[Federal Register Volume 65, Number 141 (Friday, July 21, 2000)]
[Rules and Regulations]
[Pages 45288-45289]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-18451]



[[Page 45288]]

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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: Final rule.

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SUMMARY: This 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 beneficiary not enrolled in TRICARE Prime 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 for FY 1997, 
section 734, which removed authority for nonavailability statements 
(NASs) for outpatient services. Therefore, the Act changes the 
provisions which 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.

EFFECTIVE DATE: 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.

ADDRESSES: TRICARE Management Activity, Medical Benefits and 
Reimbursement Systems, 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:

I. Final Rule Provisions

    This 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 (NAS) 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 beneficiary. The 
Act changes the existing provisions which require an 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 which shall remain valid until 42 days 
following termination of the pregnancy. We published the interim final 
rule on December 23, 1999.

II. Public Comments

    We provided a 60-day comment period on the interim final rule. We 
received no public comments, and no comments were received from other 
federal agencies with which we are required to coordinate.

III. Regulatory 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 Executive 
Order 12866 and has been reviewed by the Office of Management and 
Budget. In addition, this final rule will not significantly affect a 
substantial number of small entities. The changes set forth in the 
final rule are minor revisions to the existing regulation.
    The 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).

List of Subjects in 32 CFR Part 199

    Claims, Handicapped, Health insurance, and 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; 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 an 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) * * *
    (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).
* * * * *


[[Page 45289]]


    Dated: July 17, 2000.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 00-18451 Filed 7-20-00; 8:45 am]
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