[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