Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); reimbursement of individual health providers--Department of Defense. Final rule

The Department of Defense is publishing this document to correct errors in the final rule on reimbursement of individual health providers contained in section 199.14(g). In addition to typographical and proofreading errors, the final rule failed to specify that changes to 1991 payment levels apply to the lesser of prevailing charges or the fiscal year 1988 prevailing charge levels adjusted by the Medicare Economic Index. The Fiscal Year 1991 Defense Appropriations Act prohibited payments "in excess of amounts allowed in fiscal year 1990 for similar services." Such amounts are, by definition, the lesser of prevailing charges, MEI-limited 1988 prevailing charge levels, or actual charges.     

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); mental health services--Department of Defense. Final rule

This final rule establishes a mandatory preadmission authorization program for mental health services under CHAMPUS. Such a program is needed to promote quality assurance and contain rapidly increasingly costs in inpatient psychiatric care under CHAMPUS. By maintaining most of the procedures of the current voluntary preadmission authorization program, the final rule minimizes inconveniences for providers.     

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); medical documentation--Department of Defense. Final rule

This final rule amends DoD 6010.8-R (32 CFR part 199) which implements the Civilian Health and Medical Program of the Uniformed Services. The final rule clarifies and strengthens medical documentation requirements under the CHAMPUS. This will assist in the maintenance of an adequate level of quality care and help ensure that payment is made only for services rendered.     

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); mental health services--DoD. Final rule

This final rule is to reform CHAMPUS quality of care standards and reimbursement methods for inpatient mental health services. The rule updates existing standards for residential treatment centers (RTCs) and establishes new standards for approval as CHAMPUS-authorized providers for substance use disorder rehabilitation facilities (SUDRFs) and partial hospitalization programs (PHPs); implements recommendations of the Comptroller General of the United States that DoD establish cost-based reimbursement methods for psychiatric hospitals and residential treatment facilities; adopts another Comptroller General recommendation that DoD remove the current incentive for the use of inpatient mental health care; and eliminates payments to residential treatment centers for days in which the patient is on a leave of absence.     

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); partial hospitalization--DoD. Final rule

This final rule establishes a CHAMPUS benefit for partial hospitalization and makes corrections and clarifications on other mental health issues resulting from implementation of recent legislative changes. The partial hospitalization benefit is being added at the request of Congress to improve the availability of mental health services under CHAMPUS. The intent is to provide a needed service at a lower cost than the full hospitalization rate, and allow more efficient use of resources for needed mental health care. Facilities must be certified and enter into a participation agreement with CHAMPUS and obtain the required preauthorization prior to admitting CHAMPUS patients. Applications for facility approval may be obtained from the Director, OCHAMPUS, or a designee.     

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); continued health care benefit program--DoD. Final rule

This final rule establishes a Continued Health Care Benefit Program (CHCBP) for certain DoD and other Uniformed Services health care beneficiaries who lose eligibility for health care in the Military Health Services System (MHSS). It also provides for use of the CHAMPUS benefit structure and CHAMPUS rules and outlines procedures for the CHCBP.     

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); five separate changes--DoD. Final rule

This final rule addresses five separate changes to comply with provisions affecting CHAMPUS. These changes will update this part to include as a benefit, a screen to check for the level of lead in the blood of an infant; to eliminate the implied statement that ambulance services are covered only to, from, and between hospitals; to include other forms of prescribed contraceptives by eliminating the reference that limits prescribed contraceptives only to those taken orally; to identify three additional Gulf Conflict groups eligible for the delay in the increased deductible; and to establish lower limits on the fiscal year catastrophic cap from $10,000 to $7,500 for all eligibles except dependents of active duty personnel, whose limit remains at $1,000.     

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); TRICARE Program; reimbursement--DoD. Final rule

This final rule revises certain requirements and procedures for reimbursement under the CHAMPUS program, the purpose of which is to implement a comprehensive managed health care delivery system composed of military medical treatment facilities and CHAMPUS. Issues addressed in this rule include: implementation of changes made to the Medicare Prospective Payment System (PPS) upon which the CHAMPUS DRG-based payment system is modeled and required by law to follow wherever practicable, along with changes to make our DRG-based payment system operate better; clarification of payment reduction for noncompliance with required utilization of publication of list of ambulatory surgery procedures; limitation on ambulatory surgery group payment rates; extension of the balance billing limitations currently in place for individual and professional providers to non-institutional, non-professional providers; adjustment of the CHAMPUS maximum allowable charge (CMAC) rate in the small number of cases where the CMAC rate is less than the Medicare rate; implementation of the government-wide debarment rule where any provider excluded or suspended from CHAMPUS shall be excluded from all other programs and activities involving Federal financial assistance, such as Medicare or Medicaid; elimination of the requirement for non-participating providers to file claims; and revision of the ambulatory surgery cost-share information to enable the cost-share to be assessed against the facility claim instead of the primary surgeon's claim.     

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); TRICARE prime balance billing--DoD. Final rule

This final rule establishes financial protections for TRICARE Prime enrollees in limited circumstances when they receive covered services from a non-network provider.     

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); TRICARE Selected Reserve Dental Program--DoD. Final rule

This final rule establishes the TRICARE Selected Reserve Dental Program (TSRDP) to provide dental care to members of the Selected Reserves of the Ready Reserve. The final rule details operation of the program.     

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); health promotion and disease prevention visits and immunizations--DoD. Final rule

This final rule expands well-baby visits and immunizations to dependents under the age of six and improves access to preventive benefits for dependents age six and above to include health promotion and disease prevention visits in connection with immunizations, Pap smears, mammograms, and colon and prostate cancer screenings.     

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); TRICARE program; nonavailability statement requirements--DoD. Final rule

This final rule revises certain requirements and procedures for the TRICARE Program, the purpose of which is to implement a comprehensive managed health care delivery system composed of military medical treatment facilities and CHAMPUS. Issues addressed in this rule include priority for access to care in military treatment facilities and requirements for payment of enrollment fees. This rule also includes provisions revising the requirement that certain beneficiaries obtain a non-availability statement from a military treatment facility commander prior to receiving certain health care services from civilian providers.     

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); TRICARE Retiree Dental Program (TRDP)--DoD. Final rule

This final rule establishes the TRICARE Retiree Dental Program (TRDP), a premium based indemnity dental insurance coverage program, that will be available to retired members of the Uniformed Services, their dependents, and certain other beneficiaries.     

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); continued health care benefit program--DoD. Interim rule

This rule establishes a Continued Health Care Benefit Program (CHCBP) for certain DoD health care beneficiaries who lose eligibility for health care in the Military Health Services System (MHSS). It provides for use of the CHAMPUS benefit structure and CHAMPUS rules and procedures for the CHCBP and seeks public comments on our plan to implement the Continued Health Care Benefit Program.     

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); expanded active duty dependents dental benefit plan--DoD. Final rule

The rule establishes an expanded dental program for dependents of active duty members of the Uniformed Services. The amendment specifically describes: the legislative authority for expansion of dental benefits outside the United States; the continuation of dental benefits for active duty survivors; eligibility for pre-adoptive wards; the enhanced benefit structure; enrollment and eligibility requirements; premium cost-sharing; and benefit payment levels. The provisions of this rule will provide military families with the high quality of care they desire at an affordable price.     

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); partial hospitalization--DoD. Final rule; delay of grace period

This document is to advise interested parties that the Director, OCHAMPUS is extending the grace period for partial hospitalization programs (PHPs) already accredited under the Joint Commission on Accreditation of Health Care Organizations (JCAHO) general hospital standards to obtain JCAHO accreditation under the Mental Health Manual. Due to the number of PHPs requesting JCAHO accreditation, an extension of the grace period is needed to allow sufficient time for PHPs to receive the mandatory JCAHO accreditation.     

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); amendment on electric-powered, cart-type vehicles--Office of the Secretary of Defense. Final rule

This amends language in the CHAMPUS Regulation to allow benefit consideration for electric-powered, cart-type vehicles. This revised language will allow benefit consideration for these vehicles which may be appropriately used as alternatives to electric wheelchairs, when they are medically necessary and certified by a physician to best meet the patient's medical care needs based on the patient's physical condition and which can be operated safely by the patient.     

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); TRICARE Dental Program. Office of the Secretary, DoD. Final rule

On October 23, 2000 (65 FR 63202), the Department of Defense published a final rule on TRICARE Family Member Dental Plan. The rule had an effective date that began during the Presidential Moratium on Rules, therefore, this rule is republished to change the effective date to April 1, 2001. This rule is published exactly as previously published. No changes have been made. It revises the comprehensive CHAMPUS regulation pertaining to the Expanded Active Duty Dependents Benefit Plan, or more commonly referred to as the TRICARE Family Member Dental Plan (TFMDP). The TFMDP limited eligibility to eligible dependents of active duty members (under a call or order that does not specify a period of thirty (30) day or less). Concurrent with the timeframe of the publication of the proposed rule, the Defense Authorization Act for Fiscal Year 2000 (Pub. L. 106-65, sec. 711) was signed into law and its provisions have been incorporated into this final rule. The Act authorized a new plan, titled the TRICARE dental program (TDP), which allows the Secretary of Defense to offer a comprehensive premium based indemnity dental insurance coverage plan to eligible dependents of active duty members (under a call or order that does not specify a period of thirty (30) days or less), eligible dependents of members of the Selected Reserve and Individual Ready Reserve, and eligible members of the Selected Reserve and Individual Ready Reserve. The Act also struck section 1076b (Selected Reserve dental insurance), or Chapter 55 of title 10, United States Code, since the affected population and the authority for that particular dental insurance plan has been incorporated in 10 U.S.C. 1076a. Consistent with the proposed rule and the provisions of the Defense Authorization Act for Fiscal Year 2000, the final rule places the responsibility for TDP enrollment and a large portion of the appeals program on the dental plan contractor; allows the dental plan contractor to bill beneficiaries for plan premiums in certain circumstances; reduces the former TFMDP enrollment period from twenty-four (24) to twelve (12) months; excludes Reserve component members ordered to active duty in support of a contingency operation from the mandatory twelve (12) month enrollment; clarifies dental plan requirements for different beneficiary populations; simplifies enrollment types and exceptions; reduces cost-shares for certain enlisted grades; adds anesthesia as a covered benefit; provides clarification on the Department-s use of the Congressional waiver for surviving dependents; incorporates legislative authority for calculating the method by which premiums may be raised and allowing premium reductions for certain enlisted grades; and reduces administrative burden by reducing redundant language, referencing language appearing in other CFR sections and removing language more appropriate to the actual contract. These improvements will provide Uniformed Service members and families with numerous quality of life benefits that will improve participation in the plan, significantly reduce enrollment errors and positively effect utilization of this important dental plan. The proposed rule was titled the --TRICARE Family Member Dental Plan.