# 64 FR 32451: Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); Double Coverage > Federal · Regulations · In force URL: https://www.frixlaw.com/law-library/statutes/FR_PRORULE_99-15185 ## Section - **Citation:** 64 FR 32451 - **Heading:** Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); Double Coverage - **Jurisdiction:** Federal - **Kind:** Regulations - **Status:** In force - **Text as of:** August 14, 2026 - **Source:** Compiled text - **Location:** Federal Register / Vol. 64 / 64 FR 32451 ## Text DEPARTMENT OF DEFENSE Office of the Secretary 32 CFR Part 199 RIN 0720-AA50 Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); Double Coverage AGENCY: Office of the Secretary, DOD. ACTION: Proposed rule. ----------------------------------------------------------------------- SUMMARY: This proposed rule clarifies our double coverage policy for non-institutional claims for beneficiaries with primary health insurance. TRICARE network, non-network but participating, and non- participating providers are all reimbursed differently under current procedures. This has had the unintended effect of discouraging TRICARE network participation since non-network but participating providers receive the most favorable treatment with respect to double coverage calculations. The Department proposes to revise double coverage reimbursement calculations by reimbursing all providers up to 100 percent of the CHAMPUS Maximum Allowable Charge after the primary health insurance has paid or 115 percent for nonparticipating providers. DATES: Public comments must be received by August 16, 1999. ADDRESSES: TRICARE Management Activity (TMA), Program Development Branch, Aurora, CO 80045-6900. FOR FURTHER INFORMATION CONTACT: Lt. Col. Kathleen Larkin, Office of the Assistant Secretary of Defense (Health Affairs)/TRICARE Management Activity, telephone (703) 681-1745. Questions regarding payment of specific claims under the CHAMPUS allowable charge method should be addressed to the appropriate TRICARE/ CHAMPUS contractor. SUPPLEMENTARY INFORMATION: I. Overview of the Rule This proposed rule clarifies our double coverage policy for non- institutional claims for beneficiaries with primary health insurance. TRICARE network, non-network but participating, and non-participating providers are all reimbursed differently under current procedures and this has had the unintended effect of discouraging TRICARE network participation since non-network but participating providers receive the most favorable treatment with respect to double coverage calculations. The Department proposes to revise double coverage reimbursement calculations by reimbursing all providers up to 100 percent of the CHAMPUS Maximum Allowable Charge after the primary health insurance has paid or up to 115 percent for nonparticipating providers. II. 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 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). A discussion of the major issues received by public comments will be included with the issuance of the final rule, anticipated approximately 60 days after the end of the comment period. List of Subjects in 32 CFR Part 199 Claims, Health insurance, Individuals with disabilities, Military Personnel. Accordingly, 32 CFR part 199 is 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 199.8 is amended by adding a new paragraph (c)(4) to read as follows: Sec. 199.8 Double coverage. * * * * * (c) Application of double coverage provisions. * * * (4) Effect of Network Participation. For non-institutional claims, providers receive TRICARE/CHAMPUS payment up to 100 percent of the CMAC (established under Sec. 199.14(h)(1)(i)(B)) after the primary health insurance has paid. For nonparticipating providers, CHAMPUS will pay the difference between the amount paid by the other health insurance and the 115 percent balance billing limit established in Sec. 199.14(h)(1)(i)(C). * * * * * Dated: June 10, 1999. L.M. Bynum, Alternate Federal Register Liaison Officer, Department of Defense. 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