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.