PART 108—HEALTH CARE ELIGIBILITY UNDER THE SECRETARIAL DESIGNEE PROGRAM AND RELATED SPECIAL AUTHORITIES Authority: 10 U.S.C. 1074(c); 10 U.S.C. 2559. Source: 75 FR 72682, Nov. 26, 2010, unless otherwise noted. § 108.1 Purpose. This part: (a) Establishes policy and assigns responsibilities under 10 U.S.C. 1074(c) for health care eligibility under the Secretarial Designee Program. (b) Implements the requirement of 10 U.S.C. 2559 that the United States receive reimbursement for inpatient health care provided in the United States to foreign military or diplomatic personnel or their dependents, except in certain cases covered by Reciprocal Health Care Agreements (RHCAs) between the Department of Defense and a foreign country. § 108.2 Applicability. This part: (a) Applies to the Office of the Secretary of Defense, the Military Departments, the Office of the Chairman of the Joint Chiefs of Staff and the Joint Staff, the Combatant Commands, the Office of the Inspector General of the Department of Defense, the Defense Agencies, the DoD Field Activities, and all other organizational entities in the Department of Defense (hereafter referred to collectively as the “DoD Components”). (b) Does not apply to health care services provided to coalition forces in operational settings, or to allied forces in overseas training exercises and similar activities. Also, does not apply to health care services provided to foreign nationals overseas under DoD Instruction 3000.05, 1 2 3 1 http://www.dtic.mil/whs/directives/corres/pdf/300005p.pdf. 2 http://www.dtic.mil/whs/directives/corres/pdf/220502p.pdf. 3 http://www.dtic.mil/whs/directives/corres/pdf/231008p.pdf. § 108.3 Definition. Secretarial Designee Program. § 108.4 Policy. It is DoD policy that: (a) General Policy. (b) Foreign Military Personnel and Their Dependents. MTF Care in the United States. 4 4 http://www.dtic.mil/whs/directives/corres/pdf/100013p.pdf. (2) Non-MTF Care in the United States. (c) Foreign Diplomatic or Other Senior Foreign Officials. (1) In the United States, the approval authority is the USD(P&R). The authority to waive reimbursement for care provided in the United States, to the extent allowed by law, is the USD(P&R) or the Secretaries of the Military Departments when they are the approving authority. (2) Requests from the State Department or other agency of the U.S. Government will be considered on a reimbursable basis. (3) Under 10 U.S.C. 2559, reimbursement to the United States for care provided in the United States on an inpatient basis to foreign diplomatic personnel or their dependents is required. (d) Other Foreign Nationals. (1) The authority to waive reimbursement for care provided in the United States, to the extent allowed by law, is the USD(P&R) or the Secretaries of the Military Departments when they are the approving authority. Waiver requests will only be considered based on a direct and compelling relationship to a priority DoD mission objective. (2) Requests from the State Department or other agency of the U.S. Government will be considered on a reimbursable basis. Such requests must be supported by the U.S. Ambassador to the country involved and the Geographical Combatant Commander for that area of responsibility and must be premised on critically important interests of the United States. (e) Invited Persons Accompanying the Overseas Force. (1) In the case of employees or affiliates of news organizations, all care provided under the authority of introductory paragraph (e) of this section is reimbursable. For other individuals designated as eligible under this paragraph (e), the designation may provide, to the extent allowed by law, for outpatient care on a non-reimbursable basis, and establish a case-by-case authority for waiver of reimbursement for inpatient care. (2) This paragraph (e) does not apply to employees of the Executive Branch of the United States or personnel affiliated with contractors of the United States. (f) U.S. Nationals Overseas. (g) U.S. Government Civilian Employees and Contractor Personnel. (2) Occupational health care services provided to DoD employees under 5 U.S.C. 7901, authorities cited in DoD Instruction 6055.1, 5 5 http://www.dtic.mil/whs/directives/corres/pdf/605501p.pdf. (3) Any health care services provided by the Military Health System to employees of DoD non-appropriated fund instrumentalities shall be on a reimbursable basis. (4) In the case of DoD civilian employees forward deployed in support of U.S. military personnel engaged in hostilities, eligibility for MTF care (in addition to all eligibility for programs administered by the Department of Labor Office of Workers' Compensation Programs (OWCP)) is as follows: (i) Consistent with Policy Guidance for Provision of Medical Care to DoD Civilian Employees Injured or Wounded While Forward Deployed in Support of Hostilities, 6 6 (ii) DoD civilian employees who, subsequent to such deployment, and have been determined to have OWCP-compensable conditions are eligible for MTF care for such conditions, all on a non-reimbursable basis. (iii) USD(P&R) may, under compelling circumstances, approve additional eligibility for care in MTFs for other U.S. Government civilian employees who become ill or injured while so deployed, or other DoD civilian employees overseas. (5) Contractor Personnel Authorized to Accompany U.S. Armed Forces. 7 7 http://www.dtic.mil/whs/directives/corres/pdf/302041p.pdf. (h) Emergency Health Care. (i) Research Subject Volunteers. 8 8 http://www.dtic.mil/whs/directives/corres/pdf/321602p.pdf. (j) Continuity of Care Extensions of Eligibility. (k) Members of the Armed Forces. (l) Certain Senior Officials of the U.S. Government. (m) Nonmedical Attendants. (n) Patient Movement. 9 9 http://www.dtic.mil/whs/directives/corres/pdf/600011p.pdf. (o) Other Individuals Entitled to DoD Identification (ID) Card. (p) Reciprocity Among Military Departments. § 108.5 Eligible senior officials of the U.S. government. (a) The following individuals are Secretarial Designees for space-available care in MTFs on a reimbursable basis, unless specified otherwise by a Service Secretary: (1) The President and Vice President, and their spouses and minor children. (2) Members of Congress. (3) Members of the Cabinet. (4) Officials of the Department of Defense appointed by the President and confirmed by the Senate. (5) Article III Federal Judges. (Article III courts are: The Supreme Court of the United States, U.S. Courts of Appeal, U.S. District Courts, U.S. Court of International Trade, United States Foreign Intelligence Surveillance Court, United States Foreign Intelligence Surveillance Court of Review.) (6) Judges of the U.S. Court of Appeals for the Armed Forces. (7) Assistants to the President. (8) Director of the White House Military Office. (9) Former Presidents of the United States and their spouses, widows, and minor children. (b) [Reserved] § 108.6 Responsibilities. (a) The USD(P&R) shall: (1) Evaluate requests for and where appropriate, grant exceptions to policy established by this part and DoD Directive 5124.02, 10 10 http://www.dtic.mil/whs/directives/corres/pdf/512402p.pdf. (2) Following approval of the USD(P) and in coordination with USD(P) and the GC, DoD, and in accordance with DoD Directive 5530.3, 11 11 http://www.dtic.mil/whs/directives/corres/pdf/553003p.pdf. (b) The USD(P) shall evaluate requests and determine DoD mission interest for Secretarial Designee Status and RHCAs to identify those agreements that would be in the best interest of the Department of Defense and approve negotiations of RHCAs by the USD(P&R). (c) The USD(C) shall in coordination with USD(P&R), establish appropriate reimbursement rates, including appropriate interagency rates and rates applicable to students in International Military Education and Training programs. (d) The Under Secretary of Defense for Acquisition, Technology, and Logistics shall evaluate requests for Exception to the Transportation Policy. The authority to grant such an exception is by USD(P&R) or the Secretary of the Military Department concerned. (e) The Secretaries of the Military Departments shall: (1) Issue, revise or modify as appropriate, regulations to comply with this part. (2) Appoint a Military Department representative who will administer the Secretarial Designee Program within the Military Department and coordinate with other DoD Components in its effective operation. (3) Where and when appropriate, the Military Department concerned shall coordinate with U.S. Transportation Command/Global Patient Movement Requirements Center. (4) Identify Secretarial Designees treated at MTFs. (5) Provide an annual consolidated list reflecting the number of Secretarial Designees within their departments, reasons for such designation, location where designee is receiving treatment, the costs and sources of funding, nature and duration of treatment and expiration date of designee status to USD(P&R) and USD(C). The annual report is due 30 days after the start of the fiscal year reflecting the prior fiscal year's information. (i) In cases where the USD(P&R) designates an individual as a Secretarial Designee, the Military Department concerned shall include this individual on any lists provided to USD(P&R) and USD(C) for reporting purposes. (ii) Annually consolidate Secretarial Designee patient costs and forward those data to USD(P&R) and OSD(C), along with a report of collection for reimbursable costs. (f) The Commanders of the Geographic Combatant Commands (GCCs) shall: (1) Refer requests to waive reimbursement through the Chairman of the Joint Chiefs of Staff to the USD(P&R). (2) Refer requests for Secretarial Designee status for medical care in the United States through the Chairman of the Joint Chiefs of Staff to USD(P&R). (3) Through the Chairman of the Joint Chiefs of Staff, provide written annual reports to the USD(P&R) and USD(C) reflecting the number of individuals designated as Secretarial Designees within their geographic area of responsibility, the reasons for such designation, the expected duration of such designation, the costs and sources of funding authorizing the support of such designee status for each designee. (4) Identify Secretarial Designees treated at MTFs within their geographic area of responsibility. (5) Provide for an accounting and collection system for reimbursement of medical costs within their geographic area of responsibility. (g) The Commander, United States Transportation Command shall: (1) Coordinate patient movement with all concerned Military Departments. (2) Upon request of the Military Department concerned or Commanders of the GCCs, determine availability of DoD transportation assets, or when cost effective, coordinate with civilian ambulance authorities, to effect transportation of Secretarial Designee as appropriate. (3) Ensure the Global Patient Movement Requirements Center, as the regulating agency, will consistently serve as the single point of contact for patient movement for Secretarial Designee patients using DoD assets upon request. (4) Annually consolidate Secretarial Designee patient listing who utilized the DoD patient movement system and forward to USD(P&R) and USD(C).