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.