Source: https://www.law.cornell.edu/cfr/text/32/part-199
Timestamp: 2017-12-15 23:48:23
Document Index: 412422880

Matched Legal Cases: ['art 199', 'art 199', '§ 199', '§ 199', '§ 199', '§ 199', '§ 199', '§ 199', '§ 199', '§ 199', '§ 199', '§ 199', '§ 199', '§ 199', '§ 199', '§ 199', '§ 199', '§ 199', '§ 199', '§ 199']

32 CFR Part 199 - CIVILIAN HEALTH AND MEDICAL PROGRAM OF THE UNIFORMED SERVICES (CHAMPUS) | US Law | LII / Legal Information Institute
CFR › Title 32 › Subtitle A › Chapter I › Subchapter M › Part 199
§ 199.1 General provisions.
§ 199.4 Basic program benefits.
§ 199.6 TRICARE - authorized providers.
§ 199.7 Claims submission, review, and payment.
§ 199.9 Administrative remedies for fraud, abuse, and conflict of interest.
§ 199.10 Appeal and hearing procedures.
§ 199.13 TRICARE Dental Program.
§ 199.14 Provider reimbursement methods.
§ 199.15 Quality and utilization review peer review organization program.
§ 199.16 Supplemental Health Care Program for active duty members.
§ 199.17 TRICARE program.
§ 199.18 Uniform HMO Benefit.
§ 199.20 Continued Health Care Benefit Program (CHCBP).
§ 199.21 TRICARE Pharmacy Benefits Program.
§ 199.22 TRICARE Retiree Dental Program (TRDP).
§ 199.24 TRICARE Reserve Select.
§ 199.25 TRICARE Retired Reserve.
§ 199.26 TRICARE Young Adult.
Title 32 published on 08-Aug-2017 03:47
80 FR 46796 - Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)/TRICARE: Refills of Maintenance Medications Through Military Treatment Facility Pharmacies or National Mail Order Pharmacy Program
FR Doc. 2015-19196
80 FR 44269 - Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)/TRICARE: TRICARE Pharmacy Benefits Program
FR Doc. 2015-18290
RIN 0720-AB57
Docket No. ID: DOD-2012-HA-0049
This final rule is effective August 26, 2015.
This final rule implements new authority for an over-the-counter (OTC) drug program, makes several administrative changes to the TRICARE Pharmacy Benefits Program regulation in order to conform it to the statute, and clarifies some procedures regarding the operation of the uniform formulary. Specifically, the final rule: Provides implementing regulations for the OTC drug program that has recently been given permanent statutory authority; conforms the pharmacy program regulation to the statute (including recent statutory changes contained in the Carl Levin and Howard P. “Buck” McKeon National Defense Authorization Act for Fiscal Year 2015) regarding point-of-service availability of non-formulary drugs and copayments for all categories of drugs; clarifies the process for formulary placement of newly approved drugs; and clarifies several other uniform formulary practices.
80 FR 3926 - TRICARE; Reimbursement of Long Term Care Hospitals
FR Doc. 2015-01242
DOD-2012-HA-0146
Written comments received at the address indicated below by March 27, 2015 will be accepted.
This proposed rule requests public comment on proposed implementation for Long Term Care Hospitals (LTCHs) the statutory provision at title 10, United States Code (U.S.C.), section 1079(j)(2) that TRICARE payment methods for institutional care be determined, to the extent practicable, in accordance with the same reimbursement rules as those that apply to payments to providers of services of the same type under Medicare. This proposed rule sets forth the proposed regulation modifications necessary to implement a TRICARE reimbursement methodology similar to that applicable to Medicare beneficiaries for inpatient services provided by LTCHs.
79 FR 78698 - Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); TRICARE Retired Reserve
FR Doc. 2014-30282
RIN 0720-AB39
TRICARE Retired Reserve (TRR) is a premium-based TRICARE health plan available for purchase worldwide by qualified members of the Retired Reserve and by qualified survivors of TRR members. This final rule responds to public comments received to an interim final rule that was published in the Federal Register on August 6, 2010 (75 FR 47452-47457). That rule established requirements and procedures to implement the TRR program in fulfillment of section 705 of the National Defense Authorization Act for Fiscal Year 2010 (NDAA-10) (Pub. L. 111-84). This final rule also revises requirements and procedures as indicated.
FR Doc. 2014-30307
RIN 0720-AB61
FR Doc. 2014-30337
This final rule modifies the TRICARE regulation to add a definition of assistive technology (AT) devices for purposes of benefit coverage under the TRICARE Extended Care Health Option (ECHO) Program and to amend the definitions of durable equipment (DE) and durable medical equipment (DME) to better conform the language in the regulation to the statute. The final rule amends the language that specifically limits ordering or prescribing of DME to only a physician under the Basic Program, as this amendment will allow certain other TRICARE authorized individual professional providers, acting within the scope of their licensure, to order or prescribe DME. This final rule also incorporates a policy clarification relating to luxury, deluxe, or immaterial features of equipment or devices. That is, TRICARE cannot reimburse for the luxury, deluxe, or immaterial features of equipment or devices, but can reimburse for the base or basic equipment or device that meet the beneficiary&apos;s needs. Beneficiaries may choose to pay the provider for the luxury, deluxe, or immaterial features if they desire their equipment or device to have these “extra features.”
79 FR 78362 - TRICARE; Revision of Nonparticipating Providers Reimbursement Rate; Removal of Cost Share for Dental Sealants; TRICARE Dental Program
FR Doc. 2014-30322
Written comments received at the address indicated below by March 2, 2015 will be accepted.
79 FR 58680 - Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); TRICARE Uniform Health Maintenance Organization (HMO) Benefit—Prime Enrollment Fee Exemption for Survivors of Active Duty Deceased Sponsors and Medically Retired Uniformed Services Members and Their Dependents
FR Doc. 2014-23065
RIN 0720-AB56
DOD-2011-HA-0136
This rule is effective October 30, 2014.
This final rule creates an exception to the usual rule that TRICARE Prime enrollment fees are uniform for all retirees and their dependents and responds to public comments received to the proposed rule published in the Federal Register on June 7, 2013. Survivors of Active Duty Deceased Sponsors and Medically Retired Uniformed Services Members and their Dependents are part of the retiree group under TRICARE rules. In acknowledgment and appreciation of the sacrifices of these two beneficiary categories, the Secretary of Defense has elected to exercise his authority under the United States Code to exempt Active Duty Deceased Sponsors and Medically Retired Uniformed Services Members and their Dependents enrolled in TRICARE Prime from paying future increases to the TRICARE Prime annual enrollment fees. The Prime beneficiaries in these categories have made significant sacrifices for our country and are entitled to special recognition and benefits for their sacrifices. Therefore, the beneficiaries in these two TRICARE beneficiary categories who enrolled in TRICARE Prime prior to 10/1/2013, and those since that date, will have their annual enrollment fee frozen at the appropriate fiscal year rate: FY2011 rate $230 per single or $460 per family, FY2012 rate $260 or $520, FY2013 rate $269.38 or $538.56, or the FY2014 rate $273.84 or $547.68. The future beneficiaries added to these categories will have their fee frozen at the rate in effect at the time they are classified in either category and enroll in TRICARE Prime or, if not enrolling, at the rate in effect at the time of enrollment. The fee remains frozen as long as at least one family member remains enrolled in TRICARE Prime and there is not a break in enrollment. The fee charged for the dependent(s) of a Medically Retired Uniformed Services Member would not change if the dependent(s) was later re-classified a Survivor.
79 FR 56312 - Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)/TRICARE: TRICARE Pharmacy Benefits Program
FR Doc. 2014-22276
79 FR 51127 - Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); TRICARE Reserve Select; TRICARE Dental Program; Early Eligibility for TRICARE for Certain Reserve Component Members
FR Doc. 2014-19904
79 FR 41636 - TRICARE Certified Mental Health Counselors
FR Doc. 2014-16702
RIN 0720-AB55
79 FR 29085 - TRICARE Revision to CHAMPUS DRG-Based Payment System, Pricing of Hospital Claims
FR Doc. 2014-11194
RIN 0720-AB58
Effective Date: This Final rule is effective June 20, 2014. Applicability Date: This rule applies to claims with a discharge date of October 1, 2014, or later from hospitals paid by TRICARE under the Inpatient Prospective Payment System/Diagnosis-Related Groups-based payment system.
This Final rule changes TRICARE&apos;s current regulatory provision for inpatient hospital claims priced under the DRG-based payment system. Claims are currently priced by using the rates and weights that are in effect on a beneficiary&apos;s date of admission. This Final rule changes that provision to price such claims by using the rates and weights that are in effect on a beneficiary&apos;s date of discharge.
78 FR 75245 - Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)/TRICARE: Pilot Program for Refills of Maintenance Medications for TRICARE for Life Beneficiaries Through the TRICARE Mail Order Program
FR Doc. 2013-29434
RIN 0720-AB60
Docket No. ID: DoD-2013-HA-0085
This rule is effective February 14, 2014. Written comments received at the address indicated below by February 10, 2014 will be considered and addressed in the final rule.
78 FR 62427 - TRICARE; Removal of the Prohibition To Use Addictive Drugs in the Maintenance Treatment of Substance Dependence in TRICARE Beneficiaries
FR Doc. 2013-24232
RIN -0720-AB54
FR Doc. 2013-24233
78 FR 51061 - TRICARE; Reimbursement of Sole Community Hospitals and Adjustment to Reimbursement of Critical Access Hospitals; Correction
FR Doc. 2013-20179
Effective October 7, 2013.
On Thursday, August 8, 2013 (78 FR 48303-48311), the Department of Defense published a final rule titled TRICARE; Reimbursement of Sole Community Hospitals and Adjustment to Reimbursement of Critical Access Hospitals. Subsequent to the publication of the final rule in the Federal Register , DoD discovered two errors. This rule corrects these errors.
78 FR 50359 - Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); TRICARE Uniform Health Maintenance Organization (HMO) Benefit—Prime Enrollment Fee Exemption for Survivors of Active Duty Deceased Sponsors and Medically Retired Uniformed Services Members and Their Dependents; Withdrawal
FR Doc. 2013-20121
As of August 19, 2013 the proposed rule published August 8, 2013 (78 FR 48366-48367), is withdrawn.
On Thursday, August 8, 2013 (78 FR 48366-48367), the Department of Defense published a proposed rule titled “Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); TRICARE Uniform Health Maintenance Organization (HMO) Benefit—Prime Enrollment Fee Exemption for Survivors of Active Duty Deceased Sponsors and Medically Retired Uniformed Services Members and Their Dependents.” Subsequent to the publication of the proposed rule in the Federal Register , DoD discovered that an identical proposed rule published in the Federal Register on Friday, June 7, 2013 (78 FR 34292-34293). DoD is hereby withdrawing the proposed rule that published in the Federal Register on Thursday, August 8, 2013.
78 FR 48303 - TRICARE; Reimbursement of Sole Community Hospitals and Adjustment to Reimbursement of Critical Access Hospitals
FR Doc. 2013-19154
This rule is effective October 7, 2013. Applicability Date: The regulations setting forth the revised reimbursement system shall be applicable for all admissions to Sole Community Hospitals and Critical Access Hospitals commencing on or after the first day of the month which is at least 120 days from the date of publication of this rule in the Federal Register .
FR Doc. 2013-19152
Written comments received at the address indicated below by October 7, 2013 will be considered and addressed in the final rule.
This proposed rule would establish an exception to the usual rule that TRICARE Prime enrollment fees are uniform for the group of retirees and their dependents. Survivors and medically retired members are part of the retiree group under TRICARE rules. This exception would allow Survivors of Active Duty Deceased Sponsors and Medically Retired Uniformed Services Members and their Dependents enrolled in Prime to be exempt from future increases in TRICARE Prime enrollment fees. The Prime beneficiaries in these categories prior to 10/1/2013 would have their annual enrollment fee frozen at their current annual rate (FY 2011 rate $230 per single or $460 per family, FY 2012 rate $260 or $520, or the FY 2013 rate $269.38 or $538.56). The beneficiaries added to these categories on or after 10/1/2013 would have their fee frozen at the rate in effect at the time they are classified in either category and enroll in Prime or, if not enrolling, at the rate in effect at the time of enrollment. The fee remains frozen as long as at least one family member remains enrolled in Prime and there is not a break in enrollment. The fee charged for the dependent(s) of a Medically Retired Uniformed Services Member would not change if the dependent(s) was later re-classified a Survivor.
FR Doc. 2013-19153
Comments must be received on or before October 7, 2013. Do not submit comments directly to the point of contact or mail your comments to any address other than what is shown below. Doing so will delay the posting of the submission.
The Department of Defense (DoD) proposes several amendments to the TRICARE regulation. Specifically, the proposed rule revises the definitions of durable equipment (DE) and durable medical equipment (DME) to better conform the language in the regulation to the statute and implementing the statutory requirements will not change current policies. This rule also adds a definition of assistive technology (AT) devices for purposes of benefit coverage under the TRICARE Extended Care Health Option (ECHO) Program and removes the restriction under the TRICARE Basic Program that limits ordering or prescribing of DME to only a physician, to allow certain other authorized individual professional providers acting within the scope of their licensure to order or prescribe DME. Finally, the proposed rule incorporates a policy clarification relating to luxury, deluxe, or immaterial features of equipment or devices. Namely, TRICARE cannot reimburse for the luxury, deluxe, or immaterial features of equipment or devices. However, the TRICARE Management Activity (TMA) can reimburse for the base or basic equipment or device that meet the beneficiary&apos;s needs. Beneficiaries may pay the provider for the luxury, deluxe, or immaterial features themselves, if they desire their equipment or device to have these “extra features.”
78 FR 34292 - Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); TRICARE Uniform Health Maintenance Organization (HMO) Benefit—Prime Enrollment Fee Exemption for Survivors of Active Duty Deceased Sponsors and Medically Retired Uniformed Services Members and Their Dependents
FR Doc. 2013-13503
Written comments received at the address indicated below by August 6, 2013 will be considered and addressed in the final rule.
78 FR 32116 - TRICARE Young Adult
FR Doc. 2013-12412
RIN 0720-AB48
Docket No. ID: DOD-2011-HA-0029
78 FR 13236 - TRICARE: Smoking Cessation Program
FR Doc. 2013-03417
RIN 0720-AB50
DOD-2009-HA-0038
Effective Date: This final rule is effective March 29, 2013.
78 FR 12951 - TRICARE; Elimination of the Non-Availability Statement (NAS) Requirement for Non-Emergency Inpatient Mental Health Care
FR Doc. 2013-03418
RIN 0720-AB52
Docket No. ID: DOD-2011-HA-0059
This final rule eliminates the requirement that states a NAS is needed for non-emergency inpatient mental health care in order for a TRICARE Standard beneficiary&apos;s claim to be paid. Currently, NAS are required for non-emergency inpatient mental health care for TRICARE Standard beneficiaries who live within a military treatment facility catchment area. At this time, the number of NASs issued is negligible as most mental health admissions are emergency admissions. Requiring a NAS for a relatively few non-emergency inpatient mental health admissions is disproportionate to the cost of maintaining the systems necessary to process and coordinate the NAS.
FR Doc. 2013-03416
RIN 0720-AB49
Docket No. ID: DOD-2011-HA-0035
Effective date: This rule is effective March 28, 2013.
78 FR 10579 - TRICARE Revision to CHAMPUS DRG-Based Payment System, Pricing of Hospital Claims
FR Doc. 2013-03419
Docket No. ID DOD-2012-HA-0105
Written comments received at the address indicated below by April 15, 2013 will be accepted.
This rule proposes to change TRICARE&apos;s current regulatory provision for hospital claims priced under the DRG-based payment system. Claims are currently priced by using the rates and weights that are in effect on a beneficiary&apos;s date of admission. This rule proposes to change that provision to price such claims by using the rates and weights that are in effect on a beneficiary&apos;s date of discharge.
FR Doc. 2012-16419
Docket No. ID DOD-2012-HA-0049
The proposed rule published on Tuesday, June 26, 2012 is withdrawn as of Tuesday, June 26, 2012.
The Department of Defense published a proposed rule for the CHAMPUS/TRICARE: TRICARE Retail Pharmacy Program on Tuesday, June 26, 2012 (77 FR 38019). This rule is being published to withdrawal the proposed rule. The Department has decided to defer consideration of possible regulatory changes to the TRICARE Pharmacy Benefits Program for the present time.
77 FR 38173 - TRICARE Reimbursement Revisions
FR Doc. 2012-15509
RIN 0720-AB43
77 FR 38175 - TRICARE; Constructive Eligibility for TRICARE Benefits of Certain Persons Otherwise Ineligible Under Retroactive Determination of Entitlement to Medicare Part A Hospital Insurance Benefits
FR Doc. 2012-15508
RIN 0720-AB51
The Department is publishing this final rule to implement section 706 of the National Defense Authorization Act (NDAA) for Fiscal Year 2010, Public Law 111-84. Specifically, section 706 exempts TRICARE beneficiaries under the age of 65 who become disabled from the requirement to enroll in Medicare Part B for the retroactive months of entitlement to Medicare Part A in order to maintain TRICARE coverage. This statutory amendment and final rule only impact eligibility for the period in which the beneficiary&apos;s disability determination is pending before the Social Security Administration. Eligible beneficiaries are still required to enroll in Medicare Part B in order to maintain their TRICARE coverage for future months, but are considered to have coverage under the TRICARE program for the retroactive months of their entitlement to Medicare Part A. This final rule also amends the eligibility section of the TRICARE regulation to more clearly address reinstatement of TRICARE eligibility following a gap in coverage due to lack of enrollment in Medicare Part B.
77 FR 38177 - TRICARE; Off-Label Uses of Devices; Partial List of Examples of Unproven Drugs, Devices, Medical Treatments, or Procedures
FR Doc. 2012-15510
RIN 0720-AB23
The Department of Defense is publishing this final rule to revise the definition of “unlabeled or off-label drug” to “off-label use of a drug or device.” This provision codifies the coverage of those medically necessary indications for which there are demonstrations from medical literature, national organizations, or technology assessment bodies that the off-label use is safe and effective and in accordance with nationally accepted standards of practice in the medical community. Additionally, this rule removes the partial list of examples of unproven drugs, devices, and medical treatments or procedures proscribed in TRICARE regulations. We are removing the partial list from the regulation but will maintain the partial list in the TRICARE Policy Manual at www.tricare.mil.
77 FR 38019 - Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)/TRICARE: TRICARE Retail Pharmacy Program
FR Doc. 2012-15507
Written comments received at the address indicated below by August 27, 2012 will be considered and addressed in the final rule.
This proposed rule would make several administrative changes to the TRICARE Pharmacy Benefits Program regulations in order to conform them more closely to the statute and to clarify some procedures regarding the operation of the uniform formulary. Specifically, the proposed rule would: conform the regulation to the statute regarding point-of-service availability of non-formulary drugs; clarify the process for formulary placement of newly approved drugs; streamline the process for updating copayment requirements; specify the method for applying the statutory formula for maximum non-formulary drug copayments; and clarify several other uniform formulary practices. This rule is separate from, but not inconsistent with, the legislative proposal made by the Department to implement portions of the President&apos;s Budget for Fiscal Year 2013 relating to the TRICARE Pharmacy Benefits Program.