Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); TRICARE Prime Enrollment Procedures

DEPARTMENT OF DEFENSE

Office of the Secretary

32 CFR Part 199

RIN 0720-AA48

Civilian Health and Medical Program of the Uniformed Services

(CHAMPUS); TRICARE Prime Enrollment Procedures

AGENCY: Office of the Secretary, DOD.

ACTION: Proposed rule.

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SUMMARY: This proposed rule modifies the TRICARE Prime enrollment for

active duty families by specifying that the enrollment period is

continuous rather than a 12 month enrollment period and it allows

monthly installment payments of enrollment fees for those beneficiaries

required to pay an annual fee in order to enroll in TRICARE Prime.

These modifications are being made because TRICARE will soon be

available wordwide for active duty family members.

DATES: Public comments must be received by September 8, 1998.

ADDRESSES: Forward comments to: TRICARE Support Office (TSO), Program

Development Branch, Aurora, CO 80045-6900.

FOR FURTHER INFORMATION CONTACT:

Kathleen Larkin, Office of the Assistant Secretary of Defense (Health

Affairs), telephone (703) 681-1742.

SUPPLEMENTARY INFORMATION:

I. Proposed Changes Regarding The TRICARE Prime Enrollment Period

This proposes a change to the TRICARE Prime enrollment period from

a 12-month enrollment period to continuous enrollment until such time

as the enrollee opts to disenroll from TRICARE Prime. TRICARE Prime was

originally designed so that enrollees would be required to take

positive action to continue their enrollment in TRICARE Prime at or

before their 12-month anniversary date. Positive action to reenroll was

required because TRICARE implementation was not available in all

regions of the country and overseas locations. Now the TRICARE will

soon be available worldwide for active duty family members, the

requirement that beneficiaries must take positive steps to remain

enrolled is not longer necessary. The proposed rule allows the enrollee

to remain enrolled in TRICARE Prime until the enrollee takes positive

steps to disenroll from TRICARE Prime, or is no longer eligible for

TRICARE Prime.

II. Proposed Change to Installment Payments of Enrollment Fees

When we first instituted the requirement for annual TRICARE Prime

enrollment fees for certain beneficiary categories, we allowed for

quarterly installment payments of the enrollment fees. In keeping with

the nature of continuous enrollment, retirees, their families, and

other beneficiaries required to pay an annual enrollment fee will be

offered additional flexibility in fee payment by allowing for monthly

installment payments of enrollment fees.

III. Regulatory Procedures

Executive Order 12866 requires certain regulatory assessments for

any significant regulatory action, defined as one which would result in

an annual effect on the economy of $100 million or more, or have other

substantial impacts.

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 is not a significant regulatory action under the provisions of

Executive Order 12866, and it would not have a significant impact on a

substantial number of small entities.

The proposed rule will not impose additional information collection

requirements on the public under the Paperwork Reduction Act of 1995

(44 U.S.C. Chapter 55).

Public comments are invited. All comments will be carefully

considered. A discussion of the major issues received by public

comments will be included with the issuance of the permanent final

rule, anticipated approximately 60 days after the end of the comment

period.

List of Subjects in 32 CFR Part 199

Administrative practice and procedures, Claims, Fraud, Health care,

Health insurance, Individuals with disabilities, Military personnel,

Reporting and recordkeeping requirements.

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 199.17 is proposed to be amended by revising paragraphs

(o)(2) and (o)(3), redesignating paragraphs (o)(4) and (o)(5) as

paragraphs (o)(5) and (o)(6), respectively, and adding a new paragraph

(o)(4) to read as follows:

Sec. 199.17 TRICARE program.

* * * * *

(o) TRICARE program enrollment procedures. * * *

(2) Enrollment period. Beneficiaries who select the TRICARE Prime

option remain enrolled in TRICARE Prime until they take action to

disenroll, are no longer eligible for enrollment in TRICARE Prime, or

for failure to pay required enrollment fees. There is no minimum length

of time an enrollee must remain enrolled in TRICARE Prime before they

are eligible to disenroll. Disenrollment for failure to pay enrollment

fees is outlined in paragraph (o)(3) of this section.

(3) Installment payments of enrollment fee. The enrollment fee

required by Sec. 199.18(c) may be paid in monthly or quarterly

installments. For beneficiaries paying enrollment fees on an

installment basis, failure to make a required installment payment on a

timely basis (including a grace period, as determined by the Director,

(CHAMPUS) will result in termination of the beneficiary's enrollment in

Prime and disqualification from future enrollment in Prime for a period

of one year.

(4) Disenrollment. Any beneficiary for whom enrollment in Prime is

voluntary may disenroll at any time. Disenrollment will take effect in

accordance with administrative procedures established by the Assistant

Secretary of Defense (Health Affairs) or his or her designee.

Beneficiaries who disenroll will not be eligible to reenroll in Prime

for a one year period from the effective date of the disenrollment.

This one year exclusion may be waived by the Assistant Secretary of

Defense (Health Affairs) or his or her designee based on extraordinary

circumstances.

* * * * *

Dated: June 30, 1998.

L.M. Bynum,

Alternate OSD Federal Register Liaison Officer, Department of Defense.

[FR Doc. 98-17849 Filed 7-6-98; 8:45 am]

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