Federal Register / Vol. 60, No. 54 / Tuesday, March 21, 1995 / Proposed Rules 14919

iron in iron-containing products will

decrease the risk of pediatric

poisonings, while providing desirable

iron nutrition to those who need iron

supplementation, and on whether an

exemption for products that contain

elemental iron from any packaging and

labeling requirements that result from

the underlying rulemaking is

appropriate.

Interested persons may on or before

April 20, 1995, submit to the Dockets

Management Branch (address above)

comments on the workshop. Additional

written comments may be submitted for

30 days after the date of this workshop.

Two copies of any comments are to be

submitted, except that individuals may

submit one copy. Written comments and

submitted documents are to be

identified with the docket numbers

found in brackets in the heading of this

document. Received comments and the

transcript of the discussion identified

with the same docket numbers may be

seen in the office above between 9 a.m.

and 4 p.m., Monday through Friday.

Dated: March 16, 1995.

William B. Schultz,

Deputy Commissioner for Policy.

[FR Doc. 95–6919 Filed 3–20–95; 8:45 am]

BILLING CODE 4160–01–F

DEPARTMENT OF DEFENSE

Office of the Secretary

32 CFR Part 199

[DoD 6010.8–R]

RIN 0720–AA26

Civilian Health and Medical Program of

the Uniformed Services (CHAMPUS);

Six Separate Changes

AGENCY: Office of the Secretary, DoD.

ACTION: Proposed rule.

SUMMARY: This proposed rule addresses

six separate changes to comply with

new statutory 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; eliminate the implied

statement that ambulance services are

covered only to and from hospitals;

include other forms of prescribed

contraceptives by eliminating the

reference that limits prescribed

contraceptives only to those taken

orally; recognize chemical aversion

therapy as a treatment modality for

alcoholism by eliminating the

exclusionary language in the current

regulation; 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.

DATES: Written comments, whether from

the general public or from other

governmental agencies, must be

received on or before May 22, 1995.

ADDRESSES: Office of the Civilian Health

and Medical Program of the Uniformed

Services (OCHAMPUS), Program

Development Branch, Aurora, Co

80045–6900.

FOR FURTHER INFORMATION CONTACT:

Mr. A. Chris Armijo, Program

Development Branch, OCHAMPUS,

telephone (303) 361–1120.

SUPPLEMENTARY INFORMATION: 32 CFR

199.4 lists Basic Program benefits

including exclusions and limitations.

Paragraph (c) defines, in general terms,

the scope of reimbursable services

provided by physicians and other

authorized individual professional

providers; paragraph (e) extends

benefits under certain circumstances, to

conditions and limitations that are

subject to applicable definitions,

conditions, or exclusions that are set

forth in this or other sections of this

regulation; paragraph (f) identifies the

liabilities, in the form of cost-shares and

deductibles, to be paid by beneficiaries

or sponsors.

Well-Baby Care: Paragraph (c)(3)(xi),

provides for certain well-baby care

services for infants up to the age of two

years. A paragraph (6) will be added

under paragraph (xi)(A) to list blood

lead level screening for infants as a

benefit.

Ambulance Service: Ambulance

services are covered between points

deemed to be medically necessary for

the covered medical condition,

therefore, the restrictive language, ‘‘to,

from, and between hospitals’’ will be

removed from paragraph (d)(3)(v).

Family Planning: Paragraph (e)(3)

provides for a family planning benefit.

Paragraph (e)(3)(i)(A)(3) of this Section

allows benefits for prescribed oral

contraceptives. With the development of

new methods of contraception,

prescribed contraceptives are no longer

limited to those taken orally. We are,

therefore, amending that paragraph by

removing the word ‘‘oral’’ to expand the

coverage accordingly.

Treatment for Alcoholism: Paragraph

(e)(4)(iii)(A) of § 199.4, has historically

excluded benefits for aversion therapy

as a treatment modality for alcoholism.

At the request of OCHAMPUS, the

Office of Health Technology Assessment

(OHTA) of the Public Health Service

(PHS) conducted an assessment of the

safety and efficacy of chemical aversion

conditioning for the treatment of

alcoholism. On the basis of the OHTA

assessment, it was determined that

chemical aversion conditioning is no

less effective than other therapies for

alcoholism when it is provided

following the failure of less intrusive

therapies. This rule proposes to remove

paragraph (e)(4)(iii)(A) in its entirety to

remove exclusionary language, to

reserve that paragraph for future use,

and to revise paragraph (4)(ii), to

include coverage of chemical aversion

therapy as a treatment modality.

Financial Liability-Deductibles: Under

paragraph (f) of section 199.4,

CHAMPUS beneficiaries and sponsors

have some financial responsibility when

medical care is received from civilian

sources. Financial liability is imposed

in order to encourage use of the

Uniformed Services direct medical care

system whenever facilities and services

are available. Beneficiaries are

responsible for payment of certain

deductible and cost-sharing amounts in

connection with otherwise covered

services and supplies. The cost-share

and deductible amounts are controlled

by statute and subject to change by

Congressional action. Previous

legislation had deferred a statutory

increase in the deductible amount from

April 1, 1991, to October 1, 1991, for

dependents of active duty members who

served in the Gulf Conflict. The

National Defense Authorization Act for

Fiscal Year 1993 contains language

which prompts a revision of paragraph

(f)(2)(i)(G) of this section to identify

three new groups of Gulf Conflict

beneficiaries, besides the dependents of

active duty members, eligible for the

delay in the increased deductibles, and

to allow credit or reimbursement of

excess amounts inadvertently paid by

those groups subject to availability of

appropriated funds.

Catastrophic Loss: The National

Defense Authorization Act for Fiscal

Years 1988 and 1989 (P.L. 100–180)

amended Title 10, United States Code

and established catastrophic loss

protection for CHAMPUS beneficiaries

on a government fiscal year basis. The

law placed fiscal year limits or,

catastrophic caps, on beneficiary

liability for cost-shares and deductibles

under the CHAMPUS Basic Program.

After the fiscal year cap is met by the

beneficiary, the CHAMPUS determined

allowable amounts for all covered

services or supplies received under the

Basic Program are to be paid in full by

CHAMPUS.

For dependents of active duty

members, the maximum family liability
14920 Federal Register / Vol. 60, No. 54 / Tuesday, March 21, 1995 / Proposed Rules

is $1,000 for deductibles and cost-shares

based on allowed charges for the Basic

Program services and supplies received

in a fiscal year. For all other categories

of beneficiary families, the previous

fiscal year cap of $10,000 under P.L.

100–180 has been reduced under the

1993 Defense Authorization Act (P.L.

102–484) to $7,500. This proposed rule

implements the law which reduces the

fiscal year catastrophic other than active

duty dependents, effective for Basic

Program services and supplies received

on or after October 1, 1992.

Regulatory Procedures: OMB has

determined that this is not a significant

rule as defined by E.O. 12866.

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 proposed rule would not have a

significant impact on a substantial

number of small entities. The changes

set forth in this proposed rule are minor

revisions to the existing regulation. This

proposed rule does not impose

information collection requirements on

the public under the Paperwork

Reduction Act of 1980 (44 U.S.C. 3501–

3511). Public comments on this

proposed rule are invited and will be

considered. A discussion of any major

issues revised as a result of public

comments will be included in 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, Handicapped, Health

insurance, Military personnel.

Accordingly, 32 CFR part 199 is

proposed to be amended as follows:

PART 199—[AMENDED]

1. The authority citation for part 199

is proposed to be revised as follows:

Authority: 5 U.S.C. 301; 10 U.S.C. chapter

55.

2. Section 199.4 is proposed to be

amended in paragraph (e)(3)(i)(A)(3) by

removing the word ‘‘oral’’; by removing

and reserving paragraph (e)(4)(iii)(A); by

adding new paragraphs (c)(3)(xi)(A)(7)

and (f)(10); and by revising the first

sentence in paragraph (d)(3)(v),

paragraph (e)(4)(ii), and paragraph

(f)(2)(i)(G) to read as follows:

§ 199.4 Basic program benefits.

* * * * *

(c) * * *

(3) * * *

(xi) * * *

(A) * * *

(7) One screening of an infant to

determine the level of lead in the blood

of that infant.

* * * * *

(d) * * *

(3) * * *

(v) Ambulance. Civilian ambulance

service is covered when medically

necessary in connection with otherwise

covered services and supplies and a

covered medical condition. * * *

* * * * *

(e) * * *

(4) * * *

(ii) Authorized substance use disorder

treatment. Only those services provided

by CHAMPUS-authorized institutional

providers are covered. Such a provider

must be either an authorized hospital, or

an organized substance use disorder

treatment program in an authorized freestanding or hospital-based substance

use disorder rehabilitation facility.

Covered services consist of any or all of

the services listed below, including

chemical aversion therapy for

alcoholism. A qualified mental health

provider (physician, clinical

psychologist, clinical social worker,

psychiatric nurse specialist, (see

paragraph (c)(3)(i) of this section) shall

prescribe the particular level of

treatment. Each CHAMPUS beneficiary

is entitled to three substance use

disorder treatment benefit periods in his

or her lifetime, unless this limit is

waived pursuant to paragraph (e)(4)(v)

of this section. Unless clinically

contraindicated, the programmed use of

chemical aversion therapy is limited to

the third lifetime alcoholism benefit

period. (A benefit period begins with

the first date of covered treatment and

ends 365 days later, regardless of the

total services actually used within the

benefit period. Unused benefits cannot

be carried over to subsequent benefit

periods. Emergency and inpatient

hospital services (as described in

paragraph (e)(4)(i) of this section do not

constitute substance abuse treatment for

purposes of establishing the beginning

of a benefit period.)

* * * * *

(f) * * *

(2) * * *

(i) * * *

(G) Notwithstanding the dates

specified in paragraphs (f)(2)(i) (A) and

(B) of this section, in the case of

dependents of active duty members of

rank E–5 or above with Persian Gulf

Conflict service, dependents of service

members who were killed in the Gulf,

who died subsequent to Gulf service,

and of members who retired prior to

October 1, 1991, after having served in

the Gulf War, the deductible shall be the

amount specified in paragraph

(f)(2)(i)(A) of this section for care

rendered prior to October 1, 1991, and

the amount specified in paragraph

(f)(2)(i)(B) of this section for care

rendered after October 1, 1991.

* * * * *

(10) Catastrophic loss protection for

basic program benefits. Fiscal year

limits, or catastrophic caps, on the

amounts beneficiaries are required to

pay are established as follows:

(i) Dependents of active duty

members. The maximum family liability

is $1,000 for deductibles and cost-shares

based on allowable charges for Basic

Program services and supplies received

in a fiscal year.

(ii) All other beneficiaries. For all

other categories of beneficiary families

(including those eligible under

CHAMPVA), the fiscal year cap is

$10,000.

(iii) Payment after cap is met. After a

family has paid the maximum cost-share

and deductible amounts (dependents of

active duty members $1,000 and all

others $10,000), for a fiscal year,

CHAMPUS will pay allowable amounts

for remaining covered services through

the end of that fiscal year.

Note to paragraph (f)(2)(i)(G)(10):

Under the Defense Authorization Act for

fiscal year 1993, the cap for

beneficiaries other than dependents of

active duty members was reduced from

$10,000 to $7,500 on October 1, 1992.

The cap remains at $1,000 for

dependents of active duty members.

* * * * *

Dated: March 14, 1995.

L.M. Bynum,

Alternate, OSD Federal Register Liaison

Officer, Department of Defense.

[FR Doc. 95–6670 Filed 3–20–95; 8:45 am]

BILLING CODE 5000–04–M

ENVIRONMENTAL PROTECTION

AGENCY

40 CFR Part 52

[IL79–2–6616B; FRL–5167–8]

Approval and Promulgation of

Implementation Plans; Illinois

AGENCY: Environmental Protection

Agency (USEPA).

ACTION: Proposed rule.

SUMMARY: The USEPA proposes to

approve requested revisions to the

Chicago ozone Federal Implementation

Plan as it pertains to the following

sources: General Motors Corporation,