[Federal Register Volume 65, Number 65 (Tuesday, April 4, 2000)]
[Notices]
[Pages 17632-17633]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-8177]


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DEPARTMENT OF DEFENSE

Office of the Secretary


Continuous Open Enrollment Demonstration for the Designated 
Provider Program

AGENCY: Health Affairs, Department of Defense.

ACTION: Notice of demonstration project.

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SUMMARY: This notice is to advise interested parties of a demonstration 
project which will enroll military retirees and their family members 
(to include Medicare-eligible beneficiaries) in the Uniformed Services 
Family Health Plan on a continuous basis. The continuous open 
enrollment demonstration project will evaluate the benefits and costs 
of the program. Continuous open enrollment for retirees and their 
family members in the Designated Provider program will result in 
enrollment requirements consistent with the enrollment requirements for 
the TRICARE Prime option under the TRICARE program. In this project, 
DoD will allow eligible retirees and their family members to elect to 
enroll in the Uniformed Services Family Health Plan at any time during 
the demonstration period in exchange for their agreement to receive 
comprehensive health care services from the Designated Provider. 
Funding for the demonstration for care provided will come from existing 
DoD appropriations. This demonstration will be conducted at three of 
the seven Designated Provider sites. DoD will conduct an analysis of 
the benefits and costs of the program using the enrolled populations of 
the other four Designated Providers as the control group. The 
demonstration is scheduled to end September 30, 2001.

DATES: May 4, 2000.

FOR FURTHER INFORMATION CONTACT: Earl Hanson, TRICARE Management 
Activity (703) 681-1757.

SUPPLEMENTARY INFORMATION:  

A. Background

    Health care for retirees and their family members, to include 
Medicare-eligible military retirees and family members, is now 
available under the Designated Provider program. When DoD transitioned 
the Uniformed Services Treatment Facilities to the Designated Provider 
program providing the TRICARE Prime benefit in 1998, the Department and 
the Designated Providers agreed by contract to limit enrollment of 
retirees and their family members to once per year. In accordance with 
the National Defense Authorization Act for Fiscal Year 2000, Section 
707, the Department of Defense and the Designated Providers randomly 
selected three sites to actively participate in a continuous open 
enrollment demonstration that would allow retiree and retiree family 
members to enroll in the Uniformed Services Family Health Plan without 
regard to an annual open enrollment season. The remaining four 
Designated Providers will be control sites. The selected sites will 
comply with all provisions for their existing contracts and through a 
modification to the contracts, allow retirees and their family members 
to enroll at any time during the demonstration period. These enrollees 
will comply with existing managed care program policies and 
requirements for the Uniformed Services Family Health Plan.

C. Description of the Continuous Open Enrollment Demonstration

    (1) Location of Project: Continuous open enrollment will be 
conducted in the geographical service area of the Sisters of Charity 
Health Care System located on Staten Island, New York; the Brighton 
Marine Health Center located in Boston, Massachusetts; and the Pacific 
Medical Center located in Seattle, Washington. The control group is a 
geographic service area operated by Martin's Point Health Care located 
in Portland, Maine; Johns Hopkins Medical Services Corporation located 
in Baltimore, Maryland; CHRISTUS Health located in Houston, Texas; and 
Fairview Health System located in Cleveland, Ohio. The geographical 
service area is identified by zip codes in and around the Designated 
Providers' corporate centers.
    (2) Continuous Open Enrollment Schedule: Health care delivery is 
scheduled to begin on February 1, 2000, for the Sisters of Charity 
Health Care System and the Brighton Marine Health Center. Pacific 
Medical Center will begin providing health care services on March 1, 
2000. Prior to the beginning of health care delivery under this 
demonstration, the participating Designated Providers will issue public 
announcements providing information about the program and the 
enrollment process. The public announcements will indicate that an 
application acceptance period will begin in January 2000. The 
demonstration will continue until September 30, 2000.
    (3) Eligible population: To be eligible to enroll in this 
demonstration a military retiree or their family member must, (1) be 
eligible for care from DoD, (2) reside within geographic service area 
of participating Designated Providers, and (3) be solely reliant for 
health care services from the Military Health System and/or Title XVIII 
of the Social Security Act.
    (4) Enrollment capacity: Under this demonstration there is no 
limitation on the number of eligible beneficiaries that may enroll in 
the Designated Providers' Uniformed Services Family Health Plan. 
Enrollment outside the demonstration is limited to 110 percent of 
enrollment as of the first day of the previous fiscal year.
    (5) Enrollment: Enrollment applications will be accepted by mail or 
in person at an address designated by the participating Designated 
Providers. The enrollment fee is currently $230 for single enrollee and 
maximum of $460 for a family. It is the Department's policy to 
encourage enrollment in Medicare Part B. Therefore, enrollment fees for 
Medicare-eligible enrollees that maintain their Medicare Part B monthly 
premiums are waived under the Uniformed Services Family Health Plan.
    Enrollment under the demonstration is for a twelve-month period, 
which is automatically renewed annually. Beneficiaries may leave the 
program at the end of their twelve-month period by affirmatively 
requesting disenrollment approximately 60 calendar days prior to 
automatic renewal. Enrollees discontinuing their enrollment prior to 
any twelve-month period are locked out of further enrollment in DoD's 
TRICARE program for a period of twelve months from the effective date 
of their disenrollment. Portability, transfers, and split family 
enrollments exist between TRICARE regions and contractors, although 
portability and transfers for Medicare-eligible enrollees limited to 
Designated Provider geographic service areas.
    As a condition of enrollment, each dual-eligible beneficiary will 
be required to receive all of his or her

[[Page 17633]]

health care services, except emergency care, through the Designated 
Provider program.

D. Impact of Demonstration Project on Enrollees and the Department 
of Defense.

    The goal of the Designated Provider demonstration project is to 
allow retired beneficiaries and their dependents the opportunity to 
enroll throughout the program year. The evaluation will document the 
benefits of open enrollment opportunities to covered beneficiaries and 
the cost impact upon the Department of Defense, as well as a 
recommendation on whether to authorize open enrollments in the managed 
care plans of the Designated Providers permanently.

    Dated: March 29, 2000.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 00-8177 Filed 4-3-00; 8:45 am]
BILLING CODE 5001-10-M