[Federal Register Volume 61, Number 28 (Friday, February 9, 1996)]
[Notices]
[Pages 4962-4963]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-2755]
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[[Page 4963]]
DEPARTMENT OF DEFENSE
Office of the Secretary
Civilian Health and Medical Program of the Uniformed Services
(CHAMPUS)
AGENCY: Office of the Secretary, DoD.
ACTION: Notice of a nationwide CHAMPUS demonstration project.
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SUMMARY: On December 8, 1995, President Clinton signed Executive Order
12982 which called 3,800 members of the Select Reserve to active duty
in support of Operation Joint Endeavor. The immediate nature of this
call to active duty, and the potential for a service period of up to
270 days, may result in lack of access or disruption in continuity of
required health care services for the affected family members. An
extended absence from existing employment may result in the loss of
employer-sponsored health insurance, and the immediacy of the call-up
leaves little flexibility for alternate arrangements. Additionally,
although family members of reservists called to active duty for 31 or
more days will become eligible for CHAMPUS, they will face full payment
of an annual deductible before CHAMPUS will begin cost sharing medical
expenses. In the case of E-4's and below, this amount is $50 per
individual, $100 for family; for E-5's and above the amount is $150 per
individual and $300 for family. Payment of this out-of-pocket cost may
have an adverse impact on some economically vulnerable personnel,
especially if they have already paid an annual deductible for their
employer sponsored insurance. In previous surveys of reservists
activated for Desert Storm, 55% of enlisted members and 45% of officers
called to active duty reported a loss in income.
As a matter of general DoD personnel policy, reservists called to
active duty for periods of 31 days or more should be treated comparably
to regular active duty members. Consistent with this policy, the family
members of these reservists called to active duty in support of
Operation Joint Endeavor became eligible for CHAMPUS. However, the
normal CHAMPUS deductible requirement presents an inequity for these
families. Because health program deductibles are premised on coverage
for an entire year, a beneficiary who receives coverage for a much
shorter period receives unfavorable treatment. It is quite likely that
such beneficiaries will be required to meet a second annual deductible
under another health plan that will provide coverage during those
months of the year in which the reservist returns to his or her
civilian job. This demonstration project is designed to test an
approach for addressing this special inequity.
The Department's effective response to potential disruption or loss
of access to medical care for family members requires careful review of
operational and administrative mechanisms which can ease this hardship
in the transition from reserve to active duty status. This
demonstration is proposed for the purpose of testing whether
elimination of the annual deductible normally collected under standard
CHAMPUS will avoid unusual out-of-pocket costs, disruption of
continuity in care, impaired access and problems with beneficiary
satisfaction for activated reservists. The demonstration would waive
the CHAMPUS deductible for all reservists called to active duty for
Operation Joint Endeavor for periods of 31 days or more and allow
CHAMPUS to immediately begin cost-sharing in accordance with standard
CHAMPUS rules. The limited nature of this Presidential Selected Reserve
call-up for Operation Joint Endeavor reduces the number of activated
reservists and family members which will be available in any given
geographic area. Therefore, to achieve a level of participation
sufficient to test new strategies, this demonstration will occur
nationwide. Demonstration participants will include family members of
all Selected Reserve members called to active duty for a period of 31
days or more as a result of Executive Order 12982 of December 8, 1995.
Under Title 10, U.S. Code, Section 1092, the Department is authorized
to test different methods of financing delivery of health care services
under CHAMPUS.
DATES: Effective December 8, 1995, family members of selected reserve
members called to active duty for 31 days or more as a result of
Executive Order 12982, December 8, 1995, and who, as a result of that
Executive Order become eligible for services under CHAMPUS, may obtain
those services without paying deductibles normally required under
standard CHAMPUS. CHAMPUS eligible beneficiaries other than family
members of reservists called to active duty for Operation Joint
Endeavor are not eligible for participation. In view of the immediacy
of the deployment, we are waiving the normal thirty-day advance notice
for beginning a CHAMPUS demonstration project.
FOR FURTHER INFORMATION CONTACT:
CAPT Deborah Kamin, Office of the Assistant Secretary of Defense
(Health Affairs), (703)-697-8975.
SUPPLEMENTARY INFORMATION: The Office of the Assistant Secretary of
Defense (Health Affairs) will act as executive agent for purposes of
this demonstration and will assume overall responsibility for
demonstration policy, implementation, and monitoring.
DURATION: This demonstration will operate for one year unless extended
by separate action. Continuation of the program will depend on a
program evaluation conducted following termination of the project. It
is our hypothesis that elimination of normally imposed CHAMPUS
deductibles for this special group of beneficiaries will ease potential
financial hardship caused by unexpected increases in out-of-pocket
health care costs, avoid disruption of continuity and access to care,
and minimize beneficiary dissatisfaction in transition from reserve to
active status. This support is an important element in the welfare of
servicemembers and their families who are called to a significant and
immediate change in life circumstances. Information and experience
gained as part of this demonstration will provide the foundation for
longer term solutions in the event of future reserve activation.
EXCLUSIONS TO THE DEMONSTRATION PROJECT: Participation in this
demonstration is limited to active duty family members who become
eligible for CHAMPUS as a result of selected reserve activation in
support of Operation Joint Endeavor. This demonstration is limited to
the annual CHAMPUS deductible; other CHAMPUS cost sharing continues to
apply. All current CHAMPUS rules, unless this notice specifically
provides otherwise, will continue to apply. The changes under this
demonstration will have an effective date of December 8, 1995.
Dated: February 1, 1996.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 96-2755 Filed 2-8-96; 8:45 am]
BILLING CODE 5000-04-M
