who actually received the payments.

II. Public Comments

    The proposed rule was published on December 4, 1997 (62 FR 64191). 
We did not receive any public comments.

III. Rulemaking 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 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 rule is not significant regulatory 
action under E.O. 12886, nor would it have a significant impact on 
small entities. The changes set forth in the final rule are minor 
revisions to the existing regulation. In addition, this final rule does 
not impose new information collection requirements for purposes of the 
Paperwork Reduction Act of 1995.

List of Subjects in 32 CFR Part 199

    Claims, Handicapped, Health insurance, Military personnel.

PART 199--[AMENDED]

    Accordingly, 32 CFR Part 199 is amended a 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 199.11 is amended as follows:
    a. By revising paragraphs (b)(1) and (g) introductory heading.
    b. By redesignating paragraphs (g)(3), (g)(4), (g)(5), (g)(6), 
(g)(7), (g)(8) and (g)(9) as (g)(4), (g)(5), (g)(6), (g)(7), (g)(8), 
(g)(9) and (g)(10).
    c. By adding paragraph (g)(3) and revising newly redesignated 
paragraph (g)(10).


Sec. 199.11  Overpayments recovery.

* * * * *
    (b) * * *
    (1) Federal statutory authority. The Federal Claims Collection Act 
provides the basic authority under which claims may be asserted 
pursuant to this section. It is implemented by joint regulations issued 
by the Department of Justice and the General Accounting Office, 4 CFR 
parts 101-105. Thereunder, the heads of federal agencies or their 
designees are required to attempt collection of all claims of the 
United States for money or property arising out of the activities of 
their respective agencies. These officials may, with respect to claims 
that do not exceed $20,000, exclusive of interest, and in conformity 
with the standards promulgated in the joint regulations, compromise, 
suspend, or terminate collection action on such claims. Section 743 of 
the National Defense Authorization Act for Fiscal Year 1996 (Public Law 
104-106) authorizes the waiver (see paragraph (g)(3) of this section) 
of collection of overpayments otherwise due from a person after the 
termination of the person's CHAMPUS eligibility, because the person 
became eligible for Medicare Part A by reason of disability or end-
stage renal disease.
* * * * *
    (g) Compromise, waiver, suspension or termination of collection 
actions arising under the Federal Claims Collection Act. * * *
* * * * *
    (3) Waiver of collection of erroneous payments due from certain 
persons unaware of loss of CHAMPUS eligibility.
    (i) The Director, OCHAMPUS may waive collection of payments 
otherwise due from certain persons as a result of health benefits 
received under this part after the termination of the person's 
eligibility for such benefits. Waiver may be granted if collection of 
such payments would be against equity and good conscience and not in 
the best interest of the United States. These criteria are met by a 
finding that there is no indication of fraud, misrepresentation, fault, 
or lack of good faith on the part of the person who received the 
erroneous payment or any other person having an interest in obtaining 
such waiver.
    (ii) Persons eligible for waiver. The following persons are 
eligible for waiver:
    (A) A person who:
    (1) Is entitled to Medicare Part A by reason of disability or end 
stage renal disease;
    (2) In the absence of such entitlement, would have been eligible 
for CHAMPUS under 10 U.S.C. 1086; and
    (3) At the time of the receipt of such benefits, was under age 65.
    (B) Any participating provider of care who received direct payment 
for care provided to a person described in paragraph (g)(ii)(A) of this 
section pursuant to an assignment of benefits from such person.
    (iii) The authority to waive collection of payments under this 
section shall apply with regard to health benefits provided during the 
period beginning January 1, 1967, and ending on the later of: the 
termination date of any special enrollment period for Medicare Part B 
provided specifically for such persons; or July 1, 1996.
* * * * *
    (10) Effect of compromise, waiver, suspension or termination of 
collection action. Pursuant to the Internal Revenue Code, 26 U.S.C. 
6041, compromises and terminations of undisputed debts not discharged 
in a Title 11 bankruptcy case and totaling $600 or more for the year 
will be reported to the Internal Revenue Service in the manner 
prescribed for inclusion in the debtor's gross income for that year. 
Any action taken under paragraph (g) of this section regarding the 
compromise of a federal claim, or waiver or suspension or termination 
of collection action on a federal claim is not an initial determination 
for purposes of the appeal procedures Sec. 199.10.
* * * * *

[[Page 27679]]

    Dated: May 14, 1998.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 98-13377 Filed 5-19-98; 8:45 am]
BILLING CODE 5000-04-M