[Federal Register Volume 71, Number 165 (Friday, August 25, 2006)]
[Rules and Regulations]
[Pages 50347-50349]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E6-13719]


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DEPARTMENT OF DEFENSE

Office of the Secretary

[DoD-2006-OS-0182; 0720-AA97]

32 CFR Part 199


TRICARE Program; TRICARE Prime Remote for Active Duty Family 
Members and TRICARE Prime Enrollment Period

AGENCY: Office of the Secretary, DoD.

ACTION: Final rule.

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SUMMARY: This final rule implements 10 U.S.C. 1079(p), as added by 
section 722(b) of the Floyd D. Spence National Defense Authorization 
Act for Fiscal Year 2001. The rule provides coverage for medical care 
for active duty family members who reside with an active duty member of 
the Uniformed Services assigned to remote areas and eligible for the 
program known as TRICARE Prime Remote. Active duty family members who 
enroll in TRICARE Prime Remote for Active Duty Family Members (TPRADFM) 
will enjoy benefits generally comparable to TRICARE Prime enrollees 
including access standards, benefit coverage, and cost-shares.
    This final rule also implements Section 702 of the NDAA for FY 
2003, which establishes circumstances under which dependents of Reserve 
Components 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 may remain enrolled when the service member receives orders for 
an unaccompanied follow-on assignment.
    Finally, this final rule establishes circumstances under which 
eligible beneficiaries may enroll in TRICARE Prime for a period of less 
than 1 year.

DATES: Effective Date: This rule is effective October 24, 2006.

ADDRESSES: TRICARE Management Activity (TMA), Program Requirements 
Division, 16401 East Centretech Parkway, Aurora, CO 80011-9066.

FOR FURTHER INFORMATION CONTACT: John J.M. Leininger, Program 
Requirements Division, TMA, (303) 676-3613 for questions on the TPRADFM 
portion of this rule. Ann Fazzini, Medical Benefits and Reimbursement 
Systems, TMA, (303) 676-3803 for questions on the TRICARE Prime 
Enrollment Period portion of this rule.

SUPPLEMENTARY INFORMATION: 

I. Summary of Final Rule Provisions

    On October 30, 2000, the Floyd D. Spence National Defense 
Authorization Act (NDAA) for Fiscal Year 2001, Public Law 106-398 was 
signed into law. This final rule implements section 722(b) of this Act, 
which amended section 1079 of Title 10, United States Code, by adding 
subsection (p). It requires a TRICARE Prime-like benefit for active 
duty family members residing with their active duty Uniformed Services 
sponsor eligible for TRICARE Prime Remote, as defined by section 
1074(c)(3) of Title 10, United States Code. The reader should refer to 
the interim final rule that was published on February 6, 2002 (67 FR 
5477).
    This final rule implements Section 702 of the NDAA for FY 2003, 
which amended section 1079 of Title 10, United States Code, by adding 
subsection (3) to subsection (p) which establishes circumstances under 
which dependents of Reserve Components 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 may remain enrolled when the 
service member receives orders for an unaccompanied follow-on 
assignment. The reader should refer to the interim final rule that was 
published on July 31, 2003 [68 FR 44882] and was effective September 
29, 2003.
    This final rule also establishes circumstances under which eligible 
beneficiaries may enroll in TRICARE Prime for a period of less than one 
year. Enrollment in TRICARE Prime normally must be for a period of one 
year. Section 199.17(v), provides for the establishment of 
administrative requirements and procedures to ensure reasonable 
implementation and operation of the TRICARE program. Under this 
authority, an exception to the one-year enrollment requirement has been 
provided for Reservists and members of the National Guard who are 
called or ordered to active duty for a period of 179 days or more. A 
second exception has been established for those beneficiaries who are 
eligible to enroll in Prime but have less than one year of TRICARE 
eligibility remaining. For example, the dependents of an active duty 
member may enroll in Prime even though the member has less than one 
year of active duty remaining, and the

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member will not be eligible for retirement at the end of the member's 
active duty service. Refer to the interim final rule that was published 
on July 31, 2003, (68 FR 44882) and was effective September 29, 2003, 
for more detailed information regarding this change.

II. Public Comments

    We provided a 60-day comment period on the interim final rules. We 
received no public comments on any of the provisions cited in this 
rule.

III. Changes in the Final Rule

    The only change made to the final rule from the interim final rule 
was in 199.16 (e)(3) Enrollment. For clarity, we changed ``If an 
eligible active duty member does not enroll in the TRICARE Prime Remote 
program'' to ``Until the active duty service member enrolls in the 
TRICARE Prime Remote program''.

IV. Regulatory Procedures

    Executive Order 12866 requires that a regulatory impact analysis be 
performed on any economically significant rule. An economically 
significant 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 final rule is not a major rule under the Congressional Review 
Act, because its economic impact will be less than $100 million. The 
changes set forth in this final rule are revisions to existing 
regulation. The changes made in this final rule involve an expansion of 
TRICARE benefits. In addition, this 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 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, Dental health, Health care, Health insurance, Individuals 
with disabilities, Military personnel.

0
Accordingly, 32 CFR part 199 is amended as follows:

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 199.16 is amended by revising paragraphs (d) introductory 
text and (d)(2), to read as follows:


Sec.  199.16  Supplemental Health Care Program for active duty members.

* * * * *
    (d) Special rules and procedure. As exceptions to the general rule 
in paragraph (c) of this section, the special rules and procedures in 
this section shall govern payment and administration of claims under 
the supplemental care program. These special rules and procedures are 
subject to the TRICARE Prime Remote program for active duty service 
members set forth in paragraph (e) of this section and the waiver 
authority of paragraph (f) of this section.
* * * * *
    (2) Preauthorization by the Uniformed Services of each service is 
required for the supplemental care program except for services in cases 
of medical emergency (for which the definition in Sec. 199.2 shall 
apply) or in cases governed by the TRICARE Prime Remote program for 
active duty service members set forth in paragraph (e) of this section. 
It is the responsibility of the active duty members to obtain 
preauthorization for each service. With respect to each emergency 
inpatient admission, after such time as the emergency condition is 
addressed, authorization for any proposed continued stay must be 
obtained within two working days of admission.
* * * * *

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


Sec.  199.17  TRICARE program.

* * * * *
    (g) TRICARE Prime Remote for Active Duty Family Members. (1) In 
general. In geographic areas in which TRICARE Prime is not offered and 
in which eligible family members reside, there is offered under 10 
U.S.C. 1079(p) TRICARE Prime Remote for Active Duty Family Members as 
an enrollment option. TRICARE Prime Remote for Active Duty Family 
Members (TPRADFM) will generally follow the rules and procedures of 
TRICARE Prime, except as provided in this paragraph (g) and otherwise 
except to the extent the Director, TRICARE Management Activity 
determines them to be infeasible because of the remote area.
    (2) Active duty family member. For purposes of this paragraph (g), 
the term ``active duty family member'' means one of the following 
dependents of an active duty member of the Uniformed Services: Spouse, 
child, or unmarried child placed in the legal custody of the active 
duty member as a result of an order of a court of competent 
jurisdiction for a period of at least 12 consecutive months.
    (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 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 medical 
treatment facility 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.

[[Page 50349]]

    (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 address at which the family resides with the activated 
reservist upon activation.
    (4) Enrollment. TRICARE Prime Remote for Active Duty Family Members 
requires enrollment under procedures set forth in paragraph (o) of this 
section or as otherwise established by the Executive Director, TRICARE 
Management Activity.
    (5) Health care management requirements under TRICARE Prime Remote 
for Active Duty Family Members. The additional health care management 
requirements applicable to Prime enrollees under paragraph (n) of this 
section are applicable under TRICARE Prime Remote for Active Duty 
Family Members unless the Executive Director, TRICARE Management 
Activity determines they are infeasible because of the particular 
remote location. Enrollees will be given notice of the applicable 
management requirements in their remote location.
    (6) Cost sharing. Beneficiary cost sharing requirements under 
TRICARE Prime Remote for Active Duty Family Members are the same as 
those under TRICARE Prime under paragraph (m) of this section, except 
that the higher point-of-service option cost sharing and deductible 
shall not apply to routine primary health care services in cases in 
which, because of the remote location, the beneficiary is not assigned 
a primary care manager or the Executive Director, TRICARE Management 
Activity determines that care from a TRICARE network provider is not 
available within the TRICARE access standards under paragraph (p)(5) of 
this section. The higher point-of-service option cost sharing and 
deductible shall apply to specialty health care services received by 
any TRICARE Prime Remote for Active Duty Family Members enrollee unless 
an appropriate referral/preauthorization is obtained as required by 
section (n) under TRICARE Prime. In the case of pharmacy services under 
Sec. 199.21, where the Director, TRICARE Management Activity determines 
that no TRICARE network retail pharmacy has been established within a 
reasonable distance of the residence of the TRICARE Prime Remote for 
Active Duty Family Members enrollee, cost sharing applicable to TRICARE 
network retail pharmacies will be applicable to all CHAMPUS eligible 
pharmacies in the remote area.
* * * * *
    (o) * * *
    (1) * * *
    (2) Enrollment period.
    (i) Beneficiaries who select the TRICARE Prime option or the 
TRICARE Prime Remote for Active Duty Family Members option remain 
enrolled for 12 month 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. 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: August 15, 2006.
L. M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
 [FR Doc. E6-13719 Filed 8-24-06; 8:45 am]
BILLING CODE 5001-06-P