Federal Register / Vol. 72, No. 52 / Monday, March 19, 2007 / Notices 12783 

Response: NMFS disagrees. The 

fishery underwent significant regulatory 

modification, including seasons and 

gear, to protect sea turtles beginning in 

2000, and the gear and set 

characteristics of the fishery changed. 

Thus, it would not be appropriate to 

include data for the earlier fishing 

practices. The guidelines for assessing 

marine mammal stocks recommend 

using the most recent 5 years of 

available data to balance the use of 

current information with the need to 

average across multiple years for rarely 

observed events. 

Dated: March 13, 2007. 

James H. Lecky, 

Director, Office of Protected Resources, 

National Marine Fisheries Service. 

[FR Doc. E7–4956 Filed 3–16–07; 8:45 am] 

BILLING CODE 3510–22–S 

DEPARTMENT OF DEFENSE 

Office of the Secretary 

Office of the Secretary of Defense 

(Health Affairs)/TRICARE Management 

Activity 

AGENCY: Department of Defense. 

ACTION: Notice of a disease management 

demonstration project for TRICARE 

Standard beneficiaries. 

SUMMARY: This notice is to advise 

interested parties of a Military Health 

System (MHS) demonstration project 

entitled Disease Management 

Demonstration Project for TRICARE 

Standard Beneficiaries. Although there 

are many similarities between TRICARE 

Standard and TRICARE Prime as to the 

preventive health care services that may 

be provided in the current benefit, there 

are services that are expressly excluded 

under TRICARE Standard that may be 

offered under TRICARE Prime which 

are the essence of a disease management 

(DM) program. TRICARE currently 

requires the Managed Care Support 

Contractors (MCSCs) to provide 

‘‘disease management services’’ under 

the current contracts, without specific 

guidance. Based upon the current legal 

statutes authorizing preventive health 

care services, TRICARE must conduct a 

demonstration under 10 U.S.C. 1092 in 

order to offer TRICARE Prime benefits 

to TRICARE Standard beneficiaries 

under the DM program already in 

existence. (Section 734 of the John 

Warner National Defense Authorization 

Act for Fiscal Year 2007 (henceforth 

NDAA 2007) does not give any broader 

authority than exists today). Under this 

demonstration, disease management 

services will be provided to TRICARE 

Standard beneficiaries as part of the 

current MHS DM programs. The 

demonstration project will enable the 

MHS to provide uniform policies and 

practices on disease and chronic care 

management throughout the TRICARE 

network. Additionally, the 

demonstration will help determine the 

effectiveness of DM programs in 

improving the health status of 

beneficiaries with targeted chronic 

diseases or conditions, and any 

associated cost savings. 

DATES: Effective Date: April 1, 2007. 

This demonstration will remain in effect 

until March 31, 2009. 

ADDRESSES: TRICARE Management 

Activity (TMA), Office of the Chief 

Medical Officer, 5111 Leesburg Pike, 

Suite 810, Falls Church, VA 22041–

3206. 

FOR FURTHER INFORMATION CONTACT: CDR 

Cynthia Gantt, Office of the Chief 

Medical Officer—TRICARE 

Management Activity, telephone (703) 

681–0064. 

SUPPLEMENTARY INFORMATION: 

A. Background 

The Military Health System (MHS) is 

a $33 billion dollar enterprise, 

consisting of 76 military hospitals, over 

500 military health clinics, and an 

extensive network of private sector 

health care partners, which provides 

medical care for over 9 million 

beneficiaries and active duty service 

members. Of these beneficiaries, 

approximately 5 million are classified as 

TRICARE Prime enrollees and 4.2 

million are TRICARE Standard 

participants. 

The MHS is facing significant fiscal 

challenges in the coming years due to 

the rising costs of providing health care, 

coupled with recent expansions to the 

pool of eligible beneficiaries. The MHS 

recognizes these challenges and has 

implemented several new initiatives to 

help control costs. Disease management 

(DM) programs have become popular in 

the private sector as a means to 

accomplish this goal, with varying 

levels of effectiveness having been 

documented. The MHS has the 

opportunity to become a leader in DM, 

due to its population of long term or life 

time eligible beneficiaries and robust 

information systems. 

B. MHS Disease Management Program 

On September 1, 2006, the MHS 

implemented a new DM initiative based 

on a consistent approach across all three 

managed care regions, focusing on 

asthma and congestive heart failure. 

These programs run by the Managed 

Care Support Contractors (MCSCs) 

include beneficiaries from military 

treatment facilities and those seen by 

civilian healthcare providers within the 

TRICARE network. In this revised 

uniform approach to DM, the 

Government, with the assistance of a 

program evaluation contractor, provides 

the MCSCs risk-stratified patient lists 

and conducts a formal evaluation across 

all three Regions using national 

benchmarks. 

TRICARE’s approach to disease 

management is two-fold: (1) Keep the 

well healthy with a focus on healthy 

lifestyles, disease prevention and health 

promotion and (2) maintain an active 

disease management program for high 

risk beneficiaries with specific chronic 

disease conditions. Evidence-based 

clinical practice guidelines (CPGs) and 

educational resources developed jointly 

by the Departments of Defense (DoD) 

and Veterans Affairs (VA) are used in 

both the military treatment facility and 

MCSC DM programs. 

The MHS DM program directly 

supports the MHS strategic goal of 

effective patient partnerships by 

advocating the use of evidence-based 

practice guidelines and emphasizing 

patient self management skills. The 

goals of the DM initiatives are to 

improve clinical outcomes, increase 

patient and provider satisfaction, and 

ensure appropriate utilization of 

resources. 

C. Current TRICARE Standard Benefit 

Under 10 U.S.C. 1079(a)(13), 

TRICARE may cost share only services 

or supplies that are medically or 

psychologically necessary to prevent, 

diagnose, or treat a mental or physical 

illness, injury, or bodily malfunction as 

assessed or diagnosed by an authorized 

provider. There is additional statutory 

authority that describes what are 

preventive health care services. Under 

10 U.S.C. 1074d, members and former 

members of the uniformed services are 

entitled to preventive health care 

services including cervical cancer 

screening, breast cancer screening, and 

screening for colon and prostate cancer, 

all at intervals and using methods the 

Secretary considers appropriate. These 

same services are available to them and 

all dependents in MTFs under 10 U.S.C. 

1077(a)(14), and to all covered 

beneficiaries under TRICARE under 10 

U.S.C. 1079(a)(2). Under 10 U.S.C. 

1079(a)(2)(B), other health promotion 

and disease prevention visits for those 

over six years of age are authorized 

under TRICARE Standard only when 

done in connection with immunizations 

or with diagnostic or preventive cancer 

screening tests. (See also, 32 CFR 

199.4(g)(37)). 


ycherry on PROD1PC64 with NOTICES
12784 Federal Register / Vol. 72, No. 52 / Monday, March 19, 2007 / Notices 

Additionally, the TRICARE Prime 

program is authorized by 10 U.S.C. 

1097—1099. The statutes authorize 

Prime to ‘‘provide better services than 

those provided by [Standard]’’, and the 

Secretary ‘‘shall prescribe regulations to 

carry out this section.’’ The regulations 

that directly impact the TRICARE Prime 

program are 32 CFR 199.17 and 199.18. 

Under 32 CFR 199.18(b)(2), the 

following services are available under 

TRICARE Prime that are not authorized 

under TRICARE Standard: 

(1) ‘‘Periodic health promotion and 

disease prevention exams; 

(2) Appropriate education and 

counseling services. The exact services 

offered shall be established under 

uniform standards established by the 

Assistant Secretary of Defense (Health 

Affairs). 

(3) In addition to preventive care 

services provided pursuant to paragraph 

(b)(2) of this section, other benefit 

enhancements may be added and other 

benefit restrictions may be waived or 

relaxed in connection with health care 

services provided to include the 

Uniform HMO Benefit. Any such other 

enhancements or changes must be 

approved by the Assistant Secretary of 

Defense (Health Affairs) based on 

uniform standards.’’

Also, under TRICARE Standard, 

education and counseling services are 

expressly excluded under 32 CFR 

199.4(g)(39). 

D. National Defense Authorization Act 

(NDAA) 2007 Disease Management 

Directives 

The NDAA 2007 section 734 requires 

the design and development of a fully 

integrated program on disease and 

chronic care management for the 

military health care system that 

provides uniform policies and practices 

on disease and chronic care 

management throughout the TRICARE 

network by October 1, 2007. The NDAA 

2007 further states the program ‘‘shall 

include strategies for disease and 

chronic care management for all 

beneficiaries, including beneficiaries 

eligible for benefits under the Medicare 

program under title XVIII of the Social 

Security Act (42 U.S.C. 1395 et seq.), for 

whom the TRICARE program is not the 

primary payer for health care benefits.’’

The purposes of the MHS DM 

programs, as stated in the NDAA 2007, 

are to facilitate the improvement of the 

health status of individuals under care 

in the military health care system, to 

ensure the availability of effective 

health care services for individuals with 

diseases and other chronic conditions, 

and to ensure the proper allocation of 

health care resources for individuals 

who need care for disease or other 

chronic conditions. The NDAA 2007 

mandates the DM program to address, at 

a minimum, the following chronic 

diseases and conditions: diabetes, 

cancer, heart disease, asthma, chronic 

obstructive pulmonary disorder, and 

depression and anxiety disorders. 

E. Description of Demonstration Project 

Under this demonstration, DoD will 

waive, for disease management services 

provided to TRICARE Standard 

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

section 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 MHS will enroll 

TRICARE Standard beneficiaries in its 

DM programs. DM services provided to 

Standard beneficiaries will include, but 

are not limited to: clinical preventive 

examinations, patient education and 

counseling services, and periodic 

screening exams. 

There will be a cap on MHS DM 

program costs not to exceed the amount 

approved by the contracting officer. The 

DM program costs are total costs of DM 

services provided to both Prime and 

Standard beneficiaries. Only those 

beneficiaries identified by TRICARE 

Management Activity (TMA) for disease 

management of asthma, congestive heart 

failure, and diabetes are included in the 

current program, with other diseases or 

conditions to be added in the future as 

funding permits. The beneficiaries 

identified by TMA are included in the 

DM program unless the beneficiary 

chooses to opt out. 

This action will directly reduce 

variation across the system and result in 

improved consistency and quality for 

beneficiaries with targeted chronic 

illness, regardless of TRICARE 

classification. Furthermore, including 

TRICARE Standard beneficiaries in 

current DM efforts will inform the MHS 

about total potential savings and return 

on investment (ROI) associated with 

DM, a stated requirement for inclusion 

in the Congressional report per the 

NDAA 2007. The system-wide DM 

program will improve the quality of care 

by educating patients about their 

disease and helping them manage their 

symptoms, thereby avoiding many 

complications and possibly slowing the 

progression of their chronic disease, 

thus resulting in significant cost 

savings. 

F. Implementation 

The demonstration is effective on 

April 1, 2007. 

G. Evaluation 

An independent evaluation of the 

demonstration will be conducted. The 

evaluation will be designed to use a 

combination of administrative and 

survey measures of health care 

outcomes (clinical, utilization, financial, 

and humanistic measures) to provide 

analyses and comment on the 

effectiveness of the demonstration in 

meeting its goal of providing uniform 

disease management policies and 

practices across the MHS. 

Dated: March 13, 2007. 

L.M. Bynum, 

Alternate OSD Federal Register Liaison 

Officer, Department of Defense. 

[FR Doc. E7–4924 Filed 3–16–07; 8:45 am] 

BILLING CODE 5001–06–P 

DEPARTMENT OF DEFENSE 

Office of the Secretary 

Renewal of 18 Department of Defense 

Federal Advisory Committees 

AGENCY: DoD. 

ACTION: Establishment of Federal 

Advisory Committee. 

SUMMARY: Under the provisions of the 

Federal Advisory Committee Act of 

1972, (5 U.S.C. Appendix, as amended), 

the Sunshine in the Government Act of 

1976 (5 U.S.C. 552b, as amended), and 

41 CFR 102–3.65, the Department of 

Defense gives notice that it intents to 

establish the U.S. Southern Command 

Advisory Group, as a discretionary 

Federal advisory committee. 

This committee will provide the 

Secretary of Defense, through the 

Chairman of the Joint Chiefs of Staff and 

the Commander, U.S. Southern 

Command independent advice and 

recommendations on the dynamic, 

transnational challenges facing the 

United States and its allies with respect 

to the U.S. Southern Command 

responsibilities. In accordance with DoD 

policy and procedures, the Commander 

U.S. Southern Command is authorized 

to act upon the advice emanating from 

this advisory committee. 

The U.S. Southern Command 

Advisory Group shall be composed of 

no more than 25 members who are 

eminent authorities in the fields of 

national defense, geopolitical and 

national security affairs, or Latin 

America and the Caribbean. Committee 

members appointed by the Secretary of 

Defense, who are not full-time Federal 

officers or employees, shall serve as 

Special Government Employees under 

the authority of 5 U.S.C. 3109. 


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