[Federal Register Volume 64, Number 230 (Wednesday, December 1, 1999)]
[Proposed Rules]
[Pages 67220-67222]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-31117]
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DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 199
RIN 0720-AA54
Civilian Health and Medical Program of the Uniformed Services
(CHAMPUS); Expansion of Dependent Eligibility for TRICARE Retiree
Dental Program
AGENCY: Office of the Secretary, DoD.
ACTION: Proposed rule.
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SUMMARY: This proposed rule implements a change to the TRICARE Retiree
Dental Program (TRDP) required by the National Defense Authorization
Act for Fiscal Year 1999. This change expands eligibility for
enrollment in the program to allow dependents of certain retired
members of the Uniformed Services to enroll in the program even if the
retired member does not enroll. In addition, this rule clarifies the
existing regulatory provisions for election of TRDP coverage and
disenrollment.
DATES: Comments must be received on or before January 31, 2000.
ADDRESSES: TRICARE Management Activity, 16401 East Centretech Parkway,
Aurora, CO 80011-9043.
FOR FURTHER INFORMATION CONTACT: Linda Winter, TRICARE Management
Activity, (303) 676-3682.
SUPPLEMENTARY INFORMATION:
I. Background
Implementation of the TRICARE Retiree Dental Program (TRDP), a
[[Page 67221]]
program completely funded by enrollee premiums, was directed by
Congress in section 703 of the National Defense Authorization Act for
Fiscal Year 1997, Public Law 104-201, which amended title 10, United
States Code, by adding section 1076c. Section 1076c was subsequently
amended by the National Defense Authorization Act for Fiscal Year 1998
to expand eligibility to retirees of the Public Health Service and the
National Oceanic and Atmospheric Administration and to surviving
spouses and dependents of deceased active duty members. As amended, the
law directs the implementation of a dental program for: (1) Members of
the uniformed services who are entitled to retired pay, (2) Members of
the Retired Reserve who would be entitled to retired pay but are under
the age of 60, (3) Eligible dependents of a member in (1) or (2) who
are covered by the enrollment of the member, and (4) The unremarried
surviving spouse and eligible child dependents of a deceased member who
died while in status described in (1) or (2); the unremarried surviving
spouse and eligible child dependents who receive a surviving spouse
annuity; or the unremarried surviving spouse and eligible child
dependents of a deceased member who died while on active duty for a
period of more than 30 days and whose eligible dependents are not
eligible or no longer eligible for the Active Duty Dependents Dental
Plan.
Eligibility of dependents (other than surviving spouses and
dependents) for the TRDP was contingent on the enrollment of the
retired member. This applied even in cases where the member could not
benefit from TRDP coverage. In such cases, members had a choice of
enrolling solely to obtain coverage for their dependents, or doing
without the program altogether.
With regard to amending section 1076c of title 10 to rectify this
situation, the House National Security Committee reported, ``Presently,
dependents may enroll in the retiree dental program only if the retired
member also enrolls. However, some retired members are entitled to
receive dental care from the Secretary of Veterans Affairs or have
medical or dental conditions which preclude their use of the dental
program. The committee believes it is not reasonable to ask these
retirees to enroll in, and pay premiums for, a program which offers
them no benefits only so their dependents may also enroll in the
program. Therefore, this provision would allow the dependents of these
specific retirees to enroll in the retiree dental program
independently.''
Section 702 of the National Defense Authorization Act for Fiscal
Year 1999, Public Law 105-261, addressed this situation by extending
eligibility for the TRDP to eligible dependents of certain retired
members who are not enrolled and whose benefit from enrollment would be
severely limited at best. These are members who are enrolled with
Veterans Affairs to receive dental care, members who are enrolled
through employment in a dental plan that is not available to the
member's dependents, and members who are prevented by a medical or
dental condition from being able to use TRDP benefits.
II. Provisions of the Proposed Rule To Expand Eligibility of
Dependents
This proposed rule extends eligibility for the TRDP to eligible
dependents when the retired member is not enrolled because the member
would not benefit from the program due to any of the three conditions
stipulated in the law, which are, briefly, dental care from Veterans
Affairs, employee-only dental coverage, or medical or dental condition
which precludes dental care. To facilitate understanding and convey the
intent of the law, the proposed rule mandates that each of these
conditions must meet the test of being on-going, long-term, or enduring
as opposed to episodic, conditional, temporary, or short-term. The
retired member's circumstance must be such that the benefits of the
TRDP would not be useful currently and in the foreseeable future. This
distinction is also necessary to help limit the potential for adverse
selection and higher costs.
Given the absence of any systems of information that a member meets
any of the three qualifying conditions, the proposed rule requires that
retired members desiring to enroll their dependents under the
dependent-only provision provide documentation attesting to the
existence of these conditions. The documentation requirements are
specified as being (1) confirmation by the Department of Veterans
Affairs of its authorization for the member's ongoing, comprehensive
dental care, (2) confirmation by a member's employer or the employer's
dental plan administrator that the member is enrolled in a dental plan
through employment that is separate from the member's uniformed
service, and the dental plan is not available to the member's
dependents, or (3) confirmation by the member's physician or dentist of
the member's inability to utilize TRDP benefits due to a current and
enduring medical or dental condition. These criteria and documentation
requirements were developed with the recognition that the three
situations specified by Congress for allowing dependent-only enrollment
represent exceptional circumstances.
The availability of dental care from the Department of Veterans
Affairs is extremely limited. Sections 1710(c) and 1712 of title 38,
United States Code, and sections 17.93, and 17.160 through 17.166 of
title 38, Code of Federal Regulations specify the criteria which a
veteran must meet to be considered for dental care. The policies and
procedures for the Veterans Health Administration (VHA) Dental Program
are covered in the VHA Directive 1130 (December 7, 1998) and the VHA
Handbook 1130.1 (December 7, 1998).
The determinations of eligibility or authorization for dental care
are not based simply on enrollment for Veterans Affairs healthcare nor
are such decisions recorded in a centralized system. These are
accomplished by the Veterans Affairs at local and regional levels. In
general, entitlement to continuous, comprehensive dental benefits from
Veterans Affairs is limited to those veterans who are in receipt of a
compensable service connected dental rating, a 100% service connected
rating, or a permanent and totally disabled (unemployable) rating, or
who have been classified as former Prisoners of War (for at least 90
days). In most other cases, the dental care provided to eligible
veterans is episodic and short-term.
Just as the dental care available from Veterans Affairs is limited,
employee-only dental coverage is not prevalent in the health insurance
industry according to sources at the Health Insurance Association of
America and Delta Dental Plan of California. Similarly, expectations
are that the prevalence of medical or dental conditions that would
preclude any use for the coverage offered by the TRDP is relatively
small.
The proposed rule prohibits retroactive dependent-only enrollments
and requires that enrolled retirees satisfy any remaining enrollment
commitment prior to enrolling dependents under the dependent-only
provision. Once the initial enrollment commitment is fulfilled,
retirees who meet one of the dependents-only eligibility conditions may
disenroll with dependents remaining enrolled on a month-to-month basis.
III. Other Provisions of the Proposed Rule
In addition to implementing dependent-only eligibility, this
proposed rule clarifies the process for electing to enroll in the TRDP
by removing the apparently restrictive
[[Page 67222]]
reference to written election, thereby recognizing the existence of the
variety of methods in which an election of enrollment can be conveyed,
e.g., by written, telephonic, or e-mailed application. The proposed
rule also clarifies the 12-month enrollment lock-out provision by
specifying that the provision applies to disenrollment occurring at any
time and for any reason. This includes disenrollment after the enrollee
has fulfilled the 24-month initial enrollment commitment and
disenrollment of the retired member to convert to dependent-only
coverage.
IV. Rulemaking Procedures
Executive Order 12866 requires certain regulatory assessments for
any ``significant regulatory action,'' defined as one that would result
in an annual effect on the economy of $100 million or more, or have
other substantial impacts.
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 a regulation which would
have a significant impact on a substantial number of small entities.
This rule is not a significant regulatory action under the
provisions of Executive Order 12866, and it would not have a
significant impact on a substantial number of small entities.
This rule will not impose additional information collection
requirements on the public under the Paperwork Reduction Act of 1995
(44 U.S.C. Chapter 35).
List of Subjects in 32 CFR Part 199
Claims, Health insurance, Individuals with disabilities, Military
personnel, and Reporting and recordkeeping requirements.
Accordingly, 32 CFR part 199 is proposed to be amended as follows:
PART 199--[AMENDED]
1. The authority citation for part 199 continues to read as
follows:
Authority: 5 U.S.C. 301; 10 U.S.C. Chapter 55.
2. Section 199.22 is proposed to be amended by revising paragraphs
(d)(1)(iii), (d)(3), and (d)(4); redesignating paragraph (d)(1)(iv) as
paragraph (d)(1)(v); and adding a new paragraph (d)(1)(iv) to read as
follows:
Sec. 199.22 TRICARE Retiree Dental Program (TRDP).
* * * * *
(d) * * *
(1) * * *
(iii) Eligible dependents of a member described in paragraph
(d)(1)(i) or paragraph (d)(1)(ii) of this section who are covered by
the enrollment of the member;
(iv) Eligible dependents of a member described in paragraph
(d)(1)(i) or paragraph (d)(1)(ii) of this section when the member is
not enrolled in the program and the member meets at least one of the
conditions in paragraphs (d)(1)(iv)(A) through (C) of this section.
Already enrolled members must satisfy any remaining enrollment
commitment prior to enrollment of dependents becoming effective under
this paragraph, at which time the dependent-only enrollment will
continue on a voluntary, month-to-month basis as specified in paragraph
(d)(4) of this section. Members must provide documentation to the TRDP
contractor giving evidence of compliance with paragraphs (d)(1)(iv)(A),
(B), or (C) of this section at the time of application for enrollment
of their dependents under this paragraph.
(A) The member is enrolled under section 1705 of title 38, United
States Code, to receive ongoing, comprehensive dental care from the
Secretary of Veterans Affairs pursuant to section 1712 of title 38,
United States Code, and Secs. 17.93, 17.161, or 17.166 of title 38,
Code of Federal Regulations. Authorization of such dental care must be
confirmed in writing by the Department of Veterans Affairs.
(B) The member is enrolled in a dental plan that is available to
the member as a result of employment of the member that is separate
from the uniformed service of the member, and the dental plan is not
available to dependents of the member as a result of such separate
employment by the member. Enrollment in this dental plan and the
exclusion of dependents from enrollment in the plan must be confirmed
by documentation from the member's employer or the dental plan's
administrator.
(C) The member is prevented by a current and enduring medical or
dental condition from being able to obtain benefits under the TRDP. The
specific medical or dental condition and reason for the inability to
use the program's benefits over time, if not apparent based on the
condition, must be documented by the member's physician or dentist.
* * * * *
(3) Election of coverage. In order to initiate dental coverage,
election to enroll must be made by the retired member or eligible
dependent. Enrollment in the TRICARE Retiree Dental Program is
voluntary and will be accomplished by submission of an application to
the TRDP contractor.
(4) Enrollment periods. Initial enrollment shall be for a period of
24 months followed by month-to-month enrollment as long as the enrollee
chooses to continue enrollment. An enrollee's disenrollment from the
TRDP at any time for any reason is subject to a lock-out period of 12
months. After any lock-out period, eligible individuals may elect to
reenroll and are subject to a new initial 24-month enrollment period.
* * * * *
Dated: November 24, 1999.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 99-31117 Filed 11-30-99; 8:45 am]
BILLING CODE 5001-10-P
