[Federal Register Volume 62, Number 165 (Tuesday, August 26, 1997)]
[Proposed Rules]
[Pages 45196-45197]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-22631]
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DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 199
RIN 0720-AA41
Civilian Health and Medical Program of the Uniformed Services
(CHAMPUS); Exception to the CHAMPUS Dual Compensation/Conflict of
Interest Provisions
AGENCY: Office of the Secretary, DoD.
ACTION: Proposed Rule.
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SUMMARY: This proposed rule provides an exception to the CHAMPUS dual
compensation/conflict of interest provisions. This exception is for
part-time physician employees of government agencies.
DATES: Comments must be submitted on or before October 27, 1997.
ADDRESSES: Forward comments to the Office of the Civilian Health and
Medical Program of the Uniformed Services (OCHAMPUS), Program
Development Branch, Aurora, CO 80045-6900.
FOR FURTHER INFORMATION CONTACT: Stephen E. Isaacson, Program
Development Branch, OCHAMPUS, telephone (303) 361-1172.
SUPPLEMENTARY INFORMATION: This proposed rule provides for an
exception to the CHAMPUS dual compensation/conflict of interest
provisions. Currently, any individual who is a civilian employee of the
United States government cannot be authorized by CHAMPUS as a provider
of medical services. The justification for this prohibition is twofold.
First, it is believed that such individuals should not receive
additional government compensation above their normal pay and
allowances for providing medical services to CHAMPUS beneficiaries.
Second, payment for services provided to CHAMPUS beneficiaries poses
potential or actual conflict of interest situations since there is a
potential for personal gain by government employees by referring
patients to their private (i.e., non-government) practice.
Clearly there could be situations where a government employee
provides services to a CHAMPUS beneficiary without a conflict of
interest. However, the number of claims processed by
[[Page 45197]]
CHAMPUS makes reviewing the status of the provider and circumstances of
the services for each claim administratively unrealistic. Therefore,
this prohibition has been applied universally to all providers.
We propose to provide an exception to this prohibition. There are
situations where government agencies can meet their needs only by
employing physicians on a part-time basis. For example, an agency may
need the services of a physician in a certain specialty but cannot
justify employing the physician on a full-time basis. These part-time
employees maintain a private practice in which it is reasonable to
expect that they will encounter CHAMPUS beneficiaries unrelated to
their government employment. Therefore, we propose to permit these
individuals to be authorized CHAMPUS providers if they meet three
conditions. First, they must be employed by the government agency on a
part-time basis--that is, less than twenty (20) hours per week. We have
selected 20 hours as the limit, because we want to ensure that these
physicians are truly part-time employees needed to fill a specific
requirement. If the agency needs the services of an employee for twenty
or more hours per week, we believe a full-time employee should be
utilized. Second, the agency must certify that unique or special
circumstances detrimental to the delivery of quality health care exist
that can be overcome only by employing part-time, non-government,
physicians. Third, the agency and the physician must certify that they
understand and have taken appropriate measures to avoid violation of
Standards of Conduct, dual compensation, and conflict of interest
requirements including protection against referral of patients to the
employee's private practice.
Providers must certify on each CHAMPUS claim that he/she is not an
employee of the government. In those cases where an exception to this
prohibition has been granted, the provider will be required to certify
on the CHAMPUS claim that an exception has been granted.
Exceptions can be granted only to physicians, and no exceptions
will be granted retroactively. In addition, this exception provision
applies to part-time physicians employed by all U.S. government
agencies, such as those employed by the Department of Veterans Affairs
which probably has the most frequent need for it.
It is our intention to delegate approval of all exceptions to the
CHAMPUS fiscal intermediaries and managed care contractors. Therefore,
requests for exceptions, including the necessary certifications, must
be sent to the appropriate CHAMPUS FI/Contractor.
Regulatory Procedures
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 is not a significant regulatory action under
Executive Order 12866. The changes set forth in this proposed rule are
minor revisions to the existing regulation. Since this proposed rule
does not impose information collection requirements, it does not need
to be reviewed by the Executive Office of Management and Budget under
authority of the Paperwork Reduction Act of 1995 (44 U.S.C., Chapter
35).
List of Subjects in 32 CFR Part 199
Claims, Handicapped, Health Insurance, and Military personnel.
PART 199--[AMENDED]
Accordingly, 32 CFR Part 199 is amended as 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 199.6 is amended by revising paragraph (a)(3) to read as
follows:
Sec. 199.6 Authorized providers.
* * * * *
(a) * * *
(3) Dual compensation/conflict of interest. 5 U.S.C. 5536 prohibits
medical personnel who are active duty Uniformed Service members or
civilian employees of the Government from receiving additional
Government compensation above their normal pay and allowances for
medical care furnished. In addition, Uniformed Service members and
civilian employees of the Government are generally prohibited by law
and agency regulations and policies from participating in apparent or
actual conflict of interest situations in which a potential for
personal gain exists or in which there is an appearance of impropriety
or incompatibility with the performance of their official duties or
responsibilities. Active duty Uniformed Service members (including a
reserve member while on active duty) and civilian employees of the
United States Government shall not be authorized to be CHAMPUS
providers except as provided in this paragraph (a)(3). An exception to
this policy may be made by the Director, OCHAMPUS, on a case-by-case
basis only for a physician employed by the Government on a part-time
basis (i.e., less than 20 hours per week) when the employing agency
requests an exception based on unique or special circumstances
detrimental to the delivery of quality health care, and the employing
agency and the physician have certified that they understand and have
taken appropriate measures to avoid violation of Standards of Conduct,
dual compensation, and conflict of interest requirements including
protection against referral of patients to the employee's civilian
practice. A provider shall certify on each CHAMPUS claim that he/she is
not an active duty Uniformed Service member or civilian employee of the
Government. For those physicians who are part-time government employees
and have been granted an exception, the provider shall certify on each
CHAMPUS claim that an exception has been granted.
* * * * *
Dated: August 20, 1997.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 97-22631 Filed 8-25-97; 8:45 am]
BILLING CODE-5000-04-M
