Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); Extension of the Active Duty Dependents Dental Plan to Overseas Areas

DEPARTMENT OF DEFENSE

Office of the Secretary

32 CFR Part 199

RIN 0720-AA36

Civilian Health and Medical Program of the Uniformed Services

(CHAMPUS); Extension of the Active Duty Dependents Dental Plan to

Overseas Areas

agency: Office of the Secretary, DoD.

action: Final rule.

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

summary: This final rule implements statutory authority for the

extension of the Active Duty Dependents Dental Plan to overseas areas.

effective date: September 1, 1997.

addresses: TRICARE Management Activity, 16401 East Centretech, Aurora,

CO 80011.

for further information contact: Lt. Col. Brian Grassi, TRICARE

Management Activity, (303) 676-3496.

supplementary information:

I. Overview of the Final Rule

On June 25, 1997, an interim final rule regarding the benefit and

operational issues associated with the implementation of the extension

of the Active Duty Dependents Dental Plan to overseas areas was

published (62 FR 33940).

Military force reductions in Europe, the Middle East, and the

Pacific have resulted in diminished medical services for many areas,

particularly those areas where the active duty end strengths have

fallen below levels which would support a military medical facility.

Service members and their families, particularly those in remote areas,

have experienced access problems in obtaining dental services at

military facilities. This rule is based on section 703 of the National

Defense Authorization Act for Fiscal Year 1995, Pub. L. 103-337, and

section 732 of the National Defense Authorization Act for Fiscal Year

1998, Pub. L. 105-85, which amended Title 10, United States Code,

section 1076a. These laws allow the Department to extend the Active

Duty Dependents Dental Plan to overseas areas and waive or reduce

required cost-shares to the extent the Secretary determines appropriate

for the effective and efficient operation of the Plan. Family members

enrolled in the Active Duty Dependents Dental Plan will be allowed to

receive dental care from host nation providers and have the dental

claims processed by a dental contractor. Where applicable, host nation

providers who meet accepted professional dental practice standards will

be identified by the local military dental treatment facility (DTF)

commander and the overseas lead agents.

Enrolled family members overseas will be eligible to obtain the

same basic dental benefits offered to enrollees in the Active Duty

Dependents Dental Plan (also referred to as the TRICARE Family Member

Dental Plan or TFMDP) in the Continental United States subject to

availability and accessibility of these services. For the purposes of

this program, the Continental United States is defined as the forth-

eight contiguous states, as well as Alaska, Hawaii, Guam, Puerto Rico,

the District of Columbia, the U.S. Virgin Islands and Canada. Overseas

is defined as those countries not previously mentioned.

In order to participate, beneficiaries must voluntarily enroll in

the TFMDP and pay the standard monthly premium. In countries with a

military DTF, the local military DTF commander will refer enrollees to

designated host nation providers for all covered dental services. These

referrals will be contingent upon the lack of availability of these

dental services in the DTF and the Department's designation of

qualified host nation providers.

In countries without a military DTF, enrollees can receive

treatment for non-orthodontic dental care without a referral from any

qualified host nation provider meeting professionally accepted

standards. The Department encourages enrollees residing in these

countries to first contact their respective overseas lead agent, U.S.

Embassy or Consulate or other local representatives of the U.S.

Government before seeking non-orthodontic care to determine if any of

these agencies can assist in identifying a qualified host nation

provider in their local area. For orthodontic care in these countries,

the overseas lead agent will refer enrollees to designated host nation

providers.

Where a referral is required, the issuing activity must complete a

Non-Availability Statement (NAS) and provide this statement to the

enrollee before care can be received and the claim can be processed by

the dental contractor. To obtain a referral and NAS, family members are

not restricted to visiting a DTF of their sponsor's branch of service,

rather, they should contact their primary servicing military DTF.

[[Page 38576]]

Basic dental care encompasses diagnostic and preventive (exams, x-

rays, cleanings, etc), sealants, restorative (fillings, crowns, etc),

endodontics (root canals, etc.), periodontics (gum surgery, etc.), oral

surgery (extractions, etc.), and prosthodontics (bridges, dentures,

etc.) While the annual cap of $1,000 and lifetime cap of $1,200 for

orthodontic care is applicable in these overseas locations, the

Department will pay the enrollee's cost-share for some non-orthodontic

services as well as any difference between the provider's billed charge

and the dental claims processor's allowance, subject to the amount

remaining on the enrollee's annual or lifetime maximum.

This final rule will allow dental claims to be paid on a ``billed

charge'' basis. Billed charges are charges submitted by host nation

dental providers for the costs of dental care in their country. These

charges are not based on Diagnostic Related Groups nor are they

expected to be developed based on American Dental Association current

dental terminology codes.

Since publication of the interim final rule, section 732 of the

National Defense Authorization Act for Fiscal Year 1998 authorized the

Secretary to waive or reduce cost-shares in overseas areas. Therefore,

the Department has implemented procedures to waive the cost shares for

certain non-orthodontic benefits as long as the enrollee has not

exceeded their annual maximum. The previous procedures for waivers to

the annual and lifetime maximums are no longer applicable.

Additionally, the interim final rule stated that enrollees in

remote locations would not be required to obtain an NAS to receive

dental services. The Department has changed that provision so that

enrollees in remote locations will be required to obtain an NAS from

their respective overseas lead agent prior to receiving orthodontic

care. This change provides an opportunity for the overseas lead agent

to make referrals to designated host nation orthodontists, monitor and

approve treatment plans and advise enrollees of other options. It also

provides appropriate oversight in a benefit area where only a one-time

lifetime benefit is available.

Finally, the interim final rule limited the benefit to family

members accompanying their active duty sponsors while overseas. That

provision has been deleted because the overseas extension was

designated to be portable and available to enrolled family members

traveling or residing overseas with or without their sponsor.

II. Public Comments

The interim final rule was published on July 25, 1997 (62 FR

33940). We did not receive any public comments.

III. Rulemaking 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 final rule will not impose additional information collection

requirements on the public under the Paperwork Reduction Act of 1995

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

List of Subjects in 32 CFR Part 199

Claims, Health insurance, Individuals with disabilities and

Military personnel.

Accordingly, 32 CFR part 1999 is amended as follows:

PART 1999--[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 199.13 is amended by revising paragraph (i) to read as

follows:

Sec. 199.13 Active duty dependents dental plan.

* * * * *

(i) Extension of the Active Duty Dependents Dental Plan to areas

outside the United States. The Assistant Secretary of Defense (Health

Affairs) (ASD(HA) may, under the authority of 10 U.S.C. 1076a(h),

extend the Active Duty Dependents Dental Plan to areas other than those

areas specified in paragraph (a)(2)(i) of this section for the eligible

beneficiaries of members of the Uniformed Services. In extending the

program outside the Continental United States, the ASD(HA), or

designee, is authorized to establish program elements, methods of

administration and payment rates and procedures to providers that are

different from those in effect under this section in the Continental

United States to the extent the ASD(HA), or designee, determines

necessary for the effective and efficient operation of the plan outside

the Continental United States. This includes provisions for

preauthorization of care if the needed services are not available in a

Uniformed Service overseas dental treatment facility and payment by the

Department of certain cost-shares and other portions of a provider's

billed charges. Other differences may occur based on limitations in the

availability and capabilities of the Uniformed Services overseas dental

treatment facility and a particular nation's civilian sector providers

in certain areas. Otherwise, rules pertaining to services covered under

the plan and quality of care standards for providers shall be

comparable to those in effect under this section in the Continental

United States and available military guidelines. In addition, all

provisions of 10 U.S.C. 1076a shall remain in effect.

Dated: July 13, 1999.

L.M. Bynum,

Alternate OSD Federal Register Liaison Officer, Department of Defense.

[FR Doc. 99-18250 Filed 7-16-99; 8:45 am]

BILLING CODE 5001-10-M