[Federal Register Volume 67, Number 72 (Monday, April 15, 2002)]
[Rules and Regulations]
[Pages 18114-18115]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-8586]


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DEPARTMENT OF DEFENSE

Office of the Secretary

32 CFR Part 199

RIN-0720-AA60


TRICARE; Civilian Health and Medical Program of the Uniformed 
Services (CHAMPUS); Bonus Payments in Medically Underserved Areas

AGENCY: Office of the Secretary, DoD.

ACTION: Final rule.

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SUMMARY: This final rule implements a bonus payment, in addition to the 
amount normally paid under the allowable charge methodology, to 
physicians in medically underserved areas. For purposes of this rule, 
medically underserved areas are the same as those determined by the 
Secretary of Health and Human Services for the Medicare program. Such 
bonus payments shall be equal to the bonus payments authorized by 
Medicare, except as necessary to recognize any unique or distinct 
characteristics or requirements of the TRICARE program, and as 
described in instructions issued by the Executive Director, TRICARE 
Management Activity. This rule promotes a reimbursement enhancement to 
a limited number of physicians designed to increase TRICARE beneficiary 
access to care.

EFFECTIVE DATE: This rule is effective August 2, 2000.

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

FOR FURTHER INFORMATION CONTACT: Stan Regensberg, Medical benefits and 
Reimbursement Systems, TRICARE Management Activity, telephone (303) 
676-3742.

SUPPLEMENTARY INFORMATION:

I. Final Rule Provisions

A. Overview

    This final rule implements a bonus payment, in addition to the 
amount normally paid under the allowable charge methodology, to 
physicians in medically underserved areas. This action is undertaken 
under authority of Title 10, United States Code Chapter 55, section 
1079, Paragraph (h)(1). For purposes of this rule, medically 
underserved areas are the same as those determined by the Secretary of 
Health and Human Services for the Medicare program, as described below. 
Such bonus payments shall be equal to the bonus payments authorized by 
Medicare, except as necessary to recognize any unique or distinct 
characteristics or requirements of the TRICARE program, and as 
described in instructions issued by the Executive Director, TRICARE 
Management Activity. Bonus payments under Medicare are described below. 
If the Department of Health and Human Services acts to amend or remove 
the provision for bonus payments under Medicare, TRICARE likewise may 
follow Medicare in amendment or removing provision for such payments. 
Additionally, it provides a reimbursement enhancement that favors 
physicians in underserved areas, thus alleviating healthcare access 
problems experienced by beneficiaries residing in such areas. Finally, 
because Medicare previously established a bonus payment reimbursement 
mechanism in these areas, our emulation of this well established 
mechanism complies with existing statutory mandates that TRICARE follow 
Medicare reimbursement policy wherever practicable. This rule will not 
unilaterally increase payments to all physicians, but just those 
residing in these underserved areas. To do otherwise would prevent 
TRICARE Management Activity from fulfilling its duty to beneficiaries 
in these underserved areas.

B. Medicare Underserved Areas

    For Medicare, ``medically underserved areas'' are those HPSAs 
(Health Professional Shortage Areas) designated by the Bureau of 
Primary Health Care (BPHC) within the Health Resources and Services 
Administration (HRSA). HRSA defines the areas through a set of criteria 
and publishes lists which have names of the areas (sometimes by county, 
sometimes by census tract, or other descriptive definitions). The HPSAs 
are areas considered to have a shortage of primary care physicians, but 
Medicare pays the bonus payment for all physician services in these 
geographic areas. Medicare carriers are responsible for determining the 
boundaries of the HPSAs and qualifying physicians within these areas. 
Areas are to have a shortage of primary care health physicians; many 
are rural but that is not a criterion for inclusion; poor inter-city 
geographic areas are often included.

C. Medicare Bonus Payments

    The Medicare program pays physicians that provide services in 
medically underserved areas a bonus payment equal to ten percent of 
their Medicare payments, and the Medicare carriers calculate and pay 
these bonus payments quarterly by summing the amount of government 
payment from claims with a special modifier (QB or QU) which indicates 
that the service was provided in such an area (i.e., this is not an 
increase in the allowed amount nor does it produce a special fee 
schedule for this type of servicer, it is simply a bonus payment). The 
Medicare bonus payment is based on Sec. 1833(b) of the Social Security 
Act.

II. Public Comments

    A 60-day comment period was provided on the interim final rule. 
Comments were received from only two parties. Both the American 
Psychiatric Association and the Veterans Health Administration comments 
concerned the process that would be used to implement the bonus payment 
reimbursement system. The process that shall be used will pay 
physicians that provide services in health professional shortage areas 
the same additional payment that Medicare would pay in these areas. 
TRICARE contractors that administer and pay for physician services will 
inform physicians of the process that will be followed in order to 
receive the bonus payment from TRICARE. There was some confusion that 
occurred between the bonus

[[Page 18115]]

payment provision and the proposed rule that was published in the 
Federal Register on May 20, 2000. The two publications are separate and 
distinct.

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 rule has been designated as significant and has been reviewed 
by the Office of Management and Budget as required under the provisions 
of E.O. 12866.
    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, 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; and 10 U.S.C. Chapter 55.


    2. Section 199.14 is amended by revising paragraph (h)(2) to read 
as follows:


Sec. 199.14  Provider reimbursement methods.

* * * * *
    (h) * * *
    (2) Bonus payments in medically underserved areas. A bonus payment, 
in addition to the amount normally paid under the allowable charge 
methodology, may be made to physicians in medically underserved areas. 
For purposes of this paragraph, medically underserved areas are the 
same as those determined by the Secretary of Health and Human Services 
for the Medicare program. Such bonus payments shall be equal to the 
bonus payments authorized by Medicare, except as necessary to recognize 
any unique or distinct characteristics or requirements of the TRICARE 
program, and as described in instructions issued by the Executive 
Director, TRICARE Management Activity. If the Department of Health and 
Human Services acts to amend or remove the provision for bonus payments 
under Medicare, TRICARE likewise may follow Medicare in amending or 
removing provision for such payments.
* * * * *

    Dated: April 14, 2002.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 02-8586 Filed 4-12-02; 8:45 am]
BILLING CODE 5001-08-M