[Federal Register Volume 62, Number 233 (Thursday, December 4, 1997)]
[Proposed Rules]
[Pages 64191-64192]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-31610]
[[Page 64191]]
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DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 199
[DoD 6010.8-R]
RIN 0720-AA43
Civilian Health and Medical Program of the Uniformed Services
(CHAMPUS); Waiver of Collection of Payments Due From Certain Persons
Unaware of Loss of CHAMPUS Eligibility
AGENCY: Office of the Secretary, DoD.
ACTION: Proposed rule.
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SUMMARY: This proposed rule authorizes the waiver of collection of
payments due from individuals who lost their CHAMPUS eligibility when
they became eligible for Medicare Part A, due to disability or end
stage renal disease.
DATES: Written comments will be accepted until February 2, 1998.
ADDRESSES: Forward comments to the Office of the Assistant Secretary of
Defense (Health Affairs), 1B657 Pentagon, Washington, DC 20301-1200.
FOR FURTHER INFORMATION CONTACT:
Cynthia P. Speight, Office of Health Services Financing Policy, (703)
697-8975.
SUPPLEMENTARY INFORMATION: Formerly, under Title 10 United States Code,
Section 1086(d), a beneficiary lost eligibility for CHAMPUS when he or
she became eligible for Medicare Part A, including when eligibility was
due to disability or end stage renal disease. Payments made after the
beneficiary attained eligibility for Medicare Part A were erroneous
payments and subject to collection under the Federal Claims Collection
Act. In 1991, Congress amended 10 U.S.C. 1086(d) to provide that those
persons eligible for Medicare by reason of disability or end stage
renal disease who are enrolled in the supplementary medical insurance
program under Medicare Part B retain eligibility for CHAMPUS, secondary
to Medicare coverage. Section 743 of the National Defense Authorization
Act for Fiscal Year 1996, Public Law 104-106, provides authority,
effective February 10, 1996, to waive the collection of erroneous
civilian health care benefits from a person under age 65 who lost
eligibility for civilian care due to eligibility for Medicare as a
result of disability or end stage renal disease. The period of this
waiver authority begins January 1, 1967, and ends on the later of July
1, 1996, or the termination date of any special enrollment Medicare
period established by law for such person.
Since most payments made under CHAMPUS are paid directly to
participating providers of care, and not to the beneficiary, the
proposed rule also provides for the waiver of collection of such
payments made to participating providers. These providers are paid
based on a contractual agreement of benefits by the beneficiaries. If
the claim for these benefits cannot be paid due to ineligibility of the
beneficiary, the beneficiary indebtedness to the provider would remain.
Thus, the authority to relieve disabled CHAMPUS beneficiaries from the
indebtedness arising from these erroneous payments does not depend upon
who actually received the payments.
Regulatory Procedures
Executive Order 12866 requires that a regulatory impact analysis be
performed on any significant regulatory action, defined as one which
would have an annual effect on the economy of $100 million or more, or
have other significant effects.
The Regulatory Flexibility Act requires that each federal agency
prepare a regulatory flexibility analysis when the agency issues
regulations which would have a significant impact on a substantial
number of small entities. This proposed rule is not significant
regulatory action under E.O. 12886, nor would it have a significant
impact on small entities. The changes set forth in the proposed rule
are minor revisions to the existing regulation. In addition, this
proposed rule does not impose new information collection requirements
for purposes of the Paperwork Reduction Act of 1995 (44 U.S.C. 3501-
3511). This is a proposed rule. All public comments are invited.
List of Subjects in 32 CFR Part 199
Claims, Health insurance, Individuals with disabilities, Military
personnel.
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 199.11 is amended as follows:
a. By revising paragraphs (b)(1) and (g) heading.
b. By redesignating paragraphs (g)(3), (g)(4), (g)(5), (g)(6),
(g)(7), (g)(8) and (g)(9) as paragraphs (g)(4), (g)(5), (g)(6), (g)(7),
(g)(8), (g)(9) and (g)(10), respectively.
c. By adding paragraph (g)(3) and revising newly redesignated
paragraph (g)(10).
The additions and revisions read as follows:
Sec. 199.11 Overpayments recovery.
* * * * *
(b) * * *
(1) Federal statutory authority. The Federal Claims Collection Act
(31 U.S.C. 3701 et seq.) provides the basic authority under which
claims may be asserted pursuant to this section. It is implemented by
joint regulations issued by the Department of Justice and the General
Accounting Office, 4 CFR parts 101 through 105. Thereunder, the heads
of federal agencies or their designees are required to attempt
collection of all claims of the United States for money or property
arising out of the activities of their respective agencies. These
officials may, with respect to claims that do not exceed $20,000,
exclusive of interest, and in conformity with the standards promulgated
in the joint regulations, compromise, suspend, or terminate collection
action on such claims. Section 743 of the National Defense
Authorization Act for Fiscal Year 1996 (Pub. L. 104-106, 110 Stat. 186)
authorizes the waiver (see paragraph (g)(3) of this section) of
collection of overpayments otherwise due from a person after the
termination of the person's CHAMPUS eligibility, because the person
became eligible for Medicare Part A by reason of disability or end-
stage renal disease.
* * * * *
(g) Compromise, waiver, suspension or termination of collection
actions arisings under the Federal Claims Collection Act.
* * * * *
(3) Waiver of collection of erroneous payments due from certain
persons unaware of loss of CHAMPUS eligibility. (i) The Director,
OCHAMPUS may waive collection of payments otherwise due from certain
persons as a result of health benefits received under this Part after
the termination of the person's eligibility for such benefits. Waiver
may be granted if collection of such payments would be against equity
and good conscience and not in the best interest of the United States.
These criteria are met by a finding that there is no indication of
fraud, misrepresentation, fault, or lack of good faith on the part of
the person who received the erroneous payment or any other person
having an interest in obtaining such waiver.
(ii) Persons eligible for waiver. The following persons are
eligible for waiver:
[[Page 64192]]
(A) A person who:
(1) Is entitled to Medicare Part A by reason of disability or end
stage renal disease;
(2) In the absence of such entitlement, would have been eligible
for CHAMPUS under section 1086 of title 10, United States Code; and
(3) At the time of the receipt of such benefits, was under age 65.
(B) Any participating provider of care who received direct payment
for care provided to a person described in paragraph (g)(3)(ii)(A) of
this section pursuant to an assignment of benefits from such person.
(iii) The authority to waive collection of payments under this
section shall apply with regard to health benefits provided during the
period beginning January 1, 1967, and ending on the later of: the
termination date of any special enrollment period for Medicare Part B
provided specifically for such persons; or July 1, 1996.
* * * * *
(10) Effect of compromise, waiver, suspension or termination of
collection action. Pursuant to the Internal Revenue Code, 26 U.S.C.
6041, compromises and terminations of undisputed debts not discharged
in a Title 11 bankruptcy case and totaling $600 or more for the year
will be reported to the Internal Revenue Service in the manner
prescribed for inclusion in the debtor's gross income for that year.
Any action taken under this paragraph (g) regarding the compromise of a
federal claim, or waiver or suspension or termination of collection
action on a federal claim is not an initial determination for purposes
of the appeal procedures of Sec. 199.10.
* * * * * * *
Dated: November 26, 1997.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 97-31610 Filed 12-3-97; 8:45 am]
BILLING CODE 5000-04-M
