[Federal Register Volume 65, Number 128 (Monday, July 3, 2000)]
[Rules and Regulations]
[Pages 41002-41003]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-16264]


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DEPARTMENT OF DEFENSE

Office of the Secretary

32 CFR Part 199


TRICARE; Civilian Health and Medical Program of the Uniformed 
Services (CHAMPUS); Bonus Payments in Medically Underserved Areas

AGENCY: Office of the Secretary, DoD.

ACTION: Interim final rule.

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SUMMARY: This interim final rule implements a bonus payment, in 
addition to the amount normally paid under the allowable charge 
methodology, to providers in medically underserved areas. For purposes 
of this rule, medically underserved areas are the same as those 
determined by the Secretary of Health and Human Services for the 
Medicare program. Such bonus payments shall be equal to the bonus 
payments authorized by Medicare, except as necessary to recognize any 
unique or distinct characteristics or requirements of the CHAMPUS 
program, and as described in instructions issued by the Director, 
OCHAMPUS. Due to the urgency for such bonus payments in medically 
underserved areas to alleviate problems of access to healthcare 
coverage caused by lower payments, the interim final rule making 
process has been utilized. This rule promotes a reimbursement 
enhancement to a limited number of providers designed to increase 
CHAMPUS beneficiary access to care, which also supports the use of the 
interim final rule.

DATES: This rule is effective August 2, 2000. Written comments will be 
accepted until September 1, 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: Stan Regensberg, Medical Benefits and 
Reimbursement Systems, TRICARE Management Activity, telephone (303) 
676-3742.

SUPPLEMENTARY INFORMATION: 32 CFR Part 199, ``Civilian Health and 
Medical Program of the Uniformed Services (CHAMPUS),'' was published in 
the Federal Register on July 1, 1986. This interim final rule 
implements a bonus payment, in addition to the amount normally paid 
under the allowable charge methodology, to providers in medically 
underserved areas. For purposes of this rule, medically underserved 
areas are the same as those determined by the Secretary of Health and 
Human Services for the Medicare program. Such bonus payments shall be 
equal to the bonus payments authorized by Medicare, except as necessary 
to recognize any unique or distinct characteristics or requirements of 
the CHAMPUS program, and as described in instructions issued by the 
Director, OCHAMPUS. If the Department of Health and Human Services acts 
to amend or remove the provision for bonus payments under Medicare, 
CHAMPUS likewise may follow Medicare in amending or removing provision 
for such payments. To expedite access to healthcare coverage that has 
been impacted by lower payments in such medically underserved areas, 
the interim final rule process is being utilized. Additionally, it 
provides a reimbursement enhancement that favors providers in 
underserved areas, thus alleviating healthcare access problems 
experienced by beneficiaries residing in such areas. Finally, because 
Medicare previously established a bonus payment reimbursement mechanism 
in these areas, our emulation of this well established mechanism 
complies with existing statutory mandates that CHAMPUS follow Medicare 
reimbursement policy wherever practicable. This rule will not 
unilaterally increase payments to all providers, but just those 
residing in these underserved areas. Due to the urgency for additional 
payments to ensure beneficiary access to care in these areas, it would 
be impracticable and contrary to the public's interest not to use the 
interim final rule process. To do otherwise would prevent OCHAMPUS from 
fulfilling its duty to beneficiaries in these underserved areas.

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

[[Page 41003]]

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 Executive Order 12866, nor would it have a 
significant impact on a substantial number of small entities. The 
changes set forth in the interim final rule are minor revisions 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. Most importantly, this change directly implements a payment 
process already used by Medicare. All public comments are invited.

List of Subjects in 32 CFR Part 199

    Claims, Handicapped, Health insurance, 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 199.14 is amended by redesignating paragraphs (h)(2) and 
(h)(3) as (h)(3) and (h)(4) and adding a new paragraph (h)(2) to read 
as follows:


Sec. 199.14  Provider reimbursement methods.

* * * * *
    (h) * * *
    (2) Bonus payments in medically underserved areas. A bonus payment, 
in addition to the amount normally paid under the allowable charge 
methodology, may be made to providers in medically underserved areas. 
For purposes of this paragraph, medically underserved areas are the 
same as those determined by the Secretary of Health and Human Services 
for the Medicare program. Such bonus payments shall be equal to the 
bonus payments authorized by Medicare, except as necessary to recognize 
any unique or distinct characteristics or requirements of the CHAMPUS 
program, and as described in instructions issued by the Director, 
OCHAMPUS.
    If the Department of Health and Human Services acts to amend or 
remove the provision for bonus payments under Medicare, CHAMPUS 
likewise may follow Medicare in amending or removing provision for such 
payments.
* * * * *

    Dated: June 22, 2000.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 00-16264 Filed 6-30-00; 8:45 am]
BILLING CODE 5001-10-U