[Federal Register Volume 84, Number 187 (Thursday, September 26, 2019)]
[Proposed Rules]
[Pages 50805-50809]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-20621]


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DEPARTMENT OF DEFENSE

Office of the Secretary

32 CFR Part 199

[Docket ID: DOD-2019-HA-0090]
RIN 0720-AB76


TRICARE; Reserve and Guard Family Member Benefits; Early 
Eligibility TRICARE and Transitional Assistance Management Program for 
Certain Reserve Component Members; Extended TRICARE Program Coverage 
for Certain National Guard Members

ACTION: Proposed rule.

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SUMMARY: This rulemaking proposes changes to implement provisions of 
the National Defense Authorization Act for Fiscal Year 2017 (NDAA-17) 
to continue TRICARE program coverage for certain members of the 
National Guard and their dependents during certain disaster response 
duty. This applies discretionary authority broadened by NDAA-17 to 
propose expansion of the TRICARE Reserve and Guard Family Benefits 
program to all families of Reserve Component (RC) members on active 
duty for more than 30 days, except for the families of RC members 
performing active Guard and Reserve (AGR) duty for a period of 180 
consecutive days or more. This rulemaking also proposes to expand both 
early eligibility TRICARE coverage and Transitional Assistance 
Management Program (TAMP) coverage to RC members on active duty for 
some pre-planned missions.

DATES: Written comments received at the address indicated in the 
ADDRESSES section by November 25, 2019 will be accepted.

ADDRESSES: You may submit comments, identified by docket number and/or 
Regulation Identifier Number (RIN) number and title, by any of the 
following methods:
    Federal eRulemaking Portal: http://www.regulations.gov. Follow the 
instructions for submitting comments.
    Mail: Department of Defense, Office of the Chief Management 
Officer, Directorate for Oversight and Compliance, 4800 Mark Center 
Drive, Mailbox #24, Suite 08D09, Alexandria, VA 22350-1700.
    Instructions: All submissions received must include the agency name 
and docket number or RIN for this Federal Register document. The 
general policy for comments and other submissions from members of the 
public is to make these submissions available for public viewing at 
http://www.regulations.gov as they are received without change, 
including any personal identifiers or contact information.

FOR FURTHER INFORMATION CONTACT: Brian Smith, Defense Health Agency, 
TRICARE Health Plan, telephone (303) 676-3729.

SUPPLEMENTARY INFORMATION:

I. Introduction and Background

    Guardsmen on full-time National Guard duty under Sec.  502(f) of 32 
U.S.C. 502(f) who were called to state active duty (SAD) for disaster 
response duty, lost their premium-free TRICARE coverage. This rule 
implements authority under 10 U.S.C. 1076f (added by Sec.  711 of NDAA-
17 (Pub. L. 114-328)) and proposes to continue TRICARE coverage to 
these members of the National Guard (NG) and their eligible family 
members, upon request of the state/territory on a fully reimbursable 
basis. The TRICARE Guard and Reserve Family Benefits (TRGFB) program 
has successfully eased the transition for RC families to and from 
TRICARE since its inception under demonstration authority in September 
2001. Section 748(b) of NDAA-17 extends TRGFB to eligible family 
members of any RC member who is on active duty for more than 30 days, 
amending prior legislation that required the active duty be in support 
of a contingency operation. Transition has also been eased by early

[[Page 50806]]

eligibility TRICARE coverage that started in 2004, which is also when 
the long-standing TAMP program had its period of coverage extended to 
180 days. Section 511 of NDAA-18 expands eligibility for these programs 
to more RC members and their families under recently amended statutes.

II. Continued TRICARE Program Coverage (Sec.  199.3)

    Prior to Sec.  711 of NDAA-17, premium-free TRICARE coverage 
terminated for members of the NG on full-time NG duty (FTNGD) under 
502(f) of title 32, when they commenced state active duty (SAD) 
including response to certain disasters upon a call to duty by the 
state/territory. There is no federal statutory entitlement to premium-
free health care at Department of Defense (DoD) expense during SAD 
since it is a state responsibility and not federal responsibility. 
However, performing SAD does not disqualify them from TRICARE Reserve 
Select 10 U.S.C. 1076f. Section 711 of NDAA-17 authorizes the state/
territory request TRICARE coverage to continue when NG members transfer 
from FTNGD to SAD in response to certain disasters and reimburse the 
DoD for all health care received by NG and their family members in 
military treatment facilities or purchased from civilian providers.

III. Expansion of TRICARE Reserve and Guard Family Benefits Program 
(Sec.  199.14)

    Prior to Sec.  748(b) of NDAA-17, discretionary authority to pay 
non-network, TRICARE authorized providers up to 115% of the CHAMPUS 
Maximum Allowable Charge (CMAC) contained in 10 U.S.C. 
1079(h)(4)(C)(ii) applied only to families of RC sponsors who had been 
activated for more than 30 days in support of a contingency operation 
as defined in 10 U.S.C. 101(a)(13). In contrast, prior discretionary 
authority to waive the TRICARE deductible (10 U.S.C. 1095d(a) added by 
Sec.  714 of NDAA-99 (Pub. L. 106-65)) never contained the limitation 
that the RC sponsor's activation to be ``in support of a contingency 
operation.'' For consistency, during the demonstration and continuing 
in the permanent program to the present, the Department aligned these 
provisions by offering both features only to families of RC sponsors 
who had been activated for more than 30 days in support of a 
contingency operation.
    Together, these two features comprise the TRICARE Reserve and Guard 
Family Benefits program that help ensure timely access to healthcare 
and maintain clinically appropriate continuity of healthcare to family 
members of activated RC members, appropriately limit the out-of-pocket 
expenses for those family members, and remove potential barriers to 
healthcare access by families in order to improve the morale and 
retention of RC members.
    This proposed rule applies discretionary authority broadened by 
Sec.  748(b) of NDAA-17 to expand both the increased payment to 
providers feature and the waiver of deductible feature to all families 
of RC members on active duty for more than 30 days, except for the 
families of RC members performing AGR duty for a period of 180 
consecutive days or more (as defined in 10 U.S.C. 101(d)(6)); including 
full-time support (FTS) members of the U.S. Navy Reserve and U.S. 
Marine Corps Reserve. While AGR members are in the Selected Reserve, 
their current and future and medical benefits as well as their 
retirement benefits compare to the full-time Active Components. Adding 
these features to their current medical benefits would make their 
medical benefit better than their Active Component colleagues. 
Additionally, the career path of an AGR member has the potential for 
twenty years of cumulative active service leading to a regular 
retirement (10 U.S.C. chapter 367 [Army], chapter 571 [Navy and Marine 
Corps], and chapter 867 [Air Force]) with medical eligibility 
immediately upon retirement, rather the non-regular retirement common 
to RC members (10 U.S.C. subtitle E, part II) that delays medical 
eligibility until the RC sponsor reaches age 60. Because AGR members, 
and their eligible family members, have benefits comparable to members 
on active duty, and their eligible family members, the Department sees 
the authority of Sec.  748(b) of NDAA-17 as inapplicable to their 
circumstances.
    A. Waiver of deductible (Sec.  199.4(f)(2)(i)(H)). Eligible family 
members of RC sponsors called or ordered to active duty for more than 
30 days and who are enrolled in TRICARE Select would not be responsible 
for paying the annual deductible under TRICARE Select associated with 
their sponsor's qualifying active duty. Considering that many may have 
already paid annual deductibles under their health plan prior to 
enrolling in TRICARE Select, waiving this annual deductible 
appropriately limits out-of-pocket expenses for many RC family 
households.
    B. Increased payment to providers (Sec.  199.14(j)(1)(i)(E)). This 
feature increases TRICARE payments up to 115 percent of the CMAC, for 
TRICARE covered outpatient care received from a TRICARE authorized 
provider who does not participate (accept assignment) under TRICARE. 
This helps make it possible for RC family members to continue seeing 
civilian providers with whom they might have established relationships 
(i.e. access) while promoting clinically appropriate continuity of 
care. Section 748(b) of NDAA-17 expanded the discretionary authority 
for increased TRICARE payments to providers by removing the limitation 
from the statute (10 U.S.C. 1079(h)(4)(C)(ii)) that had required the RC 
sponsor's activation be ``in support of a contingency operation.''

IV. Expansion of Early Eligibility TRICARE and TAMP to Certain RC 
Members

    Section 511 of NDAA-18 amended 10 U.S.C. 1074(d)(2) to expand both 
early eligibility TRICARE and TAMP coverage to RC members called or 
ordered to active duty for pre-planned missions under 10 U.S.C. 12304b. 
Previously, law provided these benefits to RC members (and their 
eligible family members) only in conjunction with a call or order to 
active duty for more than 30 days in support of a contingency operation 
(10 U.S.C. 101(a)(13)(B)). Until enactment of Sec.  511, duty for pre-
planned missions had not been included in the discretionary authority 
for early eligibility TRICARE and TAMP benefits.
    The definition for contingency operation includes military duty 
under 10 U.S.C. 101(a)(13)(A) and (B), but Sec.  511 amendment 
specifies duty under subparagraph (B) in particular for both early 
eligibility TRICARE and TAMP. In addition to a contingency operation 
under subparagraph (B), this rule proposes to offer these benefits for 
duty described under subparagraph (A) as well: Military duty designated 
by the Secretary of Defense as an operation in which members of the 
armed forces are or may become involved in military actions, 
operations, or hostilities against an enemy of the United States or 
against an opposing military force.
    A. Early Eligibility TRICARE (Sec.  199.3(b)(5)(i)). Certain RC 
members who are issued delayed-effective-date orders for active duty of 
more than 30 days for a preplanned mission or in support of a 
contingency operation, would receive up to 180 days of early 
eligibility TRICARE coverage for themselves and their eligible family 
members beginning on the later of the date of the issuance of such 
order or 180 days before the date on which the period of active duty is 
to commence under such order. In addition to member readiness, this 
early eligibility TRICARE contributes to family

[[Page 50807]]

readiness by providing a period of time for the family to adjust in 
advance to TRICARE coverage before the RC member's reporting date for 
activation.
    B. Transitional Assistance Management Program (Sec.  199.3(e)(ii)). 
TAMP extends TRICARE eligibility for 180 days after separation from 
active duty so individuals have a generous amount of time to make 
arrangements for other health coverage for themselves and their 
families. In addition to RC members activated for more than 30 days in 
support of a contingency operation, RC members separating from active 
duty for a preplanned mission under 10 U.S.C. 12304b would gain TAMP 
coverage for themselves and their eligible family members.

V. Regulatory Analysis

    We developed this rule after considering numerous statutes and 
Executive Orders (E.O.s) related to rulemaking. Below we summarize our 
analyses based on these statutes or E.O.s.

A. Regulatory Planning and Review

    Executive Orders 12866 (Regulatory Planning and Review) and 13563 
(Improving Regulation and Regulatory Review) direct agencies to assess 
the costs and benefits of available regulatory alternatives and, if 
regulation is necessary, to select regulatory approaches that maximize 
net benefits (including potential economic, environmental, public 
health and safety effects, distributive impacts, and equity). Executive 
Order 13563 emphasizes the importance of quantifying both costs and 
benefits, of reducing costs, of harmonizing rules, and of promoting 
flexibility. This rule has been designated as a ``not significant'' 
regulatory action, and not economically significant, under section 3(f) 
of Executive Order 12866. Accordingly, the rule has not been reviewed 
by the Office of Management and Budget (OMB) under the requirements of 
these Executive Orders.
    Executive Order 13771 (Reducing Regulation and Controlling 
Regulatory Costs) directs agencies to reduce regulation and control 
regulatory costs and provides that ``for every one new regulation 
issued, at least two prior regulations be identified for elimination, 
and that the cost of planned regulations be prudently managed and 
controlled through a budgeting process.'' This proposed rule is not 
expected to be subject to the requirements of this Executive Order 
because it is not significant under Executive Order 12866.
1. Costs
    By removing the requirement that the disaster response duty be 
federal in order for Guardsmen to be eligible for TRICARE coverage, the 
States may see an increase of costs to be reimbursed to DoD. These 
additional costs, however, are expected to be de minimis because this 
expansion of eligibility to State disaster response duty will only 
impact a very small portion of the Guard population. These minimal 
additional costs are incurred at the request of the State for TRICARE 
coverage of Guardsmen, and upon the agreement that those costs be 
reimbursed to DoD. For this reason, States allocate health care funding 
and programs for Guardsmen and their families during State disaster 
response duty. Because States would fully reimburse the DoD for the 
cost of TRICARE coverage under Sec.  711 of NDAA-17, there is an 
assumption of zero net cost impact to DoD.
    Estimated costs to the Department with providing early eligibility 
TRICARE and TAMP coverage, as well as extending the existing deductible 
waiver and balance billing protection for all families of reservists 
utilizing TRICARE Select coverage to the entitled populations 
identified, is a total of $146 million from calendar years 2019 through 
2023 (an average of $29.2 million a year); $73.3 million associated 
with Sec.  748(b) of NDAA-17 and $72.7 million associated with Sec.  
511 of NDAA-18.
    We anticipate costs to the Government for administrative start-up 
fees from the managed care support contractors to be $230,290. These 
start-up costs will be incorporated in contracts and absorbed by DoD. 
This estimate was based on the contract modifications regarding impact 
assessment and requirements developments ($47,880), Information 
Technology systems updates ($26,085), and administrative services the 
Managed Care Support Contractors ($156,325) would need to conduct to 
support these enhanced benefits. The calculations are below.
    Under the third generation of TRICARE contracts (T3) for the 
TRICARE Overseas Program Managed Care Support Contractor (MCSC), the 
estimated cost regarding assessment and requirements development for 
the subcontractor were derived from an hourly rate of $56 at the level 
of effort (LOE) of 80 hours equals $4,480 ($56 hourly wage *80 hours), 
and for the primary MCSC, an hourly rate of $124 at 80 hours equals 
$9,920 ($124 hourly wage * 80 hours). Additionally for the 
subcontractor, estimated costs with adjusted administrative services 
were LOE of 270 hours at $124 an hour equals $33,480 ($124 hourly wage 
* 270 hours), and for IT start-up to support the additional benefit and 
population, the estimate was allocated at 50% of 235 hours at $111 an 
hour equals $26,085 ($111 hourly wage * 235 hours).
    Under the fourth generation of TRICARE Contracts (T17) for MCSCs, 
the estimated cost regarding assessment and requirements development 
for the subcontractor in each of the East and West Regions were derived 
from an hourly rate of $56 at the LOE of 80 hours and for the primary 
MCSCs, an hourly rate of $74 at 80 hours equals $5,920 ($124 hourly 
wage * 80 hours) for the East Region and an hourly rate of $124 at 80 
hours equals $9,920 ($124 hourly wage * 80 hours) for the West Region. 
Additionally for the subcontractors, estimated costs with adjusted 
administrative services were at a LOE of 270 hours at $56 an hour 
equals $15,120 ($56 hourly wage * 270 hours) for the East Region and 
270 hours at $124 an hour equals $33,480 ($124 hourly wage * 270 hours) 
for the West Region. For IT start-up to support the additional benefit 
and population in each Region, the estimate was allocated at 50% of 470 
hours at $111 an hour equals $26,085 [($111 hourly wage * 470 hours)/2] 
for the East Region and allocated at 100% of 470 hours at $140 an hour 
equals $65,800 ($140 hourly wage * 470 hours) for the West Region.
2. Benefits
    This rule proposes revisions to the requirements and procedures for 
all eligible family members of Reserve Component (RC) members activated 
more than 30 days who utilize the TRICARE Select program, proposes to 
expand Early TRICARE eligibility and TAMP to those RC members, and 
their eligible family members, who receive delay-effective-date active 
duty orders for more than 30 days in support of a contingency operation 
or a preplanned mission, and proposes to provide TRICARE program 
benefits to those Guardsmen, and their eligible family members, who 
were on Title 32, 502f Active Guard/Reserve orders and receive state 
active duty orders in support of a natural disaster.
3. Alternatives
    In proposing this rule, we have considered two alternatives:
    a. Alternative 1: No Action. Failure to implement this rule will 
mean that TRICARE regulations are not in compliance with the changes 
mandated by TRICARE statutory provisions.

[[Page 50808]]

    b. Alternative 2: Next Best Action. The next best alternative is to 
waive the annual deductible within the first CY of an activation only, 
for family members of RC members activated more than 30 days while in a 
continuous period of active duty who utilize TRICARE Select coverage, 
and not waive the annual deductible for subsequent CY years; per 
activation lasting more than 12 months or less than 12 months that 
carries into a second calendar year. While this would provide an 
estimated cost savings to the Department of $6.6 million from the 
proposed costing, the potential of exposing this beneficiary population 
to other annual deductibles under similar coverage with private 
insurance is likely. This course of action is not preferred.

B. Congressional Review Act (5 U.S.C. 801, et seq.)

    Under the Congressional Review Act, a major rule may not take 
effect until at least 60 days after submission to Congress of a report 
regarding the rule. A major rule is one that would have an annual 
effect on the economy of $100 million or more or have certain other 
impacts. This rule is not a major rule under the Congressional Review 
Act.

C. Impact on Small Entities

    The Regulatory Flexibility Act of 1980, 5 U.S.C. 601-612, as 
amended, requires Federal agencies to consider the potential impact of 
regulations on small entities during rulemaking. The term ``small 
entities'' comprises small businesses, not-for-profit organizations 
that are independently owned and operated and are not dominant in their 
fields, and governmental jurisdictions with populations of less than 
50,000. This rule will not impose any impacts on any small entities. 
This means that there will be no economic impacts on any small 
entities. Therefore, the Department of Defense under 5 U.S.C. 601-612 
certifies that this rule will not have a significant economic impact on 
a substantial number of small entities.

D. Assistance for Small Entities

    Under section 213(a) of the Small Business Regulatory Enforcement 
Fairness Act of 1996, Public Law 104-121, we want to assist small 
entities in understanding this rule so that they can better evaluate 
its effects on them and participate in the rulemaking. If the rule 
would affect your small business, organization, or governmental 
jurisdiction and you have questions concerning its provisions or 
options for compliance, please contact the person in the FOR FURTHER 
INFORMATION CONTACT section of this rule.
    Small businesses may send comments on the actions of Federal 
employees who enforce, or otherwise determine compliance with, Federal 
regulations to the Small Business and Agriculture Regulatory 
Enforcement Ombudsman and the Regional Small Business Regulatory 
Fairness Boards. The Ombudsman evaluates these actions annually and 
rates each agency's responsiveness to small business.

E. Unfunded Mandates Reform Act

    The Unfunded Mandates Reform Act of 1995, 2 U.S.C. 1531-1538, 
requires Federal agencies to assess the effects of their discretionary 
regulatory actions. In particular, the Act addresses actions that may 
result in the expenditure by a State, local, or tribal government, in 
the aggregate, or by the private sector of $100 million in 1995 
(adjusted for inflation) or more in any 1 year. Although this rule will 
not result in such an expenditure, we do discuss the effects of this 
rule elsewhere in this preamble.

F. Collection of Information

    The Paperwork Reduction Act (PRA) (44 U.S.C. 3501-3520) applies to 
collections of information using identical questions posed to, or 
reporting or recordkeeping requirements imposed on, ten or more members 
of the public. This rule does not impose requirements under the PRA.

G. Federalism

    Executive Order 13132 establishes certain requirements that an 
agency must meet when it promulgates a proposed rule (and subsequent 
final rule) that imposes substantial direct requirement costs on State 
and local governments, preempts State law, or otherwise has Federalism 
implications. This proposed rule does not have federalism implications 
that warrant the preparation of a federalism assessment in accordance 
with Executive Order 13132.

List of Subjects in 32 CFR Part 199

    Claims, Dental health, Health care, Health insurance, Individuals 
with disabilities, Military personnel.

    Accordingly, 32 CFR part 199 is proposed to be 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. Amend Sec.  199.2(b) by adding the definition of ``Disaster response 
duty'' in alphabetical order to read as follows:


Sec.  199.2  Definitions.

* * * * *
    (b) * * *
    Disaster response duty. Duty performed by a member of the National 
Guard in State status pursuant to an emergency declaration by the 
Governor of the State (or, with respect to the District of Columbia, 
the mayor of the District of Columbia) in response to a disaster or in 
preparation for an imminent disaster.
* * * * *
0
3. Amend Sec.  199.3 by:
0
a. Revising paragraphs (b)(5)(i) and (b)(5)(iii)(A) introductory text;
0
b. Adding paragraph (b)(6); and
0
c. Revising paragraph (e)(1)(ii).
    The revisions and additions read as follows:


Sec.  199.3  Eligibility.

* * * * *
    (b) * * *
    (5) * * *
    (i) Member. A member who is issued a delayed-effective-date active-
duty order for a period of more than 30 consecutive days that provides 
for active-duty service to begin under such order on a date after the 
date of the issuance of the order who is either:
    (A) A member of a Reserve Component of the armed forces who is 
ordered to active duty in support of a contingency operation under 10 
U.S.C. 101(a)(13); or
    (B) A member of the Selected Reserve who is ordered to active duty 
for a preplanned mission under 10 U.S.C. 12304b.
* * * * *
    (iii) * * *
    (A) The eligibility established by paragraphs (b)(5)(i)(A) of this 
section shall begin on or after November 6, 2003 and the eligibility 
established by paragraphs (b)(5)(i)(B) of this section shall begin on 
or after December 12, 2017, and shall be effective on the later of the 
date that is:
* * * * *
    (6) Certain members of the National Guard during certain disaster 
response duty. (i) Member. A member of the National Guard performing 
disaster response duty immediately following a period in which the 
member served on full-time National Guard duty under 32 U.S.C. 502(f).
    (ii) Dependents. CHAMPUS eligible dependents under this paragraph 
(b)(6) are those identified in paragraphs (b)(2)(i) (except former 
spouses) and (b)(2)(ii) of this section.
    (iii) Effective date. The authority established by paragraphs 
(b)(6)(i) and (ii) of this section shall begin on or after December 23, 
2016.

[[Page 50809]]

    (iv) Termination date. The eligibility established by paragraphs 
(b)(6)(i) and (ii) of this section terminates upon the date the state 
active duty for disaster response duty terminates, or any date prior, 
as determined by the State.
    (v) In this part, the term ``disaster response duty'' is defined in 
Sec.  199.2(b).
* * * * *
    (e) * * *
    (1) * * *
    (ii) A member of a Reserve Component who is separated from active 
duty served more than 30 consecutive days to which called or ordered 
either in support of a contingency operation under 10 U.S.C. 101(a)(13) 
or for a preplanned mission under 10 U.S.C. 10304b.
* * * * *
0
 4. Amend Sec.  199.4 by revising paragraph (f)(2)(i)(H) to read as 
follows:


Sec.  199.4  Basic program benefits.

* * * * *
    (f) * * *
    (2) * * *
    (i) * * *
    (H) The Director, Defense Health Agency, may waive the annual 
individual or family calendar 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, except for a Reserve Component member who 
is called or ordered to active Guard and Reserve duty for a period of 
more than 180 days as defined by 10 U.S.C. 101(d)(6).
* * * * *
0
 5. Amend Sec.  199.14 by revising paragraph (j)(1)(i)(E) to read as 
follows:


Sec.  199.14  Provider reimbursement methods.

* * * * *
    (j) * * *
    (1) * * *
    (i) * * *
    (E) Special rule for certain TRICARE Select enrollees. In the case 
of TRICARE Select enrolled-dependent spouse or child, as defined in 
Sec.  199.3(b)(2)(ii)(A) through (F) and (b)(2)(ii)(H)(1), (2), and 
(4), of a Reserve Component member serving on active duty pursuant to a 
call or order to active duty for a period of more than 30 days, except 
for a RC member who is called or ordered to active Guard and Reserve 
duty for a period of more than 180 days under 10 U.S.C. 101(d)(6), the 
Director, Defense Health Agency, may authorize non participating 
providers the allowable charge to be the CMAC level as established in 
paragraph (j)(l)(i)(B) of this section plus any balance billing amount 
up to the balance billing limit as referred to in paragraph 
(j)(l)(i)(C) of this section.
* * * * *

    Dated: September 19, 2019.
Shelly E. Finke,
 Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2019-20621 Filed 9-25-19; 8:45 am]
 BILLING CODE 5001-06-P