[Federal Register Volume 78, Number 31 (Thursday, February 14, 2013)]
[Notices]
[Pages 10608-10610]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-03414]


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DEPARTMENT OF DEFENSE

Office of the Secretary


David Grant United States Air Force Medical Center Specialty Care 
Travel Reimbursement Demonstration Project

AGENCY: Department of Defense.

ACTION: Notice of demonstration project.

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SUMMARY: This notice is to advise interested parties of a Military 
Health System (MHS) demonstration project under the authority of Title 
10, United States Code, Section 1092, entitled David Grant United 
States Air Force Medical Center Specialty Care Travel Reimbursement 
Demonstration Project. This demonstration project is intended to test 
whether providing travel reimbursement will increase utilization of the 
direct care system by selected beneficiaries. The Military Treatment 
Facility (MTF) commander would determine based on the MTF's individual 
capabilities, which specialty services in the facility currently have 
excess capacity and then offer those specialty services to qualified 
beneficiaries, including TRICARE Prime, TRICARE Standard and TRICARE 
for Life (TFL) beneficiaries, who reside more than one hour drive time 
away from the David Grant United States Air Force Medical Center 
(DGMC). These beneficiaries would be enticed to receive this specialty 
care from the more distant MTF rather than a closer authorized provider 
through the payment of travel costs from their residence to the MTF. 
The travel reimbursement offered under this demonstration will include 
roundtrip mileage reimbursement from the patient's residence to DGMC. 
Reimbursement may also include overnight lodging for the patient the 
evening before an early morning procedure and travel for a non-medical 
attendant for patients when medically indicated. This demonstration 
will test if the travel reimbursement incentive can produce a cost of 
care savings related to the recapturing of selected DoD beneficiaries. 
This travel benefit will be authorized only when the MTF commander (or 
designee) determines that the DoD cost of funding the care (including 
the travel benefit) in the MTF is likely to be less than the DoD cost 
to provide the care in the purchased care system. This demonstration 
also seeks to maximize the utilization of DGMC specialists, maintain an 
adequate clinical case mix of patients for approved Graduate Medical 
Education program functioning in the MTF, and sustain readiness-related 
medical skills activities for the military providers. This 
demonstration would be initially conducted at DGMC and its satellite 
clinic, the McClellan Clinic (MCC) as well as the clinic located at 
Beale Air Force Base (Beale). However, it could be expanded to other 
MTFs with the approval of the Assistant Secretary of Defense (Health 
Affairs), and a subsequent Federal Register notification.

DATES: This demonstration will be effective 60 days from the date of 
this notice for a period of thirty six (36) months, unless extended by 
a separate action.

ADDRESSES: TRICARE Management Activity (TMA), Health Plan Operations, 
7700 Arlington Boulevard, Suite 5101, Falls Church, VA 22042-5101.

FOR FURTHER INFORMATION CONTACT: For questions pertaining to this 
demonstration project, please contact Maj. Kevin Schultz at (707) 423-
7887.

SUPPLEMENTARY INFORMATION:

a. Background

    A basic principle of the TRICARE program and the Military Health 
System (MHS) business design is that MTFs have first priority for 
providing referred specialty care or inpatient care for all TRICARE 
Prime enrollees. If the MTF does not have the capability to provide the 
needed care or cannot provide the care within the required access 
standard, then the care will be referred to the TRICARE provider 
network. TRICARE Prime access standards require referrals for specialty 
care services to be provided with an appropriately trained provider 
within 4 weeks or sooner, if required, and within 1-hour travel time 
from the beneficiary's residence. The geographic area that represents 
1-hour travel time surrounding an MTF is referred to as the Right of 
First Refusal (ROFR) area.
    For those Prime beneficiaries that live outside the ROFR area, 
their specialty care is referred to the civilian network. TRICARE 
Standard and TFL beneficiaries maintain freedom of choice and may 
receive specialty care from any TRICARE authorized civilian provider or 
alternatively may elect to receive their care in a MTF to the extent 
such care is available to them.
    DoD's authority to reimburse travel expenses for TRICARE 
beneficiaries is currently limited to the TRICARE Prime Travel Benefit, 
provided pursuant to 10 USC 1074i, which reimburses only Prime 
beneficiaries for non-emergent medically necessary specialty care that 
is provided more than 100 miles from the beneficiary's primary care 
provider's office to the nearest specialist's office.

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The benefit is limited to specialty referrals when no other options for 
care are available within 100 miles of the primary care provider. This 
demonstration project is designed to test the effectiveness of a 
voluntary local travel reimbursement designed to recapture certain 
specialty care within the direct care system for beneficiaries who 
reside outside of the ROFR area.
    David Grant United States Air Force Medical Center (DGMC) at Travis 
Air Force Base (AFB) is currently a 116-bed facility and fulfills a key 
role in the Air Force Medical Service as the second largest deployment 
platform. A robust TRICARE eligible population remains in the Northern 
California area, however much of it is located just beyond a 60-minute 
drive time from DGMC. DGMC also operates the McClellan satellite clinic 
(MCC) in Sacramento. This satellite clinic offers an opportunity to 
recapture a larger DoD beneficiary population than is available in the 
existing DGMC Prime Service Area and ROFR area for specialty care. 
Based on surveys of existing patients at the clinic, travel distance is 
the most significant factor for why patients do not utilize DGMC for 
specialty care that may only be available at the MTF vice the clinic.
    Over the last year, DGMC specialties have begun offering outpatient 
services at MCC, with appointment availability varying based on patient 
demand. The majority of patient care can be provided at MCC including 
initial consults, medication management, and pre/post-operative visits. 
When required, the physician will schedule a patient for surgery or 
other procedure not available at MCC, at DGMC. The feedback from 
patients has been very positive as MCC offers specialty services much 
closer to the patient's residence.
    These DGMC efforts have proven to be very successful in recapturing 
specialty care in the immediate area surrounding the hospital. Through 
this demonstration project, DGMC will now seek to reach the larger 
beneficiary population that resides beyond the 60 minute drive time to 
the MTF (those outside the ROFR area) to maximize the direct care 
system and improve provider currency and deployment capability through 
increased patient acuity and volume.
    Under this demonstration, DGMC would reimburse TRICARE Prime, 
TRICARE Standard, and TFL beneficiaries who live outside of the ROFR 
area of DGMC for reasonable travel expenses when they agree to receive 
specialty procedures, including diagnostic and surgical procedures not 
otherwise available at MCC or Beale AFB, in specialties determined by 
the Commander of DGMC to have excess capacity. Reimbursement will only 
be authorized when the beneficiary resides outside of the ROFR area of 
the DGMC and (1) a specialty provider at MCC or Beale sends a patient 
to DGMC for care not available at MCC or (2) a patient is assessed by a 
specialist who is an authorized TRICARE provider and identified as a 
candidate for a surgical intervention to be performed at DGMC. There 
will be no requirement for a network provider outside of the ROFR area 
to refer the patient to DGMC, but all authorized specialty providers 
will be given information on how to make the referral if the patient 
desires to use DGMC. The demonstration project will be communicated to 
the non-Prime beneficiaries through multiple communications channels, 
to include provider outreach and other media.
    For purposes of this demonstration, once the beneficiary is 
identified as requiring a procedure at DGMC, they will be referred to 
the Beneficiary Counseling and Assistance Coordinator (BCAC) at MCC. 
The BCAC will review the patient information and determine if the 
patient is eligible for travel reimbursement. If so, the BCAC will 
brief the patient as to the process and assist the patient in applying 
for the travel as well as processing any travel vouchers. Travel for a 
non-medical attendant (NMA) for patients who require admission may be 
authorized when the attendance of a NMA is medically indicated. When 
the patient's procedure is to occur before 8:00 a.m., then 
reimbursement for the patient and an NMA may be authorized for lodging 
for the one night prior to the procedure. The maximum reimbursement 
shall be the lesser of the actual lodging costs or the locality lodging 
rate. This shall be in addition to the normal mileage reimbursement of 
51 cents per mile. If the beneficiary is hospitalized overnight, the 
NMA may also be authorized reimbursement for the mileage back to their 
residence. The MCC BCAC will assist with making arrangements at the 
Travis Fisher House, base lodging, or local hotel, based on 
availability. The amount of travel to DGMC will be minimized as much as 
possible by offering pre/post-operative visits at MCC, as well as 
diagnostic testing either at MCC or in the civilian network.
    Beneficiary participation in this demonstration program is strictly 
voluntary; beneficiaries will be allowed to seek specialty procedures/
care in the private care system if they prefer. The 60 minute drive 
time access to care standard for Prime beneficiaries would still be 
applicable, so Prime beneficiaries wanting to participate would have to 
waive their access to care standards. The authorization and oversight 
of the reimbursement and, if needed, the coordination with other 
healthcare insurance (OHI) plans will be the responsibility of the MTF.

b. Implementation

    This demonstration will be effective 60 days from the date of this 
notice for a period of thirty six (36) months.

c. Evaluation

    The results of this demonstration will allow a focused study on the 
impact a voluntary local travel reimbursement will have on encouraging 
TRICARE beneficiaries who live beyond a 60 minute drive time to an MTF 
(those outside the ROFR area) to nonetheless utilize the direct care 
system for needed specialty care in lieu of electing a closer, 
purchased care provider. Throughout the demonstration project, there 
will be monthly tracking of the number of DGMC inpatient admissions and 
outpatient encounters by demonstration participants who reside outside 
the DGMC ROFR area for the identified specialties. There will also be 
quarterly tracking of marketing initiatives to measure their 
effectiveness in ensuring that eligible beneficiaries in the target 
area are aware of the availability of specialty services at MCC and the 
corresponding travel reimbursement to/from DGMC. Success of the 
demonstration would be determined in part by a substantial increase in 
encounters from beneficiaries that reside outside the DGMC ROFR area 
for identified specialties while at the same time there is no increase 
in the referral rate to the network from DGMC for these same 
specialties for TRICARE Prime beneficiaries that reside within the ROFR 
area. Data will also be gathered regarding local travel reimbursement 
expenditures and the estimated purchased care cost-savings of 
demonstration participants. At the end of the demonstration, a thorough 
business case analysis will be conducted of the relevant expenditures 
and cost-savings, in addition to an assessment of the demonstration 
project's impact on MTF productivity, provider currency in the 
identified specialties, and utilization of excess capacity in the 
direct care system. Following this evaluation, Health Affairs may seek 
permanent authority to implement a travel reimbursement program for 
certain beneficiaries when they agree to receive specialty care in the 
direct care system.


[[Page 10610]]


    Dated: February 1, 2013.
Patricia L. Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2013-03414 Filed 2-13-13; 8:45 am]
BILLING CODE 5001-06-P