12080 Federal Register / Vol. 76, No. 43 / Friday, March 4, 2011 / Notices 

official duties require access to the 

information are trained in the proper 

safeguarding and use of the information 

and received Information Assurance and 

Privacy Act training. 

RETENTION AND DISPOSAL: 

Upon reassignment from DLA, records 

are destroyed after 1 year. 

SYSTEM MANAGER(S) AND ADDRESS: 

Director, DLA Human Resources 

Center-Military, Military Personnel and 

Administration (DHRC–M), 8725 John J. 

Kingman Road, Suite 2533, Fort Belvoir, 

VA 22060–6221, and the Heads of the 

DLA Primary Level Field Activities. 

NOTIFICATION PROCEDURE: 

Individuals seeking to determine 

whether information about themselves 

is contained in this system should 

address written inquiries to the DLA 

Privacy Office, Headquarters, Defense 

Logistics Agency, Attn: DGA, 8725 John 

J. Kingman Road, Suite 1644, Fort 

Belvoir, VA 22060–6221. 

Inquiries should contain the 

individual’s full name, SSN, mailing 

address and telephone number. 

RECORD ACCESS PROCEDURES: 

Individuals seeking access to 

information about themselves contained 

in this system should address written 

inquiries to the DLA Privacy Office, 

Headquarters, Defense Logistics Agency, 

Attn: DGA, 8725 John J. Kingman Road, 

Suite 1644, Fort Belvoir, VA 22060– 

6221. 

Inquiries should contain the 

individual’s full name, SSN, mailing 

address and telephone number. 

CONTESTING RECORD PROCEDURES: 

The DLA rules for accessing records, 

for contesting contents, and appealing 

initial agency determinations are 

contained in 32 CFR part 323, or may 

be obtained from the DLA Privacy 

Office, Headquarters, Defense Logistics 

Agency, Attn: DGA, 8725 John J. 

Kingman Road, Suite 1644, Fort Belvoir, 

VA 22060–6221. 

RECORD SOURCE CATEGORIES: 

Information is provided by the 

individual, taken from military 

personnel records, and position 

distribution reports. 

EXEMPTIONS CLAIMED FOR THE SYSTEM: 

None. 

[FR Doc. 2011–4929 Filed 3–3–11; 8:45 am] 

BILLING CODE 5001–06–P 

DEPARTMENT OF DEFENSE 

Office of the Secretary 

TRICARE Access to Care 

Demonstration Project 

AGENCY: Department of Defense. 

ACTION: Notice of demonstration project. 

SUMMARY: This notice is to advise 

interested parties of a Military Health 

System (MHS) Demonstration project 

under the authority of Title 10, U.S. 

Code, Section 1092, entitled Department 

of Defense TRICARE Access to Care 

Demonstration Project. The 

demonstration project is intended to 

improve access to urgent care including 

minor illness or injury for Coast Guard 

beneficiaries enrolled in TRICARE 

Prime or TRICARE Prime Remote while 

decreasing emergency room visits and 

healthcare costs. Under the 

demonstration, Coast Guard active duty 

service members (ADSMs) and their 

family members who are enrolled in 

TRICARE Prime or TRICARE Prime 

Remote in the South Region would be 

allowed to self-refer, without an 

authorization, to a TRICARE network 

provider such as an Urgent Care Clinic 

(UCC) or Convenience Center for up to 

four urgent care visits per year. No 

referral from their Primary Care 

Manager (PCM) or authorization by a 

Health Care Finder will be required and 

no Point of Service (POS) deductibles 

and cost shares shall apply to these four 

unmanaged visits. Additionally, when 

outside of the South region, these Coast 

Guard TRICARE Prime or Prime Remote 

enrollees may use any TRICARE 

authorized provider or UCC without 

incurring POS deductibles and cost 

shares. The ADSM and family member 

will be required to notify their PCM of 

any urgent/acute care visits to other 

than their PCM within 24 hours of the 

visit and schedule any follow-up 

treatment that might be indicated with 

their PCM. If more than the four (4) 

authorized urgent care visits are used, or 

if the beneficiary seeks care from a non 

TRICARE network or non TRICARE 

authorized provider, POS deductibles 

and cost shares as required by Title 32, 

Code of Federal Regulations (CFR), 

199.17(n)(3) may apply. Referral 

requirements for specialty care and 

inpatient authorizations will remain as 

currently required by MHS policy. 

DATES: This demonstration will be 

effective 60 days from the date of this 

notice for a period of twenty-four (24) 

months. 

ADDRESSES: TRICARE Management 

Activity (TMA), Health Plan Operations, 

5111 Leesburg Pike, Suite 810, Falls 

Church, VA 22041. 

FOR FURTHER INFORMATION CONTACT: For 

questions pertaining to this 

demonstration project, please contact 

Ms. Shane Pham at (703) 681–0039. 

SUPPLEMENTARY INFORMATION: 

a. Background 

Access for acute episodic primary 

care continues to be in high demand by 

TRICARE Prime beneficiaries. The 

current regulations require that if a 

Prime beneficiary seeks care from a 

provider other than their PCM, they 

must first obtain a referral. Otherwise, 

the care will be covered under the 

point-of-service option at greater out-ofpocket cost to the Prime beneficiary. 

This includes urgent care which 

TRICARE defines as medically 

necessary treatment for an illness or 

injury that would not result in further 

disability or death if not treated 

immediately but that requires 

professional attention within 24 hours. 

On the other hand, emergency care 

defined as a medical, maternity or 

psychiatric condition that would lead a 

‘‘prudent layperson’’ (someone with 

average knowledge of health and 

medicine) to believe that a serious 

medical condition existed, or the 

absence of medical attention would 

result in a threat to his or her life, limb 

or sight and requires immediate medical 

treatment or which has painful 

symptoms requiring immediate 

attention to relieve suffering, does not 

require an authorization. Often when a 

Prime beneficiary needs urgent care 

after hours or when the PCM does not 

have available appointments, the Prime 

beneficiary will seek care from civilian 

sources such as emergency rooms (ER). 

While many Prime beneficiaries pay no 

out-of pocket costs for ER services, the 

average cost for an ER visit is much 

higher than an urgent care visit. In many 

cases, using the ER is not necessary, and 

a patient’s condition can be treated 

through urgent care. However, TRICARE 

has found it difficult to enforce the 

required point-of-service charges when 

an ER visit was for urgent care and not 

a true medical emergency. 

There are 25,781 Coast Guard active 

duty service members and their family 

members enrolled in TRICARE Prime in 

the South Region. In the South Region, 

beneficiary ER visits are currently 

averaging 197 ER visits/1,000 

beneficiaries per year and that number 

is slowly increasing. Analysis indicates 

much of the care rendered in these ER 

visits is for acute or chronic conditions 

that are not true life threatening 

emergencies and may have been better 


jlentini on DSKJ8SOYB1PROD with NOTICES
Federal Register / Vol. 76, No. 43 / Friday, March 4, 2011 / Notices 12081 

suited for care by the PCM or in an 

urgent care setting. 

b. Implementation 

This demonstration will be effective 

60 days from the date of this notice for 

a period of twenty-four (24) months. 

c. Evaluation 

The results of this Demonstration will 

allow a focused study of the impact of 

this process on: (1) The reduction of ER 

utilization and resulting costs, (2) 

assessment of the availability and 

accessibility of less expensive acute care 

services such as UCCs, (3) reduction of 

administrative processes, and (4) impact 

on Coast Guard active duty service 

members and their families. The 

evaluation/analysis of the 

demonstration would use Fiscal Year 

2008 as the base line with follow-up 

data analysis conducted at each 6- 

month interval throughout the 24 month 

period to monitor of ER and TRICARE 

authorized UCC utilization workload 

and cost (claims data). Success of the 

demonstration would be determined by 

consistent shifts in health care 

utilization from ERs to a TRICARE 

authorized UCCs by 15–20%. A less 

than 5% shift in utilization from the ER 

to a TRICARE authorized UCCs would 

be considered insignificant. 

Dated: March 1, 2011. 

Morgan F. Park, 

Alternate OSD Federal Register Liaison 

Officer, Department of Defense. 

[FR Doc. 2011–4863 Filed 3–3–11; 8:45 am] 

BILLING CODE 5001–06–P 

DEPARTMENT OF DEFENSE 

Office of the Secretary 

Notice of Two-Year Continuation of 

Disease Management Demonstration 

Project for TRICARE Standard 

Beneficiaries 

AGENCY: Department of Defense. 

ACTION: Notice of Two-Year 

Continuation of Disease Management 

Demonstration Project for TRICARE 

Standard Beneficiaries. 

SUMMARY: This notice is to advise 

interested parties of the continuation of 

a Military Health System (MHS) 

demonstration project entitled ‘‘Disease 

Management Demonstration Project for 

TRICARE Standard Beneficiaries’’. The 

original demonstration notice was 

published on June 13, 2007 (72 FR 

32628–32629) and described a 

demonstration project to provide 

disease management (DM) services to 

TRICARE Standard beneficiaries in 

addition to the TRICARE Prime 

beneficiaries who were already entitled 

to such services. TRICARE began the 

demonstration project in March 2007 for 

Standard beneficiaries and this 

demonstration project has enabled the 

MHS to provide uniform policies and 

practices on disease and chronic care 

management throughout the TRICARE 

network. Additionally, the 

demonstration has helped determine the 

effectiveness of DM programs in 

improving the health status of 

beneficiaries with targeted chronic 

diseases or conditions, and any 

associated cost savings. The TRICARE 

Management Activity (TMA) chose a 

phased approach to determine the 

efficacy and cost effectiveness of its 

disease management demonstration, 

beginning with beneficiaries identified 

with the disease states of asthma, heart 

failure, and diabetes. TMA now intends 

to continue the disease management 

services to TRICARE Standard 

beneficiaries until a permanent 

TRICARE disease management benefit 

(per the John Warner National Defense 

Authorization Act of 2007, section 734) 

is implemented. This continuation of 

the disease management demonstration 

project will be conducted under the 

authority provided in 10 U.S.C. 1092. 

DATES: Effective date: The extension of 

the demonstration will be effective 

April 1, 2011 and will continue for a 

period of two years until March 31, 

2013. 

ADDRESSES: TRICARE Management 

Activity (TMA), 5111 Leesburg Pike, 

Suite 810, Falls Church, VA 22041– 

3206. 

FOR FURTHER INFORMATION CONTACT: 

Robin Marzullo, Disease Management 

Nurse Consultant, Population Health 

and Medical Management—TRICARE 

Management Activity, telephone (703) 

681–6717 x 1214. 

SUPPLEMENTARY INFORMATION: 

A. Background 

For additional information on the 

TRICARE demonstration project for 

disease management, please see 72 FR 

32628–32629 and 74 FR 11089–11090. 

The original demonstration notice 

focused on explaining the differences 

between the disease management 

benefits available to TRICARE Standard 

and TRICARE Prime beneficiaries and 

the manner in which disease 

management services had been provided 

prior to the demonstration. The prior 

notice explained that for purposes of the 

demonstration, the Department of 

Defense (DoD) would waive, for these 

disease management services provided 

to Standard beneficiaries, the provisions 

of 10 U.S.C. 1079(a)(13) and 32 CFR 

199.4(g)(39) that expressly exclude 

clinical preventive services for 

TRICARE Standard beneficiaries. The 

prior notice also explained the 

enrollment process and cap on disease 

management costs. 

B. Description of Extension of 

Demonstration Project 

Under this demonstration, DoD has 

waived, for disease management 

services provided to TRICARE Standard 

beneficiaries, the provisions of 10 U.S.C. 

1079(a)(13) and 32 CFR 199.4(g)(39) that 

expressly exclude clinical preventive 

services for TRICARE Standard 

beneficiaries in the current benefit. The 

Military Health System (MHS) has 

enrolled TRICARE Standard 

beneficiaries in its disease management 

programs. Disease management services 

provided to Standard beneficiaries have 

included, but have not been limited to: 

Clinical preventive examinations, 

patient education and counseling 

services, and periodic screening exams. 

MHS disease management program 

costs have been capped not to exceed 

the amount approved by the contracting 

officer. The disease management 

program costs are total costs of disease 

management services provided to both 

Prime and Standard beneficiaries. Only 

those beneficiaries identified by the 

TRICARE Management Activity (TMA) 

for disease management of asthma, heart 

failure, diabetes, COPD, depression, 

anxiety, and cancer, have been included 

in the current program. Beneficiaries 

identified by TMA are included in the 

disease management program unless 

they choose to opt out. This action 

directly reduces variation across the 

system and results in improved 

consistency and quality for beneficiaries 

with targeted chronic illness, regardless 

of TRICARE classification. Furthermore, 

including TRICARE Standard 

beneficiaries in current disease 

management efforts informs the MHS 

about total potential savings and return 

on investment (ROI) associated with 

disease management, a stated 

requirement of the John Warner 

National Defense Authorization Act for 

Fiscal Year 2007. Continuing to provide 

disease management services to all 

TRICARE beneficiaries will continue to 

maintain our overall quality of care 

throughout the MHS program. By 

educating patients about their disease 

and helping them manage their 

symptoms, many of the complications of 

these diseases can be avoided, possibly 

slowing the progression of their chronic 

disease, thus resulting in significant cost 

savings. 


jlentini on DSKJ8SOYB1PROD with NOTICES