Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); Health Promotion and Disease Prevention Visits and Immunizations

DEPARTMENT OF DEFENSE

Office of the Secretary

32 CFR Part 199

[DoD 6010.8-R]

RIN-0720-AA73

Civilian Health and Medical Program of the Uniformed Services

(CHAMPUS); Health Promotion and Disease Prevention Visits and

Immunizations

AGENCY: Office of the Secretary, DoD.

ACTION: Proposed rule.

-----------------------------------------------------------------------

SUMMARY: This proposed rule expands well-baby visits and immunizations

to dependents under the age of six and improves access to preventive

benefits for dependents age six and above to include health promotion

and disease prevention visits in connection with immunizations, pap

smears and mammograms.

DATES: Written comments will be accepted until January 6, 1997.

ADDRESSES: Forward comments to the Office of Health Services Financing

Policy, Department of Defense, Room 1B657 Pentagon, Washington, DC

20301-1200.

FOR FURTHER INFORMATION CONTACT: Cynthia P. Speight, Office of

Assistant Secretary of Defense (Health Affairs), (703) 697-8975.

SUPPLEMENTARY INFORMATION: On February 10, 1996, P.L. 104-106 was

signed into law. Section 701 of that law extends coverage of ``well-

baby visits'' and immunizations for an additional three years, from up

to two years of age to under six years of age. Section 701 also

provides for additional preventive care services under the Basic

CHAMPUS Program (see Sec. 199.4) for dependents six years of age or

older. This rule implements provisions of Public Law 104-106 by

changing ``well-baby care'' to ``well-child care'' and by providing for

additional preventive care services for dependents six years of age or

older. This rule improves availability of immunizations and other

preventive services, particularly for children. While these services

have previously been available in military hospitals and clinics,

access has depended on proximity to military medical treatment

facilities with available space and services. Access, therefore, has

not been uniformly attainable for all beneficiaries.

These proposed preventive services and immunizations are based on

recommendations of the U.S. Preventive Services Task Force which set

national health goals in their report Healthy People 2000. Broad goals

set by Healthy People 2000 included an increase in the span of healthy

life for Americans, reduction in health disparities among Americans,

and access to preventive services for all Americans. This rule

strengthens existing programs within the Department and contributes

significantly to national efforts toward meeting these goals.

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 a significant

regulatory action under E.O. 12866, nor would it have a significant

impact on small entities. In addition, this proposed rule does not

impose new information collection requirements for purposes of the

Paperwork Reduction Act of 1980 (44 U.S.C. 3501-3511). This is a

proposed rule. All public comments are invited.

[[Page 56930]]

List of Subjects in 32 CFR Part 199

Claims, Handicapped, Health insurance, 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; and 10 U.S.C. Chapter 55.

2. Section 199.2(b) is proposed to be amended by revising the

definition for ``well-baby care'' as follows:

Sec. 199.2 Definitions.

* * * * *

(b) * * *

Well-child care. A specific program of periodic health screening,

developmental assessment, and routine immunization for children under

six years of age.

* * * * *

3. Section 199.4 is proposed to be amended by revising the heading

of paragraph (c)(2), paragraphs (c)(2) (xiii), (c)(2)(xvi), (c)(3)(xi),

(g)(37), and (g)(47).

Sec. 199.4 Basic program benefits.

* * * * *

(c) * * *

(2) Covered services of physicians and other authorized

professional providers.

* * * * *

(xiii) Well-child care.

* * * * *

(xvi) Routine eye examinations. Coverage for routine eye

examinations is limited to dependents of active duty members, to one

examination per calendar year per person, and to services rendered on

or after October 1, 1984, except as provided under paragraph (c)(3)(xi)

of this section.

(3) * * *

* * * * *

(xi) Well-child care. Benefits routinely are payable for well-child

care from birth to under six years of age. These periodic health

examinations are designed for prevention, early detection and treatment

of disease and consist of screening procedures, immunizations and risk

counseling.

(A) The following services are payable when required as a part of

the specific well-child care program and when rendered by the attending

pediatrician, family physician, or a pediatric nurse practitioner.

(1) New born examination, heredity and metabolic screening, and

newborn circumcision.

(2) Periodic health supervision visits intended to promote the

optimal health for infants and children to include the following

services:

(i) History and physical examination.

(ii) Vision, hearing, and dental screening.

(iii) Developmental appraisal to include body measurement.

(iv) Immunizations as recommended by the Centers for Disease

Control and Prevention (CDC) Advisory Committee on Immunization

Practices.

(v) Pediatric blood lead level test.

(vi) Tuberculosis screening.

(vii) Blood pressure screening.

(viii) Measurement of hemoglobin and hematocrit for anemia.

(ix) Urinalysis.

(x) Health guidance and counseling.

(B) Additional services or visits required because of specific

findings or because the particular circumstances of the individual case

are covered if medically necessary and otherwise authorized for

benefits under CHAMPUS.

(C) The Director, OCHAMPUS will determine when such services are

separately reimbursable apart from the health supervision visit.

* * * * *

(g) * * *

* * * * *

(37) Preventive care. Preventive care, such as routine, annual, or

employment-requested physical examinations; routine screening

procedures; except that the following are not excluded:

(i) Well-child care.

(ii) Immunizations for individuals age six and older, as

recommended by the Centers for Disease Control and Prevention Advisory

Committee on Immunization Practices.

(iii) Rabies shots.

(iv) Tetanus shot following an accidental injury.

(v) Rh immune globulin.

(vi) Genetic tests as specified in paragraph (e)(3)(ii) of this

section.

(vii) Immunizations and physical examinations provided when

required in the case of dependents of active duty military personnel

who are traveling outside the United States as a result of an active

member's duty assignment and such travel is being performed under

orders issued by a Uniformed Service.

(viii) Screening mammography for asymptomatic women 40 years of age

and older when provided under the terms and conditions contained in the

guidelines adopted by the Director, OCHAMPUS.

(ix) Cancer screening papanicolaou (PAP) test for women who are or

have been sexually active, and women 18 years of age and older when

provided under the terms and conditions contained in the guidelines

adopted by the Director, OCHAMPUS.

(x) Other cancer screenings authorized by 10 U.S.C. 1079.

(xi) Health promotion and disease prevention visits (which may

include all of the services provided pursuant to Sec. 199.18(b)(2)) may

be provided in connection with immunizations and cancer screening

examinations authorized by paragraphs (g)(37)(ii) or (g)(37) (viii)

through (x).

* * * * *

(47) Eye and hearing examinations. Eye and hearing examinations

except as specifically provided in paragraphs (c)(2)(xvi) and

(c)(3)(xi) of this section, or except when rendered in connection with

medical or surgical treatment of a covered illness or injury.

* * * * *

Dated: October 30, 1996.

L.M. Bynum,

Alternate OSD Federal Register Liaison Officer, Department of Defense.

[FR Doc. 96-28301 Filed 11-4-96; 8:45 am]

BILLING CODE 5000-04-M