2.1.1 The Operation
Desert Shield/Desert Storm Supplemental Appropriations Act of 1991, Public
Law 102-28, April 10, 1991, allowed medical providers to voluntarily
waive the patient cost-share and/or deductible for medical services
provided family members of active duty personnel from August 2,
1990, until the date the “Persian Gulf conflict” ends as prescribed
by Presidential proclamation or by law.
2.1.1.1 Operation
Desert Storm. Operations of the United States (U.S.) Armed Forces
conducted as a consequence of the invasion of Kuwait by Iraq (including
operations known as Operation Desert Shield and Operation Desert
Storm).
2.1.1.2 Persian Gulf Conflict. The period beginning
on August 2, 1990, and ending thereafter on the date prescribed
by Presidential proclamation or by law.
2.1.1.3 A Civilian
Health Care (CHC) provider may voluntarily waive, in whole or in
part, the cost-share and/or deductible of Active Duty Family Members
(ADFMs) if the provider certifies in writing that the amount charged
the federal Government for such health care was not increased above
the amount that the health care provider would have charged the
federal Government for such health care had the payment not been
waived.
2.1.1.3.1 The legislation
only provides a temporary exemption to the cost-sharing provisions. Once
the President officially proclaims an end to the “Persian Gulf conflict”,
the cost-sharing provision will be reinstated.
2.1.1.3.2 The legislation
does not require modification of the existing claims processing guidelines.
The contractors shall process the claims normally, reflecting the
appropriate deductible, cost-share, and catastrophic cap on the
claims history, payment records, TRICARE Explanation of Benefits
(EOB), etc. The waiver of cost-sharing is between the ADFM and the
provider and does not affect the contractor’s claims processing
procedures, except as prescribed in the Program Integrity provisions
in the TRICARE Operations Manual (TOM),
Chapter 13.
2.1.1.3.3 The waiver
of cost-sharing is based on the dates of care/service.
2.1.1.3.4 The waiver
applies to both the Basic Program and the Extended Care Health Option (ECHO)
and is applicable to both inpatient and outpatient care.
2.1.1.3.5 The waiver
of cost-sharing only applies to family members of active duty personnel. The
other categories of TRICARE beneficiaries are still subject to the
cost-sharing and deductible requirements set forth in 10 United
States Code (USC) 1079 and 1086.