[Federal Register Volume 64, Number 246 (Thursday, December 23, 1999)]
[Rules and Regulations]
[Pages 72030-72031]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-33246]


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DEPARTMENT OF DEFENSE

Office of the Secretary

32 CFR Part 199


Tricare; Civilian Health and Medical Program of the Uniformed 
Services (CHAMPUS); Nonavailability Statement Requirement for Maternity 
Care

AGENCY: Office of the Secretary, DoD.

ACTION: Interim final rule.

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SUMMARY: This interim final rule implements Section 712(c) of the 
National Defense Authorization Act for Fiscal Year 2000 (Pub. L. No. 
106-65), which requires that a nonavailability-of-health-care statement 
shall be required for a non-enrolled beneficiary for TRICARE cost-share 
of maternity care services related to outpatient prenatal, outpatient 
or inpatient delivery, and outpatient post-partum care subsequent to 
the visit which confirms the pregnancy. The Act reestablishes a 
requirement which was previously eliminated under the broad direction 
of The National Defense Authorization Act of FY 1997, section 734, 
which removed authority for nonavailiability statements (NASs) for 
outpatient services. Therefore, the Act changes the existing provisions 
require an NAS for inpatient delivery but do not require an NAS for 
outpatient prenatal and post-partum care. The change will significantly 
contribute to continuity of care for maternity patients. In furtherance 
of that principle, and consistent with the previous policy, an NAS for 
maternity care shall not be required when a beneficiary has other 
health insurance for primary coverage. This is being issued as an 
interim final rule in order to comply with the statutory mandate. 
Public comments, however, are invited and will be considered in 
connection with possible revisions to this rule.

DATES: This rule is effective October 5, 1999 (the effective date of 
Section 712(c) of the National Defense Authorization Act for Fiscal 
Year 2000 (Pub. L. No. 106-65) which imposes the requirement). Written 
comments will be accepted until February 22, 2000.

ADDRESSES: Forward comments to Medical Benefits and Reimbursement 
Systems, TRICARE Management Activity, 16401 East Centretech Parkway, 
Aurora, CO 80011-9043.

FOR FURTHER INFORMATION CONTACT: Tariq Shahid, Medical Benefits and 
Reimbursement Systems, TRICARE Management Activity, telephone (303) 
676-3801.

SUPPLEMENTARY INFORMATION: This interim final rule implements section 
712(c) of the National Defense Authorization Act for Fiscal Year 2000 
(Pub. L. No. 106-65) which requires that a nonavailability-of-health-
care statement shall be required for TRICARE/CHAMPUS cost-share of 
maternity care services related to outpatient prenatal, outpatient or 
inpatient delivery, and outpatient post-partum care subsequent to the 
visit which confirms the pregnancy. The nonavailability statement 
requirement applies to non-enrolled TRICARE beneficiaries who live in a 
catchment area of a military treatment facility (MTF). Except for an 
emergency or when there is other primary health insurance coverage, 
these beneficiaries are required to obtain all maternity care from the 
MTF. If care is unavailable at the MTF, an NAS will be issued for the

[[Page 72031]]

beneficiary. The Act changes the existing provisions that require a 
nonavailability statement (NAS) for inpatient delivery but do not 
require an NAS for outpatient prenatal, outpatient delivery and post-
partum care. The change will provide for continuity of care for 
maternity patients. Beneficiaries will need one NAS for the entire 
episode of maternity care that shall remain valid until 42 days 
following termination of the pregnancy.

Regulatory Procedure

    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 Interim Final Rule is not a significant regulatory 
action under E.O. 12866, nor would it have a significant impact on 
small entities. The changes set forth in the interim final rule are 
minor revision to the existing regulation.
    The interim final rule will not impose additional information 
collection requirements on the public under the Paperwork Reduction Act 
of 1995 (44 U.S.C. 3501-3511). This rule is being issued as an interim 
final rule, with comment period, as an exception to our standard 
practice of soliciting public comments prior to issuance. The Assistant 
Secretary of Defense (Health Affairs) has determined that following the 
standard practice in this case would be impracticable, unnecessary, and 
contrary to the public interest. This determination is based on several 
factors. First, this change directly implements a statutory amendment 
enacted by Congress expressively for this purpose. Second, this rule 
implements the statutory policy without embellishment. All public 
comments are invited.

List of Subject in 32 CFR Part 199

    Claims, Handicapped, Health insurance, Military personnel.

PART 199--[AMENDED]

    Accordingly, 32 CFR 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 199.4(a) is amended by revising paragraphs (a)(9) and 
(a)(9)(i)(B).


Sec. 199.4  Basic program benefits.

    (a) * * *
* * * * *
    (9) Nonavailability Statements within a 40-mile catchment area. In 
some geographic locations, it is necessary for CHAMPUS beneficiaries 
not enrolled in TRICARE Prime to determine whether the required medical 
care can be provided through a Uniformed Services facility. If the 
required care cannot be provided, the hospital commander, or designee, 
will issue a Nonavailability Statement (DD form 1251). Except for 
emergencies, a Nonavailability Statement should be issued before 
medical care is obtained from a civilian source. Failure to secure such 
a statement may waive the beneficiary's rights to benefits under 
CHAMPUS.
    (i) * * *
    (A) * * *
    (B) For CHAMPUS beneficiaries who are not enrolled in TRICARE 
Prime, an NAS is required for services in connection with non-emergency 
inpatient hospital care and outpatient and inpatient maternity care if 
such services are available at a facility of the Uniformed Services 
located within a 40-mile radius of the residence of the beneficiary, 
except that an NAS is not required for services otherwise available at 
a facility of the Uniformed Services located within a 40-mile radius of 
the beneficiary's residence when another insurance plan or program 
provides the beneficiary primary coverage for the services. For 
maternity care, an NAS is required for services related to outpatient 
prenatal, outpatient or inpatient delivery, and outpatient post-partum 
care subsequent to the visit that confirms the pregnancy. The 
requirement for an NAS does not apply to beneficiaries enrolled in 
TRICARE Prime, even when those beneficiaries use the point-of-service 
option under Sec. 199.17(n)(3).
* * * * *
    Dated: December 16, 1999.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 99-33246 Filed 12-22-99; 8:45 am]
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