[Federal Register Volume 64, Number 137 (Monday, July 19, 1999)]
[Rules and Regulations]
[Pages 38575-38576]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-18250]
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DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 199
RIN 0720-AA36
Civilian Health and Medical Program of the Uniformed Services
(CHAMPUS); Extension of the Active Duty Dependents Dental Plan to
Overseas Areas
agency: Office of the Secretary, DoD.
action: Final rule.
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summary: This final rule implements statutory authority for the
extension of the Active Duty Dependents Dental Plan to overseas areas.
effective date: September 1, 1997.
addresses: TRICARE Management Activity, 16401 East Centretech, Aurora,
CO 80011.
for further information contact: Lt. Col. Brian Grassi, TRICARE
Management Activity, (303) 676-3496.
supplementary information:
I. Overview of the Final Rule
On June 25, 1997, an interim final rule regarding the benefit and
operational issues associated with the implementation of the extension
of the Active Duty Dependents Dental Plan to overseas areas was
published (62 FR 33940).
Military force reductions in Europe, the Middle East, and the
Pacific have resulted in diminished medical services for many areas,
particularly those areas where the active duty end strengths have
fallen below levels which would support a military medical facility.
Service members and their families, particularly those in remote areas,
have experienced access problems in obtaining dental services at
military facilities. This rule is based on section 703 of the National
Defense Authorization Act for Fiscal Year 1995, Pub. L. 103-337, and
section 732 of the National Defense Authorization Act for Fiscal Year
1998, Pub. L. 105-85, which amended Title 10, United States Code,
section 1076a. These laws allow the Department to extend the Active
Duty Dependents Dental Plan to overseas areas and waive or reduce
required cost-shares to the extent the Secretary determines appropriate
for the effective and efficient operation of the Plan. Family members
enrolled in the Active Duty Dependents Dental Plan will be allowed to
receive dental care from host nation providers and have the dental
claims processed by a dental contractor. Where applicable, host nation
providers who meet accepted professional dental practice standards will
be identified by the local military dental treatment facility (DTF)
commander and the overseas lead agents.
Enrolled family members overseas will be eligible to obtain the
same basic dental benefits offered to enrollees in the Active Duty
Dependents Dental Plan (also referred to as the TRICARE Family Member
Dental Plan or TFMDP) in the Continental United States subject to
availability and accessibility of these services. For the purposes of
this program, the Continental United States is defined as the forth-
eight contiguous states, as well as Alaska, Hawaii, Guam, Puerto Rico,
the District of Columbia, the U.S. Virgin Islands and Canada. Overseas
is defined as those countries not previously mentioned.
In order to participate, beneficiaries must voluntarily enroll in
the TFMDP and pay the standard monthly premium. In countries with a
military DTF, the local military DTF commander will refer enrollees to
designated host nation providers for all covered dental services. These
referrals will be contingent upon the lack of availability of these
dental services in the DTF and the Department's designation of
qualified host nation providers.
In countries without a military DTF, enrollees can receive
treatment for non-orthodontic dental care without a referral from any
qualified host nation provider meeting professionally accepted
standards. The Department encourages enrollees residing in these
countries to first contact their respective overseas lead agent, U.S.
Embassy or Consulate or other local representatives of the U.S.
Government before seeking non-orthodontic care to determine if any of
these agencies can assist in identifying a qualified host nation
provider in their local area. For orthodontic care in these countries,
the overseas lead agent will refer enrollees to designated host nation
providers.
Where a referral is required, the issuing activity must complete a
Non-Availability Statement (NAS) and provide this statement to the
enrollee before care can be received and the claim can be processed by
the dental contractor. To obtain a referral and NAS, family members are
not restricted to visiting a DTF of their sponsor's branch of service,
rather, they should contact their primary servicing military DTF.
[[Page 38576]]
Basic dental care encompasses diagnostic and preventive (exams, x-
rays, cleanings, etc), sealants, restorative (fillings, crowns, etc),
endodontics (root canals, etc.), periodontics (gum surgery, etc.), oral
surgery (extractions, etc.), and prosthodontics (bridges, dentures,
etc.) While the annual cap of $1,000 and lifetime cap of $1,200 for
orthodontic care is applicable in these overseas locations, the
Department will pay the enrollee's cost-share for some non-orthodontic
services as well as any difference between the provider's billed charge
and the dental claims processor's allowance, subject to the amount
remaining on the enrollee's annual or lifetime maximum.
This final rule will allow dental claims to be paid on a ``billed
charge'' basis. Billed charges are charges submitted by host nation
dental providers for the costs of dental care in their country. These
charges are not based on Diagnostic Related Groups nor are they
expected to be developed based on American Dental Association current
dental terminology codes.
Since publication of the interim final rule, section 732 of the
National Defense Authorization Act for Fiscal Year 1998 authorized the
Secretary to waive or reduce cost-shares in overseas areas. Therefore,
the Department has implemented procedures to waive the cost shares for
certain non-orthodontic benefits as long as the enrollee has not
exceeded their annual maximum. The previous procedures for waivers to
the annual and lifetime maximums are no longer applicable.
Additionally, the interim final rule stated that enrollees in
remote locations would not be required to obtain an NAS to receive
dental services. The Department has changed that provision so that
enrollees in remote locations will be required to obtain an NAS from
their respective overseas lead agent prior to receiving orthodontic
care. This change provides an opportunity for the overseas lead agent
to make referrals to designated host nation orthodontists, monitor and
approve treatment plans and advise enrollees of other options. It also
provides appropriate oversight in a benefit area where only a one-time
lifetime benefit is available.
Finally, the interim final rule limited the benefit to family
members accompanying their active duty sponsors while overseas. That
provision has been deleted because the overseas extension was
designated to be portable and available to enrolled family members
traveling or residing overseas with or without their sponsor.
II. Public Comments
The interim final rule was published on July 25, 1997 (62 FR
33940). We did not receive any public comments.
III. 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.
This is not a significant regulatory action under the provisions of
Executive Order 12866, and it would not have a significant impact on a
substantial number of small entities.
The final rule will not impose additional information collection
requirements on the public under the Paperwork Reduction Act of 1995
(44 U.S.C. Chapter 55).
List of Subjects in 32 CFR Part 199
Claims, Health insurance, Individuals with disabilities and
Military personnel.
Accordingly, 32 CFR part 1999 is amended as follows:
PART 1999--[AMENDED]
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 199.13 is amended by revising paragraph (i) to read as
follows:
Sec. 199.13 Active duty dependents dental plan.
* * * * *
(i) Extension of the Active Duty Dependents Dental Plan to areas
outside the United States. The Assistant Secretary of Defense (Health
Affairs) (ASD(HA) may, under the authority of 10 U.S.C. 1076a(h),
extend the Active Duty Dependents Dental Plan to areas other than those
areas specified in paragraph (a)(2)(i) of this section for the eligible
beneficiaries of members of the Uniformed Services. In extending the
program outside the Continental United States, the ASD(HA), or
designee, is authorized to establish program elements, methods of
administration and payment rates and procedures to providers that are
different from those in effect under this section in the Continental
United States to the extent the ASD(HA), or designee, determines
necessary for the effective and efficient operation of the plan outside
the Continental United States. This includes provisions for
preauthorization of care if the needed services are not available in a
Uniformed Service overseas dental treatment facility and payment by the
Department of certain cost-shares and other portions of a provider's
billed charges. Other differences may occur based on limitations in the
availability and capabilities of the Uniformed Services overseas dental
treatment facility and a particular nation's civilian sector providers
in certain areas. Otherwise, rules pertaining to services covered under
the plan and quality of care standards for providers shall be
comparable to those in effect under this section in the Continental
United States and available military guidelines. In addition, all
provisions of 10 U.S.C. 1076a shall remain in effect.
Dated: July 13, 1999.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 99-18250 Filed 7-16-99; 8:45 am]
BILLING CODE 5001-10-M