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

DEPARTMENT OF DEFENSE

Office of the Secretary

32 CFR Part 199

[DoD 6010.8-R]

RIN 0720-AA43

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: Proposed rule.

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SUMMARY: This proposed 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.

DATES: Written comments will be accepted until February 2, 1998.

ADDRESSES: Forward comments to the Office of the Assistant Secretary of

Defense (Health Affairs), 1B657 Pentagon, Washington, DC 20301-1200.

FOR FURTHER INFORMATION CONTACT:

Cynthia P. Speight, Office of Health Services Financing Policy, (703)

697-8975.

SUPPLEMENTARY INFORMATION: 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 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, Public Law 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

proposed 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.

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 significant

regulatory action under E.O. 12886, nor would it have a significant

impact on small entities. The changes set forth in the proposed rule

are minor revisions to the existing regulation. In addition, this

proposed rule does not impose new information collection requirements

for purposes of the Paperwork Reduction Act of 1995 (44 U.S.C. 3501-

3511). This is a proposed rule. All public comments are invited.

List of Subjects in 32 CFR Part 199

Claims, Health insurance, Individuals with disabilities, Military

personnel.

Accordingly, 32 CFR part 199 is proposed to be amended as follows:

PART 199--[AMENDED]

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) heading.

b. By redesignating paragraphs (g)(3), (g)(4), (g)(5), (g)(6),

(g)(7), (g)(8) and (g)(9) as paragraphs (g)(4), (g)(5), (g)(6), (g)(7),

(g)(8), (g)(9) and (g)(10), respectively.

c. By adding paragraph (g)(3) and revising newly redesignated

paragraph (g)(10).

The additions and revisions read as follows:

Sec. 199.11 Overpayments recovery.

* * * * *

(b) * * *

(1) Federal statutory authority. The Federal Claims Collection Act

(31 U.S.C. 3701 et seq.) 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 through 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 (Pub. L. 104-106, 110 Stat. 186)

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 arisings 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:

[[Page 64192]]

(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 section 1086 of title 10, United States Code; 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)(3)(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 this paragraph (g) 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 of Sec. 199.10.

* * * * * * *

Dated: November 26, 1997.

L.M. Bynum,

Alternate OSD Federal Register Liaison Officer, Department of Defense.

[FR Doc. 97-31610 Filed 12-3-97; 8:45 am]

BILLING CODE 5000-04-M