[Federal Register Volume 67, Number 29 (Tuesday, February 12, 2002)]
[Rules and Regulations]
[Pages 6408-6410]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-2767]


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DEPARTMENT OF DEFENSE

Office of the Secretary

32 CFR Part 199

[0720-AA59]


Enrollment of Certain Family Members of E-4 and Below Into 
TRICARE Prime

AGENCY: Office of the Secretary, DoD.

ACTION: Final rule.

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SUMMARY: This final rule provides for the enrollment of certain family 
members of E-4 and below in TRICARE Prime. Sponsors with non-enrolled 
family members will be automatically referred to the local TRICARE 
Service Center for enrollment. They will be given the opportunity to 
select or be assigned a primary care manager, or to refuse enrollment 
into TRICARE Prime. This enrollment may be terminated at any time and 
these family members may re-enroll at any time.

EFFECTIVE DATE: February 12, 2002.

[[Page 6409]]


ADDRESSES: TRICARE Management Activity (TMA), Program Operations 
Directorate, 5111 Leesburg Pike, Suite 810, Falls Church, VA 22041-
3206.

FOR FURTHER INFORMATION CONTACT: Mr. Duaine Goodno, Office of the 
Assistant Secretary of Defense (Health Affairs)/TRICARE Management 
Activity, telephone (703) 681-0039.
    Questions regarding payment of specific claims under the CHAMPUS 
allowable charge method should be addressed to the appropriate TRICARE/
CHAMPUS contractor.

SUPPLEMENTARY INFORMATION:

I. Overview of the Rule

    This final rule implements section 712 of the National Defense 
Authorization Act for Fiscal Year 1999 which modified chapter 55 of 
title 10, United States Code by adding a new section 1097a which 
provides for automatic TRICARE Prime enrollment for active duty 
families of E-4 and below in certain circumstances. Owing to the small 
number of family members of E-4 and below who are not already enrolled 
in TRICARE Prime, and the nature of TRICARE Prime enrollment, the 
Department will send an enrollment letter to all sponsors with non-
enrolled family members. Sponsors with non-enrolled family members will 
be automatically referred to the local TRICARE Service Center for 
enrollment. They will be given the opportunity to select or be assigned 
a primary care manager, or to refuse enrollment into TRICARE Prime. The 
choice of whether to remain enrolled in TRICARE Prime, or to decline 
enrollment to participate in TRICARE Extra or Standard remains 
completely voluntary. They may also re-enroll at any time. The one year 
lock-out provision for early disenrollment will not apply to any family 
member of E-4 and below regardless of how or when they were enrolled.
    Beneficiaries who are enrolled into TRICARE Prime will receive 
official notification of their enrollment in writing such as a letter 
with beneficiary card. For those who remain eligible for TRICARE Prime 
enrollment, the sponsor will be sent a written notification of the 
pending expiration and renewal of the TRICARE Prime enrollment. TRICARE 
Prime enrollments shall be automatically renewed upon the expiration of 
the enrollment unless the renewal is declined by the sponsor.

II. Review of Comments

    The interim final rule was published in the Federal Register on 
June 28, 2000 (65 FR 39804). We received one comment from a beneficiary 
group who felt that the intent of the program reflects a paternalistic 
attitude indicating junior enlisted family members lack the capacity to 
make a selection of health care benefits that is in their best 
interest. They contend that proper education concerning the TRICARE 
benefit would be a more effective method to assure beneficiaries that 
they have made a proper selection of health care services. They also 
recommend that we design a mechanism whereby the beneficiary 
acknowledges enrollment in the program such as an enrollment form as is 
required today. They are particularly concerned with the transient 
nature of the military community and the potential of forcing families 
into high Point of Service charges.
    Response: Based on the above comments, the Department will focus on 
marketing this program to this beneficiary population. An enrollment 
form will continue to be required of these beneficiaries which will 
document the fact that they accept the TRICARE Prime rules and it will 
allow them to provide their primary care manager preferences.

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 rule has been designated as significant and has been reviewed 
by the Office Management and Budget as required under the provisions of 
Executive Order 12866.
    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).
    This rule is being issued as a final rule.

List of Subjects in 32 CFR Part 199

    Administrative practice and procedure, Claims, Health care, Health 
insurance, Individuals with disabilities, Military personnel.

    Accordingly, 32 CFR part 199 is 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 199.17 is amended by revising paragraphs (b)(3), 
(c)(2)(i), (n)(1) and (o)(4) to read as follows:


Sec. 199.17  TRICARE program.

* * * * *
    (b) * * *
    (3) Automatic enrollment of certain dependents: Under 10 U.S.C. 
1097a, in the case of dependents of active duty members in the grade of 
E-1 to E-4, such dependents who reside in a catchment area of a 
military treatment facility shall be enrolled in TRICARE Prime 
consistent with procedures established under paragraph (o)(7) of this 
section. The enrollment of a dependent of the member may be terminated 
by the member, dependent or other responsible individual at any time.
    (c) * * *
    (2) * * *
    (i) Dependents of active duty members are eligible to enroll in 
Prime. After all active duty members are enrolled, those dependents of 
active duty members in the grade of E-1 to E-4 will have second 
priority and all other dependents of active duty members will have 
third priority.
* * * * *
    (n) * * *
    (1) Primary care manager. (i) All active duty members and Prime 
enrollees will be assigned or allowed to select a primary care manager 
pursuant to a system established by the MTF Commander or other 
authorized official, and consistent with the access standards in 
paragraph (p)(5)(i) of this section. The primary care manager may be an 
individual, physician, a group practice, a clinic, a treatment site, or 
other designation. The primary care manager may be part of the MTF or 
the Prime civilian provider network. The enrollee will be given the 
opportunity to register a preference for primary care manager from a 
list of choices provided by the MTF Commander. This preference will be 
entered on a TRICARE Prime enrollment form or similar document. 
Preference requests will be honored subject to availability, under the 
MTF beneficiary category priority system and other operational 
requirements established by the commander and other authorized person. 
MTF PCM nonavailability may be a condition of assignment to a civilian 
provider network PCM.

[[Page 6410]]

    (ii) Prime enrollees who are dependents of active duty members in 
pay grades E-1 through E-4 shall have priority over other active duty 
dependents for enrollment with MTF PCMs, subject to MTF capacity.
* * * * *
    (o) * * *
    (4) Voluntary disenrollment. Any non-active duty beneficiary may 
disenroll at any time. Disenrollment will take effect in accordance 
with administrative procedures established by the Assistant Secretary 
of Defense (Health Affairs). Beneficiaries who disenroll prior to their 
annual enrollment renewal date will not be eligible to reenroll in 
Prime for a one-year period from the effective date of the 
disenrollment. This one-year exclusion may be waived by the Assistant 
Secretary of Defense (Health Affairs) based on extraordinary 
circumstances. This one-year period does not apply to any dependent 
whose sponsor is in the grade of E-1 to E-4.
* * * * *

    Dated: January 31, 2002.
L.M. Bynum,
Alternate Federal Register Notice Liaison Officer, Department of 
Defense.
[FR Doc. 02-2767 Filed 2-11-02; 8:45 am]
BILLING CODE 5001-08-M