[Federal Register Volume 78, Number 51 (Friday, March 15, 2013)]
[Notices]
[Pages 16476-16477]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-06022]


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DEPARTMENT OF DEFENSE

Office of the Secretary


Notice for Termination of a Disease Management Demonstration 
Project for TRICARE Standard Beneficiaries

AGENCY: Office of the Secretary of Defense, (Health Affairs)/TRICARE 
Management Activity, DoD.

ACTION: Notice for termination of a Disease Management Demonstration 
Project for TRICARE Standard Beneficiaries.

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SUMMARY: This notice is to advise interested parties of the termination 
of a Military Health System (MHS) demonstration project entitled 
``Disease Management Demonstration Project for TRICARE Standard 
Beneficiaries.'' The demonstration provided disease management (DM) 
services to TRICARE Standard beneficiaries who are not eligible to 
receive some DM-like services under the basic benefit regulations. 
TRICARE began the demonstration project in March 2007 for Standard 
beneficiaries and this demonstration project has enabled the MHS to 
evaluate the programs and identify ways to improve the provision of 
effective services by detecting strengths and weaknesses of the 
programs, as well as evidence of best practices. As the TRICARE 
Management Activity (TMA) chose a phased approach, the demonstration 
was extended twice, on March 16, 2009 (74 FR 11089-11090), and again on 
March 4, 2011 (76 FR 12081-12082), to allow time for all program 
evaluations. TMA intends to continue to provide DM services to eligible 
TRICARE beneficiaries through strategies based on evidence-based best 
practices, beneficiary's needs, plan category, and location of health 
care provision.

DATES: Effective date: March 31, 2013.

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

FOR FURTHER INFORMATION CONTACT: Robin Marzullo, TRICARE Management

[[Page 16477]]

Activity, Office of the Chief Medical Officer (703) 681-6173.

SUPPLEMENTARY INFORMATION: As a result of Section 734 0f the 2007 
National Defense Authorization Act, the MHS implemented uniform 
policies and practices for DM throughout the TRICARE network. To 
include the Standard beneficiaries, who could not receive many of the 
services that are the cornerstone of DM per the Basic Benefit 
Regulations, a two year demonstration notice was published June 13 2007 
(72 FR 32628-32629). The demonstration project provided for measuring 
the effectiveness of the DM programs in improving the health of TRICARE 
beneficiaries with chronic conditions. In addition, it allowed the MHS 
to identify best practices for improving the care management services 
for individuals with chronic conditions. The demonstration was extended 
twice. On March 16, 2009 a notice (74 FR 11089-11090) was published 
that extended the demonstration through March 31, 2011 and on March 4, 
2011 (76 FR 12081-12082) further extended the demonstration through 
March 31, 2013. For several years, TRICARE has been evaluating the best 
way to provide assistance to people with certain chronic medical 
conditions. Based on TRICARE's evaluation of best health care 
practices, we found that chronic medical conditions are best managed as 
a routine part of good medical practice, and when structured to fit the 
individual beneficiary's circumstances and their specific health plan. 
Multiple analyses of the DM program were conducted, and in that same 
time period other studies for similar programs were piloted nationally 
that provided additional insight. The results of these analyses and 
literature reviews provided identification of evidence-based best 
practices that support the future direction of the MHS disease and 
chronic condition management programs. These best practices include 
team based--provider directed care, care coordination, self-management 
education and transitional care services that target at risk 
populations, have access to timely data, close interactions with care 
coordinators and primary care physicians, face-to-face contact with 
individuals involved in their own care, and supported by practices 
predominantly staffed by registered nurses.
    Given the focus with the primary care provider in moving forward 
with disease and chronic care management, and the lack of a defined 
provider for the Standard beneficiaries, TMA has determined that the 
best course is for the Standard beneficiaries to receive disease and 
chronic care management direction from the provider of their choosing. 
TMA envisions the following scenarios related to the distinct 
structures of the health care benefit within TRICARE (Direct Care 
through the Military Treatment Facilities, Private Sector Care through 
contracted and non-contracted network providers, the US Family Health 
Plans etc.), chronic care management based on the above mentioned best-
practices will be available to beneficiaries and adapted based on these 
factors. The DM services will also take into consideration the 
different benefit plans available (Prime, which operates like an HMO 
and requires enrollment with a primary care provider, vs. Standard 
which functions as a fee-for-service plan), and will modify the chronic 
care services provided to best match that plan. For example, Prime 
beneficiaries enrolled at an MTF would receive their services through a 
Patient-Centered Medical Home (where available). A Prime beneficiary 
enrolled to the network would receive DM services provided through the 
Managed Care Support Contractor's program. A Standard beneficiary not 
enrolled to a primary care provider, would receive disease and chronic 
care management from their chosen provider inside or outside the 
network, and would have access to disease specific educational 
information through the regional contractor Web sites or TRICARE 
online. Since the standard beneficiaries are not required to enroll 
with a primary care provider, and there is no visibility to the 
services they receive outside the network, it is not practicable to 
determine if they are receiving the recommended best-practices, and in 
turn to measure outcomes and determine effectiveness of care. As a 
result, it has been determined that Standard beneficiaries are best 
served being care-managed by the provider of their choosing; the 
provider being familiar with the Standard beneficiaries gaps in care 
and on-going needs.
    TMA has developed a strategic plan for the on-going provision of 
disease and chronic care management services, based on the evidence-
based best practices noted above, and have determined that the need for 
this demonstration has ceased. It is important to note that the end of 
this demonstration does not change the basic benefit for the Standard 
beneficiaries; they will continue to have access to all the services 
identified in 32 CFR 199.4.

    Dated: March 12, 2013.
Aaron Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2013-06022 Filed 3-14-13; 8:45 am]
BILLING CODE 5001-06-P