Tricare; Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); Nonavailability Statement Requirement for Maternity Care

DEPARTMENT OF DEFENSE

Office of the Secretary

32 CFR Part 199

Tricare; Civilian Health and Medical Program of the Uniformed

Services (CHAMPUS); Nonavailability Statement Requirement for Maternity

Care

AGENCY: Office of the Secretary, DoD.

ACTION: Interim final rule.

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SUMMARY: This interim final rule implements Section 712(c) of the

National Defense Authorization Act for Fiscal Year 2000 (Pub. L. No.

106-65), which requires that a nonavailability-of-health-care statement

shall be required for a non-enrolled beneficiary for TRICARE cost-share

of maternity care services related to outpatient prenatal, outpatient

or inpatient delivery, and outpatient post-partum care subsequent to

the visit which confirms the pregnancy. The Act reestablishes a

requirement which was previously eliminated under the broad direction

of The National Defense Authorization Act of FY 1997, section 734,

which removed authority for nonavailiability statements (NASs) for

outpatient services. Therefore, the Act changes the existing provisions

require an NAS for inpatient delivery but do not require an NAS for

outpatient prenatal and post-partum care. The change will significantly

contribute to continuity of care for maternity patients. In furtherance

of that principle, and consistent with the previous policy, an NAS for

maternity care shall not be required when a beneficiary has other

health insurance for primary coverage. This is being issued as an

interim final rule in order to comply with the statutory mandate.

Public comments, however, are invited and will be considered in

connection with possible revisions to this rule.

DATES: This rule is effective October 5, 1999 (the effective date of

Section 712(c) of the National Defense Authorization Act for Fiscal

Year 2000 (Pub. L. No. 106-65) which imposes the requirement). Written

comments will be accepted until February 22, 2000.

ADDRESSES: Forward comments to Medical Benefits and Reimbursement

Systems, TRICARE Management Activity, 16401 East Centretech Parkway,

Aurora, CO 80011-9043.

FOR FURTHER INFORMATION CONTACT: Tariq Shahid, Medical Benefits and

Reimbursement Systems, TRICARE Management Activity, telephone (303)

676-3801.

SUPPLEMENTARY INFORMATION: This interim final rule implements section

712(c) of the National Defense Authorization Act for Fiscal Year 2000

(Pub. L. No. 106-65) which requires that a nonavailability-of-health-

care statement shall be required for TRICARE/CHAMPUS cost-share of

maternity care services related to outpatient prenatal, outpatient or

inpatient delivery, and outpatient post-partum care subsequent to the

visit which confirms the pregnancy. The nonavailability statement

requirement applies to non-enrolled TRICARE beneficiaries who live in a

catchment area of a military treatment facility (MTF). Except for an

emergency or when there is other primary health insurance coverage,

these beneficiaries are required to obtain all maternity care from the

MTF. If care is unavailable at the MTF, an NAS will be issued for the

[[Page 72031]]

beneficiary. The Act changes the existing provisions that require a

nonavailability statement (NAS) for inpatient delivery but do not

require an NAS for outpatient prenatal, outpatient delivery and post-

partum care. The change will provide for continuity of care for

maternity patients. Beneficiaries will need one NAS for the entire

episode of maternity care that shall remain valid until 42 days

following termination of the pregnancy.

Regulatory Procedure

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 Interim Final Rule is not a significant regulatory

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

small entities. The changes set forth in the interim final rule are

minor revision to the existing regulation.

The interim final rule will not impose additional information

collection requirements on the public under the Paperwork Reduction Act

of 1995 (44 U.S.C. 3501-3511). This rule is being issued as an interim

final rule, with comment period, as an exception to our standard

practice of soliciting public comments prior to issuance. The Assistant

Secretary of Defense (Health Affairs) has determined that following the

standard practice in this case would be impracticable, unnecessary, and

contrary to the public interest. This determination is based on several

factors. First, this change directly implements a statutory amendment

enacted by Congress expressively for this purpose. Second, this rule

implements the statutory policy without embellishment. All public

comments are invited.

List of Subject in 32 CFR Part 199

Claims, Handicapped, Health insurance, Military personnel.

PART 199--[AMENDED]

Accordingly, 32 CFR 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 199.4(a) is amended by revising paragraphs (a)(9) and

(a)(9)(i)(B).

Sec. 199.4 Basic program benefits.

(a) * * *

* * * * *

(9) Nonavailability Statements within a 40-mile catchment area. In

some geographic locations, it is necessary for CHAMPUS beneficiaries

not enrolled in TRICARE Prime to determine whether the required medical

care can be provided through a Uniformed Services facility. If the

required care cannot be provided, the hospital commander, or designee,

will issue a Nonavailability Statement (DD form 1251). Except for

emergencies, a Nonavailability Statement should be issued before

medical care is obtained from a civilian source. Failure to secure such

a statement may waive the beneficiary's rights to benefits under

CHAMPUS.

(i) * * *

(A) * * *

(B) For CHAMPUS beneficiaries who are not enrolled in TRICARE

Prime, an NAS is required for services in connection with non-emergency

inpatient hospital care and outpatient and inpatient maternity care if

such services are available at a facility of the Uniformed Services

located within a 40-mile radius of the residence of the beneficiary,

except that an NAS is not required for services otherwise available at

a facility of the Uniformed Services located within a 40-mile radius of

the beneficiary's residence when another insurance plan or program

provides the beneficiary primary coverage for the services. For

maternity care, an NAS is required for services related to outpatient

prenatal, outpatient or inpatient delivery, and outpatient post-partum

care subsequent to the visit that confirms the pregnancy. The

requirement for an NAS does not apply to beneficiaries enrolled in

TRICARE Prime, even when those beneficiaries use the point-of-service

option under Sec. 199.17(n)(3).

* * * * *

Dated: December 16, 1999.

L.M. Bynum,

Alternate OSD Federal Register Liaison Officer, Department of Defense.

[FR Doc. 99-33246 Filed 12-22-99; 8:45 am]

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