Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)

SUMMARY: On December 8, 1995, President Clinton signed Executive Order 12982 which called 3,800 members of the Select Reserve to active duty in support of Operation Joint Endeavor. The immediate nature of this call to active duty, and the potential for a service period of up to 270 days, may result in lack of access or disruption in continuity of required health care services for the affected family members. An extended absence from existing employment may result in the loss of employer-sponsored health insurance, and the immediacy of the call-up leaves little flexibility for alternate arrangements. Additionally, although family members of reservists called to active duty for 31 or more days will become eligible for CHAMPUS, they will face full payment of an annual deductible before CHAMPUS will begin cost sharing medical expenses. In the case of E-4's and below, this amount is $50 per individual, $100 for family; for E-5's and above the amount is $150 per individual and $300 for family. Payment of this out-of-pocket cost may have an adverse impact on some economically vulnerable personnel, especially if they have already paid an annual deductible for their employer sponsored insurance. In previous surveys of reservists activated for Desert Storm, 55% of enlisted members and 45% of officers called to active duty reported a loss in income.

As a matter of general DoD personnel policy, reservists called to active duty for periods of 31 days or more should be treated comparably to regular active duty members. Consistent with this policy, the family members of these reservists called to active duty in support of Operation Joint Endeavor became eligible for CHAMPUS. However, the normal CHAMPUS deductible requirement presents an inequity for these families. Because health program deductibles are premised on coverage for an entire year, a beneficiary who receives coverage for a much shorter period receives unfavorable treatment. It is quite likely that such beneficiaries will be required to meet a second annual deductible under another health plan that will provide coverage during those months of the year in which the reservist returns to his or her civilian job. This demonstration project is designed to test an approach for addressing this special inequity.

The Department's effective response to potential disruption or loss of access to medical care for family members requires careful review of operational and administrative mechanisms which can ease this hardship in the transition from reserve to active duty status. This demonstration is proposed for the purpose of testing whether elimination of the annual deductible normally collected under standard CHAMPUS will avoid unusual out-of-pocket costs, disruption of continuity in care, impaired access and problems with beneficiary satisfaction for activated reservists. The demonstration would waive the CHAMPUS deductible for all reservists called to active duty for Operation Joint Endeavor for periods of 31 days or more and allow CHAMPUS to immediately begin cost-sharing in accordance with standard CHAMPUS rules. The limited nature of this Presidential Selected Reserve call-up for Operation Joint Endeavor reduces the number of activated reservists and family members which will be available in any given geographic area. Therefore, to achieve a level of participation sufficient to test new strategies, this demonstration will occur nationwide. Demonstration participants will include family members of all Selected Reserve members called to active duty for a period of 31 days or more as a result of Executive Order 12982 of December 8, 1995. Under Title 10, U.S. Code, Section 1092, the Department is authorized to test different methods of financing delivery of health care services under CHAMPUS.

DATES: Effective December 8, 1995, family members of selected reserve members called to active duty for 31 days or more as a result of Executive Order 12982, December 8, 1995, and who, as a result of that Executive Order become eligible for services under CHAMPUS, may obtain those services without paying deductibles normally required under standard CHAMPUS. CHAMPUS eligible beneficiaries other than family members of reservists called to active duty for Operation Joint Endeavor are not eligible for participation. In view of the immediacy of the deployment, we are waiving the normal thirty-day advance notice for beginning a CHAMPUS demonstration project.

FOR FURTHER INFORMATION CONTACT:

CAPT Deborah Kamin, Office of the Assistant Secretary of Defense (Health Affairs), (703)-697-8975.

SUPPLEMENTARY INFORMATION: The Office of the Assistant Secretary of Defense (Health Affairs) will act as executive agent for purposes of this demonstration and will assume overall responsibility for demonstration policy, implementation, and monitoring.

DURATION: This demonstration will operate for one year unless extended by separate action. Continuation of the program will depend on a program evaluation conducted following termination of the project. It is our hypothesis that elimination of normally imposed CHAMPUS deductibles for this special group of beneficiaries will ease potential financial hardship caused by unexpected increases in out-of-pocket health care costs, avoid disruption of continuity and access to care, and minimize beneficiary dissatisfaction in transition from reserve to active status. This support is an important element in the welfare of servicemembers and their families who are called to a significant and immediate change in life circumstances. Information and experience gained as part of this demonstration will provide the foundation for longer term solutions in the event of future reserve activation.

EXCLUSIONS TO THE DEMONSTRATION PROJECT: Participation in this demonstration is limited to active duty family members who become eligible for CHAMPUS as a result of selected reserve activation in support of Operation Joint Endeavor. This demonstration is limited to the annual CHAMPUS deductible; other CHAMPUS cost sharing continues to apply. All current CHAMPUS rules, unless this notice specifically provides otherwise, will continue to apply. The changes under this demonstration will have an effective date of December 8, 1995.

Dated: February 1, 1996.

L.M. Bynum,

Alternate OSD Federal Register Liaison Officer, Department of Defense.

BILLING CODE 5000-04-M