[Federal Register Volume 64, Number 230 (Wednesday, December 1, 1999)]
[Proposed Rules]
[Pages 67220-67222]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-31117]


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DEPARTMENT OF DEFENSE

Office of the Secretary

32 CFR Part 199

RIN 0720-AA54


Civilian Health and Medical Program of the Uniformed Services 
(CHAMPUS); Expansion of Dependent Eligibility for TRICARE Retiree 
Dental Program

AGENCY: Office of the Secretary, DoD.

ACTION: Proposed rule.

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SUMMARY: This proposed rule implements a change to the TRICARE Retiree 
Dental Program (TRDP) required by the National Defense Authorization 
Act for Fiscal Year 1999. This change expands eligibility for 
enrollment in the program to allow dependents of certain retired 
members of the Uniformed Services to enroll in the program even if the 
retired member does not enroll. In addition, this rule clarifies the 
existing regulatory provisions for election of TRDP coverage and 
disenrollment.

DATES: Comments must be received on or before January 31, 2000.

ADDRESSES: TRICARE Management Activity, 16401 East Centretech Parkway, 
Aurora, CO 80011-9043.

FOR FURTHER INFORMATION CONTACT: Linda Winter, TRICARE Management 
Activity, (303) 676-3682.

SUPPLEMENTARY INFORMATION:

I. Background

    Implementation of the TRICARE Retiree Dental Program (TRDP), a

[[Page 67221]]

program completely funded by enrollee premiums, was directed by 
Congress in section 703 of the National Defense Authorization Act for 
Fiscal Year 1997, Public Law 104-201, which amended title 10, United 
States Code, by adding section 1076c. Section 1076c was subsequently 
amended by the National Defense Authorization Act for Fiscal Year 1998 
to expand eligibility to retirees of the Public Health Service and the 
National Oceanic and Atmospheric Administration and to surviving 
spouses and dependents of deceased active duty members. As amended, the 
law directs the implementation of a dental program for: (1) Members of 
the uniformed services who are entitled to retired pay, (2) Members of 
the Retired Reserve who would be entitled to retired pay but are under 
the age of 60, (3) Eligible dependents of a member in (1) or (2) who 
are covered by the enrollment of the member, and (4) The unremarried 
surviving spouse and eligible child dependents of a deceased member who 
died while in status described in (1) or (2); the unremarried surviving 
spouse and eligible child dependents who receive a surviving spouse 
annuity; or the unremarried surviving spouse and eligible child 
dependents of a deceased member who died while on active duty for a 
period of more than 30 days and whose eligible dependents are not 
eligible or no longer eligible for the Active Duty Dependents Dental 
Plan.
    Eligibility of dependents (other than surviving spouses and 
dependents) for the TRDP was contingent on the enrollment of the 
retired member. This applied even in cases where the member could not 
benefit from TRDP coverage. In such cases, members had a choice of 
enrolling solely to obtain coverage for their dependents, or doing 
without the program altogether.
    With regard to amending section 1076c of title 10 to rectify this 
situation, the House National Security Committee reported, ``Presently, 
dependents may enroll in the retiree dental program only if the retired 
member also enrolls. However, some retired members are entitled to 
receive dental care from the Secretary of Veterans Affairs or have 
medical or dental conditions which preclude their use of the dental 
program. The committee believes it is not reasonable to ask these 
retirees to enroll in, and pay premiums for, a program which offers 
them no benefits only so their dependents may also enroll in the 
program. Therefore, this provision would allow the dependents of these 
specific retirees to enroll in the retiree dental program 
independently.''
    Section 702 of the National Defense Authorization Act for Fiscal 
Year 1999, Public Law 105-261, addressed this situation by extending 
eligibility for the TRDP to eligible dependents of certain retired 
members who are not enrolled and whose benefit from enrollment would be 
severely limited at best. These are members who are enrolled with 
Veterans Affairs to receive dental care, members who are enrolled 
through employment in a dental plan that is not available to the 
member's dependents, and members who are prevented by a medical or 
dental condition from being able to use TRDP benefits.

II. Provisions of the Proposed Rule To Expand Eligibility of 
Dependents

    This proposed rule extends eligibility for the TRDP to eligible 
dependents when the retired member is not enrolled because the member 
would not benefit from the program due to any of the three conditions 
stipulated in the law, which are, briefly, dental care from Veterans 
Affairs, employee-only dental coverage, or medical or dental condition 
which precludes dental care. To facilitate understanding and convey the 
intent of the law, the proposed rule mandates that each of these 
conditions must meet the test of being on-going, long-term, or enduring 
as opposed to episodic, conditional, temporary, or short-term. The 
retired member's circumstance must be such that the benefits of the 
TRDP would not be useful currently and in the foreseeable future. This 
distinction is also necessary to help limit the potential for adverse 
selection and higher costs.
    Given the absence of any systems of information that a member meets 
any of the three qualifying conditions, the proposed rule requires that 
retired members desiring to enroll their dependents under the 
dependent-only provision provide documentation attesting to the 
existence of these conditions. The documentation requirements are 
specified as being (1) confirmation by the Department of Veterans 
Affairs of its authorization for the member's ongoing, comprehensive 
dental care, (2) confirmation by a member's employer or the employer's 
dental plan administrator that the member is enrolled in a dental plan 
through employment that is separate from the member's uniformed 
service, and the dental plan is not available to the member's 
dependents, or (3) confirmation by the member's physician or dentist of 
the member's inability to utilize TRDP benefits due to a current and 
enduring medical or dental condition. These criteria and documentation 
requirements were developed with the recognition that the three 
situations specified by Congress for allowing dependent-only enrollment 
represent exceptional circumstances.
    The availability of dental care from the Department of Veterans 
Affairs is extremely limited. Sections 1710(c) and 1712 of title 38, 
United States Code, and sections 17.93, and 17.160 through 17.166 of 
title 38, Code of Federal Regulations specify the criteria which a 
veteran must meet to be considered for dental care. The policies and 
procedures for the Veterans Health Administration (VHA) Dental Program 
are covered in the VHA Directive 1130 (December 7, 1998) and the VHA 
Handbook 1130.1 (December 7, 1998).
    The determinations of eligibility or authorization for dental care 
are not based simply on enrollment for Veterans Affairs healthcare nor 
are such decisions recorded in a centralized system. These are 
accomplished by the Veterans Affairs at local and regional levels. In 
general, entitlement to continuous, comprehensive dental benefits from 
Veterans Affairs is limited to those veterans who are in receipt of a 
compensable service connected dental rating, a 100% service connected 
rating, or a permanent and totally disabled (unemployable) rating, or 
who have been classified as former Prisoners of War (for at least 90 
days). In most other cases, the dental care provided to eligible 
veterans is episodic and short-term.
    Just as the dental care available from Veterans Affairs is limited, 
employee-only dental coverage is not prevalent in the health insurance 
industry according to sources at the Health Insurance Association of 
America and Delta Dental Plan of California. Similarly, expectations 
are that the prevalence of medical or dental conditions that would 
preclude any use for the coverage offered by the TRDP is relatively 
small.
    The proposed rule prohibits retroactive dependent-only enrollments 
and requires that enrolled retirees satisfy any remaining enrollment 
commitment prior to enrolling dependents under the dependent-only 
provision. Once the initial enrollment commitment is fulfilled, 
retirees who meet one of the dependents-only eligibility conditions may 
disenroll with dependents remaining enrolled on a month-to-month basis.

III. Other Provisions of the Proposed Rule

    In addition to implementing dependent-only eligibility, this 
proposed rule clarifies the process for electing to enroll in the TRDP 
by removing the apparently restrictive

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reference to written election, thereby recognizing the existence of the 
variety of methods in which an election of enrollment can be conveyed, 
e.g., by written, telephonic, or e-mailed application. The proposed 
rule also clarifies the 12-month enrollment lock-out provision by 
specifying that the provision applies to disenrollment occurring at any 
time and for any reason. This includes disenrollment after the enrollee 
has fulfilled the 24-month initial enrollment commitment and 
disenrollment of the retired member to convert to dependent-only 
coverage.

IV. Rulemaking Procedures

    Executive Order 12866 requires certain regulatory assessments for 
any ``significant regulatory action,'' defined as one that 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 rule 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.
    This rule will not impose additional information collection 
requirements on the public under the Paperwork Reduction Act of 1995 
(44 U.S.C. Chapter 35).

List of Subjects in 32 CFR Part 199

    Claims, Health insurance, Individuals with disabilities, Military 
personnel, and Reporting and recordkeeping requirements.

    Accordingly, 32 CFR part 199 is proposed to be amended as follows:

PART 199--[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 199.22 is proposed to be amended by revising paragraphs 
(d)(1)(iii), (d)(3), and (d)(4); redesignating paragraph (d)(1)(iv) as 
paragraph (d)(1)(v); and adding a new paragraph (d)(1)(iv) to read as 
follows:


Sec. 199.22  TRICARE Retiree Dental Program (TRDP).

* * * * *
    (d) * * *
    (1) * * *
    (iii) Eligible dependents of a member described in paragraph 
(d)(1)(i) or paragraph (d)(1)(ii) of this section who are covered by 
the enrollment of the member;
    (iv) Eligible dependents of a member described in paragraph 
(d)(1)(i) or paragraph (d)(1)(ii) of this section when the member is 
not enrolled in the program and the member meets at least one of the 
conditions in paragraphs (d)(1)(iv)(A) through (C) of this section. 
Already enrolled members must satisfy any remaining enrollment 
commitment prior to enrollment of dependents becoming effective under 
this paragraph, at which time the dependent-only enrollment will 
continue on a voluntary, month-to-month basis as specified in paragraph 
(d)(4) of this section. Members must provide documentation to the TRDP 
contractor giving evidence of compliance with paragraphs (d)(1)(iv)(A), 
(B), or (C) of this section at the time of application for enrollment 
of their dependents under this paragraph.
    (A) The member is enrolled under section 1705 of title 38, United 
States Code, to receive ongoing, comprehensive dental care from the 
Secretary of Veterans Affairs pursuant to section 1712 of title 38, 
United States Code, and Secs. 17.93, 17.161, or 17.166 of title 38, 
Code of Federal Regulations. Authorization of such dental care must be 
confirmed in writing by the Department of Veterans Affairs.
    (B) The member is enrolled in a dental plan that is available to 
the member as a result of employment of the member that is separate 
from the uniformed service of the member, and the dental plan is not 
available to dependents of the member as a result of such separate 
employment by the member. Enrollment in this dental plan and the 
exclusion of dependents from enrollment in the plan must be confirmed 
by documentation from the member's employer or the dental plan's 
administrator.
    (C) The member is prevented by a current and enduring medical or 
dental condition from being able to obtain benefits under the TRDP. The 
specific medical or dental condition and reason for the inability to 
use the program's benefits over time, if not apparent based on the 
condition, must be documented by the member's physician or dentist.
* * * * *
    (3) Election of coverage. In order to initiate dental coverage, 
election to enroll must be made by the retired member or eligible 
dependent. Enrollment in the TRICARE Retiree Dental Program is 
voluntary and will be accomplished by submission of an application to 
the TRDP contractor.
    (4) Enrollment periods. Initial enrollment shall be for a period of 
24 months followed by month-to-month enrollment as long as the enrollee 
chooses to continue enrollment. An enrollee's disenrollment from the 
TRDP at any time for any reason is subject to a lock-out period of 12 
months. After any lock-out period, eligible individuals may elect to 
reenroll and are subject to a new initial 24-month enrollment period.
* * * * *
    Dated: November 24, 1999.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 99-31117 Filed 11-30-99; 8:45 am]
BILLING CODE 5001-10-P