[Federal Register Volume 60, Number 54 (Tuesday, March 21, 1995)]
[Proposed Rules]
[Pages 14919-14920]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-6670]
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DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 199
[DoD 6010.8-R]
RIN 0720-AA26
Civilian Health and Medical Program of the Uniformed Services
(CHAMPUS); Six Separate Changes
AGENCY: Office of the Secretary, DoD.
ACTION: Proposed rule.
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SUMMARY: This proposed rule addresses six separate changes to comply
with new statutory provisions affecting CHAMPUS. These changes will
update this part to include as a benefit, a screen to check for the
level of lead in the blood of an infant; eliminate the implied
statement that ambulance services are covered only to and from
hospitals; include other forms of prescribed contraceptives by
eliminating the reference that limits prescribed contraceptives only to
those taken orally; recognize chemical aversion therapy as a treatment
modality for alcoholism by eliminating the exclusionary language in the
current regulation; identify three additional Gulf Conflict groups
eligible for the delay in the increased deductible; and to establish
lower limits on the fiscal year catastrophic cap from $10,000 to $7,500
for all eligibles except dependents of active duty personnel, whose
limit remains at $1,000.
DATES: Written comments, whether from the general public or from other
governmental agencies, must be received on or before May 22, 1995.
ADDRESSES: Office of the Civilian Health and Medical Program of the
Uniformed Services (OCHAMPUS), Program Development Branch, Aurora, Co
80045-6900.
FOR FURTHER INFORMATION CONTACT:
Mr. A. Chris Armijo, Program Development Branch, OCHAMPUS, telephone
(303) 361-1120.
SUPPLEMENTARY INFORMATION: 32 CFR 199.4 lists Basic Program benefits
including exclusions and limitations. Paragraph (c) defines, in general
terms, the scope of reimbursable services provided by physicians and
other authorized individual professional providers; paragraph (e)
extends benefits under certain circumstances, to conditions and
limitations that are subject to applicable definitions, conditions, or
exclusions that are set forth in this or other sections of this
regulation; paragraph (f) identifies the liabilities, in the form of
cost-shares and deductibles, to be paid by beneficiaries or sponsors.
Well-Baby Care: Paragraph (c)(3)(xi), provides for certain well-
baby care services for infants up to the age of two years. A paragraph
(6) will be added under paragraph (xi)(A) to list blood lead level
screening for infants as a benefit.
Ambulance Service: Ambulance services are covered between points
deemed to be medically necessary for the covered medical condition,
therefore, the restrictive language, ``to, from, and between
hospitals'' will be removed from paragraph (d)(3)(v).
Family Planning: Paragraph (e)(3) provides for a family planning
benefit. Paragraph (e)(3)(i)(A)(3) of this Section allows benefits for
prescribed oral contraceptives. With the development of new methods of
contraception, prescribed contraceptives are no longer limited to those
taken orally. We are, therefore, amending that paragraph by removing
the word ``oral'' to expand the coverage accordingly.
Treatment for Alcoholism: Paragraph (e)(4)(iii)(A) of Sec. 199.4,
has historically excluded benefits for aversion therapy as a treatment
modality for alcoholism. At the request of OCHAMPUS, the Office of
Health Technology Assessment (OHTA) of the Public Health Service (PHS)
conducted an assessment of the safety and efficacy of chemical aversion
conditioning for the treatment of alcoholism. On the basis of the OHTA
assessment, it was determined that chemical aversion conditioning is no
less effective than other therapies for alcoholism when it is provided
following the failure of less intrusive therapies. This rule proposes
to remove paragraph (e)(4)(iii)(A) in its entirety to remove
exclusionary language, to reserve that paragraph for future use, and to
revise paragraph (4)(ii), to include coverage of chemical aversion
therapy as a treatment modality.
Financial Liability-Deductibles: Under paragraph (f) of section
199.4, CHAMPUS beneficiaries and sponsors have some financial
responsibility when medical care is received from civilian sources.
Financial liability is imposed in order to encourage use of the
Uniformed Services direct medical care system whenever facilities and
services are available. Beneficiaries are responsible for payment of
certain deductible and cost-sharing amounts in connection with
otherwise covered services and supplies. The cost-share and deductible
amounts are controlled by statute and subject to change by
Congressional action. Previous legislation had deferred a statutory
increase in the deductible amount from April 1, 1991, to October 1,
1991, for dependents of active duty members who served in the Gulf
Conflict. The National Defense Authorization Act for Fiscal Year 1993
contains language which prompts a revision of paragraph (f)(2)(i)(G) of
this section to identify three new groups of Gulf Conflict
beneficiaries, besides the dependents of active duty members, eligible
for the delay in the increased deductibles, and to allow credit or
reimbursement of excess amounts inadvertently paid by those groups
subject to availability of appropriated funds.
Catastrophic Loss: The National Defense Authorization Act for
Fiscal Years 1988 and 1989 (P.L. 100-180) amended Title 10, United
States Code and established catastrophic loss protection for CHAMPUS
beneficiaries on a government fiscal year basis. The law placed fiscal
year limits or, catastrophic caps, on beneficiary liability for cost-
shares and deductibles under the CHAMPUS Basic Program. After the
fiscal year cap is met by the beneficiary, the CHAMPUS determined
allowable amounts for all covered services or supplies received under
the Basic Program are to be paid in full by CHAMPUS.
For dependents of active duty members, the maximum family liability
[[Page 14920]] is $1,000 for deductibles and cost-shares based on
allowed charges for the Basic Program services and supplies received in
a fiscal year. For all other categories of beneficiary families, the
previous fiscal year cap of $10,000 under P.L. 100-180 has been reduced
under the 1993 Defense Authorization Act (P.L. 102-484) to $7,500. This
proposed rule implements the law which reduces the fiscal year
catastrophic other than active duty dependents, effective for Basic
Program services and supplies received on or after October 1, 1992.
Regulatory Procedures: OMB has determined that this is not a
significant rule as defined by E.O. 12866.
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 proposed rule would not have a significant impact on a
substantial number of small entities. The changes set forth in this
proposed rule are minor revisions to the existing regulation. This
proposed rule does not impose information collection requirements on
the public under the Paperwork Reduction Act of 1980 (44 U.S.C. 3501-
3511). Public comments on this proposed rule are invited and will be
considered. A discussion of any major issues revised as a result of
public comments will be included in issuance of the final rule,
anticipated approximately 60 days after the end of the comment period.
List of Subjects in 32 CFR Part 199
Claims, Handicapped, Health insurance, Military personnel.
Accordingly, 32 CFR part 199 is proposed to be amended as follows:
PART 199--[AMENDED]
1. The authority citation for part 199 is proposed to be revised as
follows:
Authority: 5 U.S.C. 301; 10 U.S.C. chapter 55.
2. Section 199.4 is proposed to be amended in paragraph
(e)(3)(i)(A)(3) by removing the word ``oral''; by removing and
reserving paragraph (e)(4)(iii)(A); by adding new paragraphs
(c)(3)(xi)(A)(7) and (f)(10); and by revising the first sentence in
paragraph (d)(3)(v), paragraph (e)(4)(ii), and paragraph (f)(2)(i)(G)
to read as follows:
Sec. 199.4 Basic program benefits.
* * * * *
(c) * * *
(3) * * *
(xi) * * *
(A) * * *
(7) One screening of an infant to determine the level of lead in
the blood of that infant.
* * * * *
(d) * * *
(3) * * *
(v) Ambulance. Civilian ambulance service is covered when medically
necessary in connection with otherwise covered services and supplies
and a covered medical condition. * * *
* * * * *
(e) * * *
(4) * * *
(ii) Authorized substance use disorder treatment. Only those
services provided by CHAMPUS-authorized institutional providers are
covered. Such a provider must be either an authorized hospital, or an
organized substance use disorder treatment program in an authorized
free-standing or hospital-based substance use disorder rehabilitation
facility. Covered services consist of any or all of the services listed
below, including chemical aversion therapy for alcoholism. A qualified
mental health provider (physician, clinical psychologist, clinical
social worker, psychiatric nurse specialist, (see paragraph (c)(3)(i)
of this section) shall prescribe the particular level of treatment.
Each CHAMPUS beneficiary is entitled to three substance use disorder
treatment benefit periods in his or her lifetime, unless this limit is
waived pursuant to paragraph (e)(4)(v) of this section. Unless
clinically contraindicated, the programmed use of chemical aversion
therapy is limited to the third lifetime alcoholism benefit period. (A
benefit period begins with the first date of covered treatment and ends
365 days later, regardless of the total services actually used within
the benefit period. Unused benefits cannot be carried over to
subsequent benefit periods. Emergency and inpatient hospital services
(as described in paragraph (e)(4)(i) of this section do not constitute
substance abuse treatment for purposes of establishing the beginning of
a benefit period.)
* * * * *
(f) * * *
(2) * * *
(i) * * *
(G) Notwithstanding the dates specified in paragraphs (f)(2)(i) (A)
and (B) of this section, in the case of dependents of active duty
members of rank E-5 or above with Persian Gulf Conflict service,
dependents of service members who were killed in the Gulf, who died
subsequent to Gulf service, and of members who retired prior to October
1, 1991, after having served in the Gulf War, the deductible shall be
the amount specified in paragraph (f)(2)(i)(A) of this section for care
rendered prior to October 1, 1991, and the amount specified in
paragraph (f)(2)(i)(B) of this section for care rendered after October
1, 1991.
* * * * *
(10) Catastrophic loss protection for basic program benefits.
Fiscal year limits, or catastrophic caps, on the amounts beneficiaries
are required to pay are established as follows:
(i) Dependents of active duty members. The maximum family liability
is $1,000 for deductibles and cost-shares based on allowable charges
for Basic Program services and supplies received in a fiscal year.
(ii) All other beneficiaries. For all other categories of
beneficiary families (including those eligible under CHAMPVA), the
fiscal year cap is $10,000.
(iii) Payment after cap is met. After a family has paid the maximum
cost-share and deductible amounts (dependents of active duty members
$1,000 and all others $10,000), for a fiscal year, CHAMPUS will pay
allowable amounts for remaining covered services through the end of
that fiscal year.
Note to paragraph (f)(2)(i)(G)(10): Under the Defense Authorization
Act for fiscal year 1993, the cap for beneficiaries other than
dependents of active duty members was reduced from $10,000 to $7,500 on
October 1, 1992. The cap remains at $1,000 for dependents of active
duty members.
* * * * *
Dated: March 14, 1995.
L.M. Bynum,
Alternate, OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 95-6670 Filed 3-20-95; 8:45 am]
BILLING CODE 5000-04-M
