[Federal Register Volume 76, Number 43 (Friday, March 4, 2011)]
[Notices]
[Pages 12081-12082]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-4865]


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DEPARTMENT OF DEFENSE

Office of the Secretary


Notice of Two-Year Continuation of Disease Management 
Demonstration Project for TRICARE Standard Beneficiaries

AGENCY: Department of Defense.

ACTION: Notice of Two-Year Continuation of Disease Management 
Demonstration Project for TRICARE Standard Beneficiaries.

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SUMMARY: This notice is to advise interested parties of the 
continuation of a Military Health System (MHS) demonstration project 
entitled ``Disease Management Demonstration Project for TRICARE 
Standard Beneficiaries''. The original demonstration notice was 
published on June 13, 2007 (72 FR 32628-32629) and described a 
demonstration project to provide disease management (DM) services to 
TRICARE Standard beneficiaries in addition to the TRICARE Prime 
beneficiaries who were already entitled to such services. TRICARE began 
the demonstration project in March 2007 for Standard beneficiaries and 
this demonstration project has enabled the MHS to provide uniform 
policies and practices on disease and chronic care management 
throughout the TRICARE network. Additionally, the demonstration has 
helped determine the effectiveness of DM programs in improving the 
health status of beneficiaries with targeted chronic diseases or 
conditions, and any associated cost savings. The TRICARE Management 
Activity (TMA) chose a phased approach to determine the efficacy and 
cost effectiveness of its disease management demonstration, beginning 
with beneficiaries identified with the disease states of asthma, heart 
failure, and diabetes. TMA now intends to continue the disease 
management services to TRICARE Standard beneficiaries until a permanent 
TRICARE disease management benefit (per the John Warner National 
Defense Authorization Act of 2007, section 734) is implemented. This 
continuation of the disease management demonstration project will be 
conducted under the authority provided in 10 U.S.C. 1092.

DATES: Effective date: The extension of the demonstration will be 
effective April 1, 2011 and will continue for a period of two years 
until March 31, 2013.

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

FOR FURTHER INFORMATION CONTACT: Robin Marzullo, Disease Management 
Nurse Consultant, Population Health and Medical Management--TRICARE 
Management Activity, telephone (703) 681-6717 x 1214.

SUPPLEMENTARY INFORMATION: 

A. Background

    For additional information on the TRICARE demonstration project for 
disease management, please see 72 FR 32628-32629 and 74 FR 11089-11090. 
The original demonstration notice focused on explaining the differences 
between the disease management benefits available to TRICARE Standard 
and TRICARE Prime beneficiaries and the manner in which disease 
management services had been provided prior to the demonstration. The 
prior notice explained that for purposes of the demonstration, the 
Department of Defense (DoD) would waive, for these disease management 
services provided to Standard beneficiaries, the provisions of 10 
U.S.C. 1079(a)(13) and 32 CFR 199.4(g)(39) that expressly exclude 
clinical preventive services for TRICARE Standard beneficiaries. The 
prior notice also explained the enrollment process and cap on disease 
management costs.

B. Description of Extension of Demonstration Project

    Under this demonstration, DoD has waived, for disease management 
services provided to TRICARE Standard beneficiaries, the provisions of 
10 U.S.C. 1079(a)(13) and 32 CFR 199.4(g)(39) that expressly exclude 
clinical preventive services for TRICARE Standard beneficiaries in the 
current benefit. The Military Health System (MHS) has enrolled TRICARE 
Standard beneficiaries in its disease management programs. Disease 
management services provided to Standard beneficiaries have included, 
but have not been limited to: Clinical preventive examinations, patient 
education and counseling services, and periodic screening exams. MHS 
disease management program costs have been capped not to exceed the 
amount approved by the contracting officer. The disease management 
program costs are total costs of disease management services provided 
to both Prime and Standard beneficiaries. Only those beneficiaries 
identified by the TRICARE Management Activity (TMA) for disease 
management of asthma, heart failure, diabetes, COPD, depression, 
anxiety, and cancer, have been included in the current program. 
Beneficiaries identified by TMA are included in the disease management 
program unless they choose to opt out. This action directly reduces 
variation across the system and results in improved consistency and 
quality for beneficiaries with targeted chronic illness, regardless of 
TRICARE classification. Furthermore, including TRICARE Standard 
beneficiaries in current disease management efforts informs the MHS 
about total potential savings and return on investment (ROI) associated 
with disease management, a stated requirement of the John Warner 
National Defense Authorization Act for Fiscal Year 2007. Continuing to 
provide disease management services to all TRICARE beneficiaries will 
continue to maintain our overall quality of care throughout the MHS 
program. By educating patients about their disease and helping them 
manage their symptoms, many of the complications of these diseases can 
be avoided, possibly slowing the progression of their chronic disease, 
thus resulting in significant cost savings.

[[Page 12082]]

C. Implementation

    The extension of the demonstration will be effective on April 1, 
2011. The terms and conditions of the original demonstration as 
provided in the Notice published at 72 FR 32368-32369 will continue on 
that date.

D. Evaluation

    An independent evaluation of the demonstration will continue to be 
conducted. The evaluation is designed to use a combination of 
administrative and survey measures of health care outcomes (clinical, 
utilization, financial, and humanistic measures) to provide analyses 
and comment on meeting its goal of providing uniform disease management 
policies and practices across the MHS.

    Dated: March 1, 2011.
Morgan F. Park,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2011-4865 Filed 3-3-11; 8:45 am]
BILLING CODE 5001-06-P