Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); Individual Case Management

This final rule implements provisions of the 1993 National Defense Authorization Act which allows the Secretary of Defense to establish a case management program for CHAMPUS beneficiaries with extraordinary medical or psychological disorders and to allow such beneficiaries medical or psychological services, supplies, or durable medical equipment excluded by law or regulation as a TRICARE/CHAMPUS benefit. Under this program, waiver of benefit limits or exclusions to the basic TRICARE/CHAMPUS program may be authorized for beneficiaries when the provision of such services or supplies is cost effective and clinically appropriate, as compared to historical or projected TRICARE/ CHAMPUS utilization of health care services. Such waivers will also provide families in crisis time for transition to other sources of support when TRICARE/CHAMPUS benefits have been exhausted. This case management program is designed to provide a cost-effective plan of care by targeting appropriate resources to meet the individual needs of the beneficiary.