[Federal Register Volume 68, Number 147 (Thursday, July 31, 2003)]
[Rules and Regulations]
[Pages 44882-44884]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-19453]


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DEPARTMENT OF DEFENSE

Office of the Secretary

32 CFR Part 199

RIN-0720-AA72


TRICARE Program; Waiver of Certain TRICARE Deductibles; 
Clarification of TRICARE Prime Enrollment Period; Enrollment in TRICARE 
Prime Remote for Active Duty Family Members

AGENCY: Office of the Secretary, DoD.

ACTION: Interim final rule.

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SUMMARY: A proposed rule to implement section 714 of the National 
Defense Authorization Act (NDAA) for Fiscal Year 2000 was published on 
April 18, 2002 (67 FR 19141) to authorize the Secretary of Defense to 
waive the TRICARE deductible in certain cases for care provided to a 
dependent of a member of a Reserve Component or the National Guard who 
is called to active duty for more than 30 days but less than one year. 
The proposed rule also established circumstances under which eligible 
beneficiaries may enroll in TRICARE Prime for a period of less than one 
year. The proposed rule is withdrawn and instead is implemented along 
with section 702 of the NDAA for FY 2003, which establishes 
circumstances under which dependents of Reserve Component and National 
Guard members called to active duty in support of contingency 
operations may enroll in TRICARE Prime Remote for Active Duty Family 
Members, and dependents of TRICARE Prime Remote service members who are 
enrolled in TRICARE Prime Remote for Active Duty Family Members may 
remain enrolled when the service member receives orders for an 
unaccompanied follow-on assignment. This interim final rule authorizes 
the Secretary of Defense to waive the TRICARE deductible in certain 
cases for care provided to a dependent of a member of a Reserve 
Component or the National Guard who is called to active duty for more 
than 30 days but less than 1 year. It establishes circumstances under 
which eligible beneficiaries may enroll in TRICARE Prime for a period 
of less than 1 year.

EFFECTIVE DATE: This interim final rule is effective September 29, 
2003.

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

FOR FURTHER INFORMATION CONTACT: Stephen E. Isaacson, Medical Benefits 
and Reimbursement Systems, TMA, (303) 676-3572.

SUPPLEMENTARY INFORMATION: 

I. Summary of Interim Final Rule Provisions

    The reader should refer to the proposed rule that was published on 
April 18, 2002, (67 FR 19141) for more detailed information regarding 
these changes. This interim final rule describes the circumstances 
under which eligible dependents of active duty members, and eligible 
dependents of Reserve Component and National Guard members called to 
active duty in support of contingency operations may enroll in TRICARE 
Prime Remote for Active Duty Family Members. In addition, this interim 
rule describes the circumstances under which eligible dependents of 
TRICARE Prime Remote service members who are enrolled in the TRICARE 
Prime Remote for Active Duty Family Member program may remain enrolled 
when the service member receives a follow-on accompanied assignment and 
the dependents continue to reside in the TRICARE Prime Remote location.
    Changes to the provisions for TRICARE Prime Remote for Active Duty 
Family Members (TPRADFM) are required by Section 702 of P.L. 107-314 
(the NDAA for FY 2003). First, family members who are enrolled in 
TPRADFM may continue their enrollment when the member has relocated 
without the family members pursuant to orders for a permanent change of 
duty station, if the orders do not authorize dependents to accompany 
the member to the new duty station at the expense of the United States, 
and if the family members continue to reside at the same location at 
which they were enrolled in TPRADFM. Second, family members of a 
reserve component member ordered to active duty for a period of more 
than 30 days may enroll in TPRADFM if they reside with the member and 
if the residence is more than fifty (50) miles, or approximately one 
hour driving time, from the nearest military medical treatment facility 
adequate to provide the needed care.
    The changes related to TPRADFM were not included in the original 
proposed rule, but, since they are statutorily required and also 
require a change to a paragraph of 32 CFR Part 199.17 that was being 
revised pursuant to the proposed rule, we are including all of the 
changes in this interim final rule.

II. Public Comments

    We provided a 60-day comment period on the proposed rule. We 
received no public comments.

III. Changes in the Interim Final Rule

    In both paragraph (f)(2)(i)(H) of Section 199.4 and paragraph 
(o)(2) of Section 199.17, we have clarified that these provisions apply 
only to members of the National Guard who are ordered to federal active 
duty under authority of the President and not to those members who are 
ordered to active duty under the authority of a governor of a state. In 
addition, in paragraph (f)(2)(i)(H) of Section 199.4, we have changed 
``the Secretary of Defense, or a designee,'' to ``the Director, TRICARE 
Management Activity'' as the authority to waive the annual fiscal year 
deductible. This is only a wording change and not a substantive change, 
since the Secretary of Defense, through 32 CFR 199.1(c)(2) and 32 CFR 
part 367, has delegated authority to the Assistant Secretary of Defense 
(Health Affairs), who has delegated authority to the Director, TRICARE 
Management Activity, to provide policy guidance, management control, 
and coordination as required by CHAMPUS.
    The proposed rule would have established in the regulation an 
administrative authority for Reservists and members of the National 
Guard who are called or ordered to active duty for a period of 179 days 
or more to enroll in TRICARE Prime. We are changing that provision in 
this interim final rule.
    Reserve components (including both reservists and members of the 
National Guard) participate in military conflicts and peacekeeping 
missions in areas such as Bosnia, Kosovo, and southwest Asia, and 
assist in homeland security. The operational tempo following the events 
of September 11, 2001, showed a dramatic increase in the number of 
reservists activated for these requirements. These reservists receive 
varying levels of medical benefits according to their primary residence 
location, length of call up, and type of activation order. For example, 
the Department established a demonstration in order to ease the burden 
imposed on the large number of reserve component members who have been 
activated in response to September 11 under Operations Noble Eagle and 
Enduring Freedom (66 FR 55928). This demonstration which is called the 
TRICARE Reserve Family Member

[[Page 44883]]

Demonstration Project (TRFMDP) provides three enhancements to the 
TRICARE Standard benefit for their family members: the annual 
deductible was waived, the requirement to obtain a non-availability 
statement was waived, and TRICARE will pay up to fifteen percent above 
the TRICARE maximum allowable charge for services received from 
nonparticipating providers. However, the demonstration is due to expire 
on November 1, 2003, although large numbers of individuals continue to 
be activated. In addition, family members of reserve component members 
who are activated under other authorities do not receive these enhanced 
benefits.
    In order to eliminate these discrepancies while continuing to 
provide some enhanced benefits to family members of activated reserve 
component members, the Department has authorized family members of 
activated reserve component members who live in military treatment 
facility catchment areas to enroll in TRICARE Prime if the member is 
activated for more than 30 days rather than for 179 days or more. A 
catchment area is established by zip codes, but is generally a home 
residence within 50 miles, or approximately one hour driving time, from 
the nearest military treatment facility adequate to provide care. This 
change accomplishes three goals. First, it provides family members of 
these activated reserve component members with substantially the same 
benefits available to family members of activated reserve component 
members under the TRFMDP. Second, it provides these family members with 
the same benefits available to family members who live outside 
catchment areas under the TPRADFM through the provisions of Section 702 
of P.L. 107-314. Third, it ensures that the medical benefits available 
to family members of activated reservists are as similar as possible to 
those available to family members of active duty members.
    This interim final rule establishes specific regulatory authority 
for this provision.

IV. Regulatory Procedures

    Executive Order 12866 requires that a regulatory impact analysis be 
performed on any major rule. A ``major rule'' is defined as one that 
would result in the annual effect on the national economy of $100 
million or more, or have other substantial impact. 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 regulations which would have a significant 
impact on a substantial number of small entities.
    This interim final rule is not major rule under the Congressional 
Review Act. The changes set forth in this interim final rule are minor 
revisions to existing regulation. The changes made in this interim 
final rule involve an expansion of TRICARE benefits. In addition, this 
interim final rule will have minor impact and will not significantly 
affect a substantial number of small entities. In light of the above, 
no regulatory impact analysis is required.
    This rule has been designated as significant and has been reviewed 
by the Office Management and Budget as required under the provisions of 
E.O. 12866.
    This interim 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).

List of Subjects in 32 CFR Part 199

    Claims, handicapped, health insurance, and military personnel.

PART 199--[AMENDED]

0
1. The authority citation for part 199 continues to read as follows:

    Authority: 5 U.S.C. 301; 10 U.S.C. Chapter 55.


0
2. Section 199.4 is amended by adding a new paragraph (f)(2)(i)(H) as 
follows:


Sec.  199.4  Basic program benefits.

    (f) * * *
    (2) * * *
    (i) * * *
    (H) The Director, TRICARE Management Activity, may waive the annual 
individual or family fiscal year deductible for dependents of a Reserve 
Component member who is called or ordered to active duty for a period 
of more than 30 days but less than one year or a National guard member 
who is called or ordered to full-time federal National guard duty for a 
period of more than 30 days but less than one year, in support of a 
contingency operation (as defined in 10 U.S.C. 101(a)(13)). For 
purposes of this paragraph, a dependent is a lawful husband or wife of 
the member and a child as defined in paragraphs (b)(2)(ii)(A) through 
(F) and (b)(2)(ii)(H)(1), (2) and (4) of Part 199.3.
* * * * *

0
3. Section 199.17 is amended by revising paragraphs (g)(3), (o) and 
(o)(2) as follows:


Sec.  199.17  TRICARE Program.

    (g) * * *
    (3) Eligibility.
    (i) An active duty family member is eligible for TRICARE Prime 
Remote for Active Duty Family Members if he or she is eligible for 
CHAMPUS and, on or after December 2, 2003 meets the criteria of either 
(g)(3)(i)(A) and (B), or (g)(3)(i)(C):
    (A) The family member's active duty sponsor has been assigned 
permanent duty as a recruiter; as an instructor at an educational 
institution, an administrator of a program, or to provide 
administrative services in support of a program of instruction for the 
Reserve Officers' Training Corps; as a full-time adviser to a unit of a 
reserve component; or any other permanent duty designated by the 
Director, TRICARE Management Activity that the Director determines is 
more than 50 miles, or approximately one hour driving time, from the 
nearest military treatment facility that is adequate to provide care.
    (B) The family members and active duty sponsor, pursuant to the 
assignment of duty described in paragraph (g)(3)(i)(A) of this section, 
reside at a location designed by the Director, TRICARE Management 
Activity, that the Director determines is more than 50 miles, or 
approximately one hour driving time, from the nearest military medical 
treatment facility that is adequate to provide care.
    (c) The family member, having resided together with the active duty 
sponsor while the sponsor served in an assignment described in 
(g)(3)(i)(A), continues to reside at the same location after the 
sponsor relocates without the family member pursuant to orders for a 
permanent change of duty station, and the orders do not authorize 
dependents to accompany the sponsor to the new duty station at the 
expense of the United States.
    (ii) A family member who is a dependent of a reserve component 
member is eligible for TRICARE Prime Remote for Active Duty Family 
members if he or she is eligible for CHAMPUS and meets all of the 
following additional criteria:
    (A) The reserve component member has been ordered to active duty 
for a period of more than 30 days.
    (B) The family member resides with the member.
    (C) The Director, TRICARE Management Activity, determines the 
residence of the reserve component member is more than 50 miles, or 
approximately one hour driving time, from the nearest military medical 
treatment facility that is adequate to provide care.
    (D) ``Resides with'' is defined as the TRICARE Prime Remote 
residence

[[Page 44884]]

address at which the family resides with the activated reservist upon 
activation.
* * * * *
    (o) TRICARE program enrollment procedures. There are certain 
requirements pertaining to procedures for enrollment in Prime and 
TRICARE Prime Remote for Active Duty Family Members. (These procedures 
do not apply to active duty members, whose enrollment is mandatory).
    (1) * * *
    (2) Enrollment period. The following provisions apply to enrollment 
periods on or after March 10, 2003.
    (i) Beneficiaries who select the TRICARE Prime option or the 
TRICARE Prime Remote for Active Duty Family Members option remain 
enrolled for 12 months increments until: they take action to disenroll; 
they are no longer eligible for enrollment in TRICARE Prime or TRICARE 
Prime Remote for Active Duty Family Members; or they are disenrolled 
for failure to pay required enrollment fees if applicable. For those 
who remain eligible for TRICARE Prime enrollment, no later than 15 days 
before the expiration date of an 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. Termination of enrollment for 
failure to pay enrollment fees is addressed in paragraph (o)(3) of this 
section.
    (ii) Exceptions to the 12-month enrollment period.
    (A) Beneficiaries who are eligible to enroll in TRICARE Prime but 
have less than one year of TRICARE eligibility remaining.
    (B) The dependents of a reservist who is called or ordered to 
active duty or of a member of the National Guard who is called or 
ordered to full-time federal National Guard duty for a period of more 
than 30 days.
* * * * *

    Dated: July 24, 2003.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 03-19453 Filed 7-30-03; 8:45 am]
BILLING CODE 5001-08-M