[Federal Register Volume 63, Number 97 (Wednesday, May 20, 1998)]
[Rules and Regulations]
[Pages 27677-27679]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-13377]
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DEPARTMENT OF DEFENSE
Office of the Secretary
32 Part 199
RIN 0720-AA43
[DoD 6010.8-R]
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: Final rule.
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SUMMARY: This final 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.
EFFECTIVE DATE: This final rule is effective June 19, 1998.
ADDRESSES: TRICARE Management Activity, 1B657 Pentagon, Washington, DC
20301-1200.
FOR FURTHER INFORMATION CONTACT: Cynthia P. Speight, TRICARE Management
Activity, (703) 697-8975.
SUPPLEMENTARY INFORMATION:
I. Overview of the Final Rule
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
[[Page 27678]]
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, Pub. L. 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 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.
II. Public Comments
The proposed rule was published on December 4, 1997 (62 FR 64191).
We did not receive any public comments.
III. Rulemaking 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 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 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 final rule are minor
revisions to the existing regulation. In addition, this final rule does
not impose new information collection requirements for purposes of the
Paperwork Reduction Act of 1995.
List of Subjects in 32 CFR Part 199
Claims, Handicapped, Health insurance, Military personnel.
PART 199--[AMENDED]
Accordingly, 32 CFR Part 199 is amended a follows:
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) introductory heading.
b. By redesignating paragraphs (g)(3), (g)(4), (g)(5), (g)(6),
(g)(7), (g)(8) and (g)(9) as (g)(4), (g)(5), (g)(6), (g)(7), (g)(8),
(g)(9) and (g)(10).
c. By adding paragraph (g)(3) and revising newly redesignated
paragraph (g)(10).
Sec. 199.11 Overpayments recovery.
* * * * *
(b) * * *
(1) Federal statutory authority. The Federal Claims Collection Act
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 101-105. 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 (Public Law
104-106) 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 arising 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:
(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 10 U.S.C. 1086; 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)(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 paragraph (g) of this section 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 Sec. 199.10.
* * * * *
[[Page 27679]]
Dated: May 14, 1998.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 98-13377 Filed 5-19-98; 8:45 am]
BILLING CODE 5000-04-M
