[Federal Register Volume 64, Number 246 (Thursday, December 23, 1999)]
[Rules and Regulations]
[Pages 72030-72031]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-33246]
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DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 199
Tricare; Civilian Health and Medical Program of the Uniformed
Services (CHAMPUS); Nonavailability Statement Requirement for Maternity
Care
AGENCY: Office of the Secretary, DoD.
ACTION: Interim final rule.
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SUMMARY: This interim final rule implements Section 712(c) of the
National Defense Authorization Act for Fiscal Year 2000 (Pub. L. No.
106-65), which requires that a nonavailability-of-health-care statement
shall be required for a non-enrolled beneficiary for TRICARE cost-share
of maternity care services related to outpatient prenatal, outpatient
or inpatient delivery, and outpatient post-partum care subsequent to
the visit which confirms the pregnancy. The Act reestablishes a
requirement which was previously eliminated under the broad direction
of The National Defense Authorization Act of FY 1997, section 734,
which removed authority for nonavailiability statements (NASs) for
outpatient services. Therefore, the Act changes the existing provisions
require an NAS for inpatient delivery but do not require an NAS for
outpatient prenatal and post-partum care. The change will significantly
contribute to continuity of care for maternity patients. In furtherance
of that principle, and consistent with the previous policy, an NAS for
maternity care shall not be required when a beneficiary has other
health insurance for primary coverage. This is being issued as an
interim final rule in order to comply with the statutory mandate.
Public comments, however, are invited and will be considered in
connection with possible revisions to this rule.
DATES: This rule is effective October 5, 1999 (the effective date of
Section 712(c) of the National Defense Authorization Act for Fiscal
Year 2000 (Pub. L. No. 106-65) which imposes the requirement). Written
comments will be accepted until February 22, 2000.
ADDRESSES: Forward comments to Medical Benefits and Reimbursement
Systems, TRICARE Management Activity, 16401 East Centretech Parkway,
Aurora, CO 80011-9043.
FOR FURTHER INFORMATION CONTACT: Tariq Shahid, Medical Benefits and
Reimbursement Systems, TRICARE Management Activity, telephone (303)
676-3801.
SUPPLEMENTARY INFORMATION: This interim final rule implements section
712(c) of the National Defense Authorization Act for Fiscal Year 2000
(Pub. L. No. 106-65) which requires that a nonavailability-of-health-
care statement shall be required for TRICARE/CHAMPUS cost-share of
maternity care services related to outpatient prenatal, outpatient or
inpatient delivery, and outpatient post-partum care subsequent to the
visit which confirms the pregnancy. The nonavailability statement
requirement applies to non-enrolled TRICARE beneficiaries who live in a
catchment area of a military treatment facility (MTF). Except for an
emergency or when there is other primary health insurance coverage,
these beneficiaries are required to obtain all maternity care from the
MTF. If care is unavailable at the MTF, an NAS will be issued for the
[[Page 72031]]
beneficiary. The Act changes the existing provisions that require a
nonavailability statement (NAS) for inpatient delivery but do not
require an NAS for outpatient prenatal, outpatient delivery and post-
partum care. The change will provide for continuity of care for
maternity patients. Beneficiaries will need one NAS for the entire
episode of maternity care that shall remain valid until 42 days
following termination of the pregnancy.
Regulatory Procedure
Executive order 12866 requires certain regulatory assessments for
any significant regulatory action, defined as one which 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 Interim Final Rule is not a significant regulatory
action under E.O. 12866, nor would it have a significant impact on
small entities. The changes set forth in the interim final rule are
minor revision to the existing regulation.
The interim final rule will not impose additional information
collection requirements on the public under the Paperwork Reduction Act
of 1995 (44 U.S.C. 3501-3511). This rule is being issued as an interim
final rule, with comment period, as an exception to our standard
practice of soliciting public comments prior to issuance. The Assistant
Secretary of Defense (Health Affairs) has determined that following the
standard practice in this case would be impracticable, unnecessary, and
contrary to the public interest. This determination is based on several
factors. First, this change directly implements a statutory amendment
enacted by Congress expressively for this purpose. Second, this rule
implements the statutory policy without embellishment. All public
comments are invited.
List of Subject in 32 CFR Part 199
Claims, Handicapped, Health insurance, Military personnel.
PART 199--[AMENDED]
Accordingly, 32 CFR 199 is amended as follows:
1. The authority citation for Part 199 continues to read as
follows:
Authority: 5 U.S.C. 301 and 10 U.S.C. Chapter 55.
2. Section 199.4(a) is amended by revising paragraphs (a)(9) and
(a)(9)(i)(B).
Sec. 199.4 Basic program benefits.
(a) * * *
* * * * *
(9) Nonavailability Statements within a 40-mile catchment area. In
some geographic locations, it is necessary for CHAMPUS beneficiaries
not enrolled in TRICARE Prime to determine whether the required medical
care can be provided through a Uniformed Services facility. If the
required care cannot be provided, the hospital commander, or designee,
will issue a Nonavailability Statement (DD form 1251). Except for
emergencies, a Nonavailability Statement should be issued before
medical care is obtained from a civilian source. Failure to secure such
a statement may waive the beneficiary's rights to benefits under
CHAMPUS.
(i) * * *
(A) * * *
(B) For CHAMPUS beneficiaries who are not enrolled in TRICARE
Prime, an NAS is required for services in connection with non-emergency
inpatient hospital care and outpatient and inpatient maternity care if
such services are available at a facility of the Uniformed Services
located within a 40-mile radius of the residence of the beneficiary,
except that an NAS is not required for services otherwise available at
a facility of the Uniformed Services located within a 40-mile radius of
the beneficiary's residence when another insurance plan or program
provides the beneficiary primary coverage for the services. For
maternity care, an NAS is required for services related to outpatient
prenatal, outpatient or inpatient delivery, and outpatient post-partum
care subsequent to the visit that confirms the pregnancy. The
requirement for an NAS does not apply to beneficiaries enrolled in
TRICARE Prime, even when those beneficiaries use the point-of-service
option under Sec. 199.17(n)(3).
* * * * *
Dated: December 16, 1999.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 99-33246 Filed 12-22-99; 8:45 am]
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