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 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