81_FR_40800 81 FR 40680 - Access to Healthcare Under the TRICARE Program for Beneficiaries of TRICARE Prime

81 FR 40680 - Access to Healthcare Under the TRICARE Program for Beneficiaries of TRICARE Prime

DEPARTMENT OF DEFENSE
Office of the Secretary

Federal Register Volume 81, Issue 120 (June 22, 2016)

Page Range40680-40681
FR Document2016-14786

This notice is to advise interested parties of the Military Health System's access to health care standards addressed in Title 32, Code of Federal Regulations (32 CFR), Section 199.17 for TRICARE Prime beneficiaries under the TRICARE Program and how the Secretary of Defense plans to ensure that beneficiaries under TRICARE Prime who are seeking an appointment for health care will obtain an appointment within established access to health care standards. Access to health care under the TRICARE Program for TRICARE Prime beneficiaries was established in October 1995 and remains current.

Federal Register, Volume 81 Issue 120 (Wednesday, June 22, 2016) 
[Federal Register Volume 81, Number 120 (Wednesday, June 22, 2016)]
[Notices]
[Pages 40680-40681]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2016-14786]



[[Page 40680]]

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DEPARTMENT OF DEFENSE

Office of the Secretary


Access to Healthcare Under the TRICARE Program for Beneficiaries 
of TRICARE Prime

AGENCY: Office of the Secretary, Department of Defense.

ACTION: Notice of access to health care standards for TRICARE Prime 
beneficiaries under the TRICARE Program.

-----------------------------------------------------------------------

SUMMARY: This notice is to advise interested parties of the Military 
Health System's access to health care standards addressed in Title 32, 
Code of Federal Regulations (32 CFR), Section 199.17 for TRICARE Prime 
beneficiaries under the TRICARE Program and how the Secretary of 
Defense plans to ensure that beneficiaries under TRICARE Prime who are 
seeking an appointment for health care will obtain an appointment 
within established access to health care standards. Access to health 
care under the TRICARE Program for TRICARE Prime beneficiaries was 
established in October 1995 and remains current.

ADDRESSES: Defense Health Agency, TRICARE Health Plan, 7700 Arlington 
Boulevard, Suite 5101, Falls Church, Virginia 22042-5101.

FOR FURTHER INFORMATION CONTACT: Ms. Michelle Graves, TRICARE Health 
Plan, telephone (703) 681-0039.

SUPPLEMENTARY INFORMATION: 

A. Background on Access to Health Care for TRICARE Prime Beneficiaries 
Under the TRICARE Program

    Section 704 of the National Defense Authorization Act for Fiscal 
Year 2016 (NDAA for FY16) requires the Secretary of Defense to 
establish and publicize access to care standards for beneficiaries 
enrolled in TRICARE Prime at military treatment facilities (MTFs) or 
with civilian network providers. The Department has already established 
Prime maximum wait times and travel distances for Prime primary and 
specialty care appointments as required by Section 704 of the NDAA for 
FY 2016.
    Access to care standards for TRICARE Prime enrollees have been in 
place since the start of the TRICARE Prime program in 1995. TRICARE 
Prime access standards were published in a Federal Register notice on 
October 5, 1995 (60 FR 52100-52101) and promulgated in 32 CFR 
199.17(p)(5)(i-v). These same standards are also disseminated 
throughout the Military Health System via Assistant Secretary of 
Defense (Health Affairs) Memorandum 11-005, ``TRICARE Policy for Access 
to Care,'' dated February 23, 2011. Finally, these standards are 
incorporated by reference in existing and future TRICARE regional 
support contracts. TRICARE Prime access to health care standards apply 
regardless of the location of the beneficiary's primary care manager 
(military treatment facility or civilian network).

B. Description of the Health Care Access Standards for TRICARE Prime 
Beneficiaries

    The health care access standards outlined in this notice are set 
forth in 32 CFR 199.17(p)(5)(i-v). These access standards remain 
current and in force without any amendment to date.
    Access standards. Preferred provider networks will have attributes 
of size, composition, mix of providers, and geographical distribution 
so that the networks, coupled with the MTF capabilities, can adequately 
address the health care needs of the enrollees. The capabilities of the 
MTF plus preferred provider network will meet the following access 
standards with respect to the needs of the expected number of 
enrollees:
    (i) Under normal circumstances, enrollee travel time may not exceed 
30 minutes from home to primary care delivery site unless a longer time 
is necessary because of the absence of providers (including providers 
not part of the network) in the area.
    (ii) The wait time for an appointment for a well-patient visit or a 
specialty care referral shall not exceed four weeks; for a routine 
visit, the wait time for an appointment shall not exceed one week; and 
for an urgent care visit the wait time for an appointment shall be 
within 24 hours. (The specialty care time standard does not apply in 
the case of a follow-up appointment that for clinical reasons is 
specifically stated for a later period.)
    (iii) Emergency services shall be available and accessible to 
handle emergencies (and urgent care visits if not available from other 
primary care providers pursuant to paragraph (p)(5)(ii) of 32 CFR 
199.17), within the service area 24 hours a day, seven days a week.
    (iv) The network shall include a sufficient number and mix of board 
certified specialists to meet reasonably the anticipated needs of 
enrollees. Travel time for specialty care shall not exceed one hour 
under normal circumstances, unless a longer time is necessary because 
of the absence of providers (including providers not part of the 
network) in the area. This requirement does not apply under the 
Specialized Treatment Services Program.
    (v) Office waiting times in non-emergency circumstances shall not 
exceed 30 minutes, except when emergency care is being provided to 
patients, and the normal schedule is disrupted.

C. Description of How the Secretary of Defense Plans To Ensure That 
Beneficiaries Under TRICARE Prime Who Are Seeking an Appointment for 
Health Care Will Obtain an Appointment Within Established Access to 
Health Care Standards

    In an effort to ensure TRICARE Prime beneficiaries obtain an 
appointment within access to health care standards at an MTF, the 
Military Health System implemented a first-call resolution policy in 
calendar year 2015. This policy outlines standard processes to ensure 
TRICARE Prime beneficiaries are not asked to call back to the MTFs if 
no appointments are available within the established access to health 
care standards. The policy also identifies responsibilities of MTF 
Directors, primary care, specialist care and other stakeholders 
identified in the appointing process to ensure patient satisfaction for 
our beneficiaries. The policy outlines specific procedures to correctly 
transfer calls in accordance with existing access to care standards, 
referral management protocols and proper use of managing clinic 
schedules to ensure appointing success the first time one of our 
beneficiaries seeks access. In addition, a Joint Outpatient Experience 
Survey will be used to measure the impact of the first-call resolution 
policy from beneficiaries' perspectives on whether they obtained an 
appointment within health care access standards.
    For those TRICARE Prime beneficiaries seeking an appointment with a 
TRICARE Prime civilian network provider, if the beneficiary cannot be 
scheduled for a visit in the MTF or TRICARE Prime network within the 
access to care standards, the beneficiary will be authorized an out-of-
network provider visit with no point-of-service charge. The TRICARE 
Reimbursement Manual will be revised to reflect the above statement. In 
addition, as stated in the TRICARE Operations Manual (TOM Chapter 1, 
Section 3, Paragraph 1.0), ``Contractors are charged with providing or 
arranging for delivery of quality, timely health care services and have 
the responsibility for providing the timely and accurate processing of 
all claims received into their custody, whether for network or non-
network care.''

[[Page 40681]]

D. Communications

    The Defense Health Agency will post the TRICARE Prime access to 
care standards on the TRICARE.mil Web site and execute a strategic 
communication plan to educate beneficiaries enrolled in TRICARE Prime 
about the access to care standards.

    Dated: June 17, 2016.
Aaron Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2016-14786 Filed 6-21-16; 8:45 am]
 BILLING CODE 5001-06-P

40680 Federal Register / Vol. 81, No. 120 / Wednesday, June 22, 2016 / Notices DEPARTMENT OF DEFENSE ‘‘TRICARE Policy for Access to Care,’’ Specialized Treatment Services dated February 23, 2011. Finally, these Program. Office of the Secretary standards are incorporated by reference (v) Office waiting times in non- in existing and future TRICARE regional emergency circumstances shall not Access to Healthcare Under the support contracts. TRICARE Prime exceed 30 minutes, except when TRICARE Program for Beneficiaries of access to health care standards apply emergency care is being provided to TRICARE Prime regardless of the location of the patients, and the normal schedule is AGENCY: Office of the Secretary, beneficiary’s primary care manager disrupted. Department of Defense. (military treatment facility or civilian C. Description of How the Secretary of network). Defense Plans To Ensure That ACTION: Notice of access to health care standards for TRICARE Prime B. Description of the Health Care Beneficiaries Under TRICARE Prime beneficiaries under the TRICARE Access Standards for TRICARE Prime Who Are Seeking an Appointment for Program. Beneficiaries Health Care Will Obtain an The health care access standards Appointment Within Established SUMMARY: This notice is to advise Access to Health Care Standards interested parties of the Military Health outlined in this notice are set forth in 32 System’s access to health care standards CFR 199.17(p)(5)(i–v). These access In an effort to ensure TRICARE Prime addressed in Title 32, Code of Federal standards remain current and in force beneficiaries obtain an appointment Regulations (32 CFR), Section 199.17 for without any amendment to date. within access to health care standards at Access standards. Preferred provider an MTF, the Military Health System TRICARE Prime beneficiaries under the networks will have attributes of size, implemented a first-call resolution TRICARE Program and how the composition, mix of providers, and policy in calendar year 2015. This Secretary of Defense plans to ensure that geographical distribution so that the policy outlines standard processes to beneficiaries under TRICARE Prime networks, coupled with the MTF ensure TRICARE Prime beneficiaries are who are seeking an appointment for capabilities, can adequately address the not asked to call back to the MTFs if no health care will obtain an appointment health care needs of the enrollees. The appointments are available within the within established access to health care capabilities of the MTF plus preferred established access to health care standards. Access to health care under provider network will meet the standards. The policy also identifies the TRICARE Program for TRICARE following access standards with respect responsibilities of MTF Directors, Prime beneficiaries was established in primary care, specialist care and other to the needs of the expected number of October 1995 and remains current. stakeholders identified in the enrollees: ADDRESSES: Defense Health Agency, (i) Under normal circumstances, appointing process to ensure patient TRICARE Health Plan, 7700 Arlington enrollee travel time may not exceed 30 satisfaction for our beneficiaries. The Boulevard, Suite 5101, Falls Church, minutes from home to primary care policy outlines specific procedures to Virginia 22042–5101. delivery site unless a longer time is correctly transfer calls in accordance FOR FURTHER INFORMATION CONTACT: Ms. necessary because of the absence of with existing access to care standards, Michelle Graves, TRICARE Health Plan, providers (including providers not part referral management protocols and telephone (703) 681–0039. of the network) in the area. proper use of managing clinic schedules SUPPLEMENTARY INFORMATION: (ii) The wait time for an appointment to ensure appointing success the first for a well-patient visit or a specialty time one of our beneficiaries seeks A. Background on Access to Health care referral shall not exceed four access. In addition, a Joint Outpatient Care for TRICARE Prime Beneficiaries weeks; for a routine visit, the wait time Experience Survey will be used to Under the TRICARE Program for an appointment shall not exceed one measure the impact of the first-call Section 704 of the National Defense week; and for an urgent care visit the resolution policy from beneficiaries’ Authorization Act for Fiscal Year 2016 wait time for an appointment shall be perspectives on whether they obtained (NDAA for FY16) requires the Secretary within 24 hours. (The specialty care an appointment within health care of Defense to establish and publicize time standard does not apply in the case access standards. access to care standards for beneficiaries of a follow-up appointment that for For those TRICARE Prime enrolled in TRICARE Prime at military clinical reasons is specifically stated for beneficiaries seeking an appointment treatment facilities (MTFs) or with a later period.) with a TRICARE Prime civilian network civilian network providers. The (iii) Emergency services shall be provider, if the beneficiary cannot be Department has already established available and accessible to handle scheduled for a visit in the MTF or Prime maximum wait times and travel emergencies (and urgent care visits if TRICARE Prime network within the distances for Prime primary and not available from other primary care access to care standards, the beneficiary specialty care appointments as required providers pursuant to paragraph will be authorized an out-of-network by Section 704 of the NDAA for FY (p)(5)(ii) of 32 CFR 199.17), within the provider visit with no point-of-service 2016. service area 24 hours a day, seven days charge. The TRICARE Reimbursement Access to care standards for TRICARE a week. Manual will be revised to reflect the Prime enrollees have been in place since (iv) The network shall include a above statement. In addition, as stated the start of the TRICARE Prime program sufficient number and mix of board in the TRICARE Operations Manual in 1995. TRICARE Prime access certified specialists to meet reasonably (TOM Chapter 1, Section 3, Paragraph standards were published in a Federal the anticipated needs of enrollees. 1.0), ‘‘Contractors are charged with mstockstill on DSK3G9T082PROD with NOTICES Register notice on October 5, 1995 (60 Travel time for specialty care shall not providing or arranging for delivery of FR 52100–52101) and promulgated in exceed one hour under normal quality, timely health care services and 32 CFR 199.17(p)(5)(i–v). These same circumstances, unless a longer time is have the responsibility for providing the standards are also disseminated necessary because of the absence of timely and accurate processing of all throughout the Military Health System providers (including providers not part claims received into their custody, via Assistant Secretary of Defense of the network) in the area. This whether for network or non-network (Health Affairs) Memorandum 11–005, requirement does not apply under the care.’’ VerDate Sep<11>2014 20:02 Jun 21, 2016 Jkt 238001 PO 00000 Frm 00028 Fmt 4703 Sfmt 4703 E:\FR\FM\22JNN1.SGM 22JNN1

Federal Register / Vol. 81, No. 120 / Wednesday, June 22, 2016 / Notices 40681 D. Communications study resulted in the determination that a result of aging infrastructure and The Defense Health Agency will post there was Federal interest in continuing inadequate channel dimensions for the TRICARE Prime access to care to the feasibility phase of the study. modern vessels. Alternatives to be standards on the TRICARE.mil Web site Funding for the feasibility phase of the evaluated in the feasibility phase and execute a strategic communication study was approved in Fiscal Year 2016. include: plan to educate beneficiaries enrolled in Recognizing the hydrologic connectivity • Moving the gates away from the TRICARE Prime about the access to care of the GIWW system, the decision was river; standards. made to conduct the assessment of the • Widening the gates; BRFG and CRL separately and combine • Reconfiguring the guide wall to Dated: June 17, 2016. the results into one integrated feasibility lessen the angle to the GIWW; Aaron Siegel, report. • Straightening the crossing at the Alternate OSD Federal Register Liaison Navigation along the GIWW is Brazos and Colorado Rivers; Officer, Department of Defense. constrained at the confluence with the • Lock modifications (construction of [FR Doc. 2016–14786 Filed 6–21–16; 8:45 am] BRFG and the CRL resulting in the new locks); BILLING CODE 5001–06–P following conditions: • Removal of floodgates; and/or; • Inadequate channel and crossing • Some combination of these and widths for modern vessels; DEPARTMENT OF DEFENSE • Outdated floodgate construction other measures. and width in the floodgate chambers at Meeting. The Galveston District will Department of the Army, Corps of the Brazos River; hold the Initial Public Scoping Meeting Engineers • Outdated lock construction at the for the Feasibility Phase on July 12, Colorado River leading to mechanical 2016 from 6:00–8:00 p.m. at the West Public Notice of Intent for Studies and failure; Columbia Civic Center. The purpose of Initial Scoping Meeting for Gulf • Shutdown of operations during the meeting will be to inform the Intracoastal Waterway Brazos River high water periods presenting a community about the proposed Floodgates and Colorado River Locks significant security concern; navigation modification project, present Feasibility Study • Increased hydrology (river flows how the study will be conducted, solicit due to flood events) impacting public input regarding the initial scope AGENCY: Department of the Army, U.S. navigation traffic; of potential issues/alternatives to be Army Corps of Engineers, DoD. • Increased operations and addressed, and identify those issues/ ACTION: Notice of intent and public alternatives that should be analyzed maintenance costs to prevent marine scoping meeting. further, or eliminated, based on their buildup on mechanical elements of the SUMMARY: This notice provides a structures; significance and effects on the summary of the ongoing feasibility • Increased sedimentation at the environment. The information from the study activities for the Gulf Intracoastal mouth of the rivers; public meeting will be used in the Waterway (GIWW) Brazos River • Shoreline erosion. development of an Environmental Floodgates (BRFG) and Colorado River The Feasibility Study will assess the Impact Statement in compliance with Locks (CRL) Feasibility Study and conditions identified above and develop the National Environmental Policy Act solicit public input regarding the study. specific measures/alternatives that can (NEPA) requirements. This notice serves The objective of the feasibility study is be combined or used as standalone as an invitation for the public to attend. to investigate and recommend solutions actions to address the problems at each The public will be provided an to improve traffic safety and navigation location. opportunity for questions and efficiencies at the confluence of the Study Process. During the feasibility comments. GIWW with the BRFG and CRL. The phase, detailed engineering, hydrology, We are soliciting comments/concerns GIWW BRFG/CRL Feasibility Study will economic analysis, and environmental on the opportunities to improve identify and evaluate possible structural studies are performed. The goal of the navigation along the GIWW at the and navigation alternatives to reduce feasibility phase is to find the most cost- Brazos and Colorado Rivers, the traffic accidents and navigation delays. effective solution that responds to the identification of resources that may The non-Federal sponsor for the project problems identified above while occur within the study area, and other is the Texas Department of protecting the Nation’s environment. social, economic, and environmental Transportation (TXDOT). The final feasibility report documents concerns. the study results and findings, the All interested parties are invited to DATES: The Galveston District will hold selection process of the recommended provide input to this study. Please send the Initial Public Scoping Meeting for alternative, and the costs and benefits of the Feasibility Phase of the study on your comments or questions regarding the recommended plan. The feasibility this notice or mailing list updates to July 12, 2016 from 6:00–8:00 p.m. study ends when the report is submitted USACE SWG, 2000 Ft. Point Rd., ADDRESSES: The meeting will be held at to Congress for authorization. Galveston, TX 77550. Written input can the West Columbia Civic Center, 516 E. Study Status. The Feasibility study also be submitted and is requested by Brazos Ave. (State Highway 35), West will reevaluate the proposed August 11, 2016. If we can provide Columbia, TX 77486. alternatives identified in the 2000 further information, contact the project FOR FURTHER INFORMATION CONTACT: Reconnaissance Study to determine the manager, Ms. Franchelle Craft, by phone Franchelle Craft, (409) 766–3187. feasibility of undertaking modifications mstockstill on DSK3G9T082PROD with NOTICES at (409) 766–3187 or by email at SUPPLEMENTARY INFORMATION: to the Brazos and Colorado river franchelle.e.craft@usace.army.mil. Study Background. In 2000, the crossings, as well as identify changes to Galveston District completed a the floodgate and lock structures at each Eric W. Verwers, reconnaissance study to assess the location that are economically and Director, Regional Planning and feasibility of modifying the environmentally justified. There is a Environmental Center. configurations of the BRFG and CRL to need to reduce navigation impacts and [FR Doc. 2016–14694 Filed 6–21–16; 8:45 am] reduce traffic accidents and delays. The costly waterborne traffic delays that are BILLING CODE 3720–58–P VerDate Sep<11>2014 20:02 Jun 21, 2016 Jkt 238001 PO 00000 Frm 00029 Fmt 4703 Sfmt 9990 E:\FR\FM\22JNN1.SGM 22JNN1


Document Created: 2016-06-22 01:05:33
Document Modified: 2016-06-22 01:05:33
CategoryRegulatory Information
CollectionFederal Register
sudoc ClassAE 2.7:
GS 4.107:
AE 2.106:
PublisherOffice of the Federal Register, National Archives and Records Administration
SectionNotices
ActionNotice of access to health care standards for TRICARE Prime beneficiaries under the TRICARE Program.
ContactMs. Michelle Graves, TRICARE Health Plan, telephone (703) 681-0039.
FR Citation81 FR 40680 
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