(5) Rotation of general duty dental officers among different sections of dental services, or other means for increasing their experience and knowledge in all aspects of dentistry.

(6) Improvement in the qualifications of auxiliary personnel through planned and supervised on-the-job training and attendance at appropriate school courses.

§ 577.41 For whom authorized. Dental care is authorized for the same persons and under the same conditions as medical care (§§ 577.1, 577.2, 577.5 and 577.15), except as provided in § 577.40 to 577.42.

§ 577.42 Dental care by civilian dentists-(a) For whom authorized. Subject to the conditions and limitations specified herein, dental care by civilian dentists at the expense of Army Medical Service funds is authorized for the following personnel and none other when the required care cannot be procured from available dental facilities of the Department of Defense or other Federal agencies outside the Department of Defense: Provided, That this authorization will not apply to personnel who obtain elective dentistry from civilian dentists:

(1) Officers, warrant officers, and enlisted personnel of the Regular Army and cadets of the United States Military Academy when on a duty status or when absent on any authorized leave or pass. Charges incurred for civilian dental care when absent without leave are the sole responsibility of the individual concerned.

(2) Officers, warrant officers, and enlisted personnel of the Army Reserve; the federally recognized National Guard of the several States, Territories, and the District of Columbia; the National Guard of the United States; and the Army without specification as to component when ordered or called into active Federal service, when ordered to active duty for training, or while performing reserve duty training.

(3) Members of the Reserve Officers' Training Corps en route to, or from, or during their attendance at camps of instruction under section 47a, National Defense Act.

(4) Applicants for enlistment or reenlistment and registrants under the Universal Military Training and Service

Act (62 Stat. 604) as amended (50 U. S. C. App. 451 et seq.) (limited to necessary dental examination except as provided in subparagraphs (5) and (6) of this paragraph).

(5) Applicants for enlistment or registrants whose physical fitness for military service cannot be determined without hospital study.

(6) Applicants for enlistment who suffer acute illnesses and injuries while awaiting or undergoing enlistment processing at recruiting main stations or at Armed Forces Examining Stations (limited to emergency dental care, including hospitalization).

(7) Prisoners.

(8) Prisoners of war, persons interned by the Army, and other persons in military custody or confinement.

(9) Civilian seamen in the service of vessels operated by the Department of the Army.

(b) Emergency dental care. Prior approval of higher authority is not required for the employment of a civilian dentist for emergency dental treatment, which is defined as dental treatment for the relief of pain, or acute conditions, or of dental injuries caused by direct violence. Such care will be confined to the relief of the immediate emergency.

(c) Routine dental care. Routine dental care will include all preventive, therapeutic, restorative and oral surgical measures, other than those of an emergency nature which are necessary to maintain dental health and function, but will not include those measures required primarily for cosmetic reasons or for correction of minor nonprogressive defects. Civilian dentists may not be employed at public expense for the treatment of chronic lesions, filling operations, prosthetic replacements, and other prolonged or extensive procedures, such as those required following the relief of an immediate emergency, until specific approval for such employment has been received from the approving authority: Provided, That in the case of military personnel on detail without troops in foreign countries, dental service of this character which is urgently necessary may be procured at reasonable rates without prior approval of higher authority.

DEPENDENTS' MEDICAL CARE [ADDED] AUTHORITY: §§ 577.60 to 577.70 issued under sec. 3012, 70A Stat. 157; 10 U. S. C. 3012. Interpret or apply secs. 101-303, 70 Stat. 250254; 37 U. S. C. 401-423.

SOURCE: 577.60 to 577.70 appear at 21 F. R. 9969, Dec. 14, 1956, except as otherwise noted.

§ 577.60 Purpose and scope. Sections 577.60-577.70 promulgate the medical service policies and procedures for administering the medical and dental care program for dependents of members and retired members of the uniformed services and dependents of persons who died while a member or retired member of the uniformed services under the Dependents' Medical Care Act and is applicable to the uniformed services. They are to be used in conjunction with §§ 577.80577.93.

§ 577.61 References—(a) The Dependents' Medical Care Act. See Public Law 569, 84th Congress (70 Stat. 250).

(b) Fiscal policies; dependents' medical care. See §§ 577.80-577.93.

§ 577.62 Definition of terms used in §§ 577.60-577.70. (a) "Uniformed services" means the Army, the Navy, the Air Force, the Marine Corps, the Coast Guard, the Commissioned Corps of the Coast and Geodetic Survey, and the Commissioned Corps of the Public Health Service.

(b) "Member of a uniformed service" means a person appointed, enlisted, inducted, called, or ordered, or conscripted in a uniformed service who is serving on active duty or active duty training pursuant to call or order that does not specify a period of 30 days or less.

(c) "Retired member of a uniformed service" means a member or former member of a uniformed service who is entitled to retired, retirement, or retainer or equivalent pay as a result of service in a uniformed service, other than a member or former member entitled to retired or retirement pay under Title 10, United States Code, sections 1331-1337 (formerly Title III of the Army and Air Force Vitalization and Retirement Equalization Act of 1948) who has served less than 8 years on full-time duty in the active military service, other than active duty for training.

(d) "Dependent" means any person who bears to a member or retired mem

ber of a uniformed service, or to a person who died while a member or retired member of a uniformed service, any of the following relationships:

(1) The lawful wife;

(2) The unremarried widow;;

(3) The lawful husband, if he is in fact dependent on the member or retired member for over one-half of his support;

(4) The unremarried widower, if he was in fact dependent upon the member or retired member at the time of her death for over one-half of his support because of a mental or physical incapacity;

(5) An unmarried legitimate child (including an adopted child or stepchild), if such child has not passed his 21st birthday;

(6) A parent or parent-in-law, if the said parent or parent-in-law is, or was at the time of the member's or retired member's death, in fact dependent on the said member or retired member for over one-half of his support and is or was at the time of the member's or retired member's death, actually residing in the household of the said member or retired member. For the purposes of 8577.60-577.70, the requirement of actually residing in the household shall be fulfilled when the parent or parentin-law actually resides, or was residing at the time of death of a member or retired member, in a dwelling place provided or maintained by said member or retired member; or

[Subparagraph (6) amended, 22 F. R. 7074, Sept. 4, 1957]

(7) An unmarried legitimate child (including an adopted child or stepchild) who:

(i) Has passed his 21st birthday, if the child is incapable of self-support because of a mental or physical incapacity that existed prior to his reaching the age of 21 and is, or was at the time of the member's or retired member's death, in fact dependent on him for over one-half of his support, or

(ii) Has not passed his 23d birthday and is enrolled in a full-time course of study in an institution of higher learning as approved by the Secretary of Defense or Secretary of Health, Education, and Welfare, and is, or was at the time of the member's or retired member's death, in fact dependent on him for

over one-half of his support. The institutions which are approved as accredited are those currently listed by the regional accrediting associations or national professional associations by the U. S. Office of Education, Department of Health, Education, and Welfare. The current reference list is "Education Directory 1955-56, Part 3, Higher Education," for sale at a cost of $0.50 per copy, by the Superintendent of Documents, U. S. Government Printing Office, Washington 25, D. C. For determination as to accreditation of a foreign institution of higher learning, a statement may be obtained by the member from the Office of Education, Department of Health, Education, and Welfare, Washington 25, D. C.

(e) "Dependents eligible for civilian medical care" means the lawful wife or the dependent lawful husband (spouses) and children who are dependents of members of the uniformed services, hereinafter referred to as "spouses and children."

(f) "Secretary of a uniformed service" means the Secretary of the Army, Navy (for the Navy and Marine Corps), or Air Force, or for the other uniformed services (Coast Guard, Public Health Service, Coast and Geodetic Survey), the Secretary of Health, Education, and Welfare.

(g) "Continental United States" means the 48 States and the District of Columbia.

(h) "Executive agent" means the Secretary of the Army who acts for the uniformed services in negotiating and administering contracts for medical (physicians) and hospital services under the policy guidance of the Department of Defense within the continental United States, Alaska, Hawaii, and Puerto Rico.

(i) "Contractor" means the legal entity with which the Government enters into a contract for the purpose of implementing the Dependents' Medical Care Act, such as a State society, an insurance company, Blue Shield, or Blue Cross.

(j) "Local schedule of allowances" means the professional fee schedule for payment of physicians' services applicable to a local area. In the continental United States, Alaska, Hawaii, and Puerto Rico, the schedule of allowances is that schedule negotiated with the physicians' representatives and approved by the executive agent for the Department of Defense and the Department of

Health, Education, and Welfare. Where such a schedule of allowances has not been negotiated and approved, the executive agent may provide a schedule of allowances for use in payment for physicians' services. Where the term "local schedule of allowances" is utilized in §§ 577.60-577.70, and no schedule is in existence, particularly in oversea areas, the standard charge for service rendered by physicians in the locality concerned will be used as a guide in lieu of such schedule.

(k) Miscellaneous medical and technical terminology: (1) "Diagnosis" means a determination of the existence and nature, or absence, of disease or injury by history with physical and mental findings, including physical examinations and the utilization of medically accepted diagnostic procedures, e. g., laboratory tests and pathology and radiological examinations.

(2) "Outpatient care" means the medical services which are normally performed in the home, a physician's office, or the outpatient department of a hospital, clinic, or dispensary.

(3) "Maternity and infant care" means the medical and surgical care for the mother incident to pregnancy, including prenatal care, delivery, postnatal care, care of the infant, and treatment of complications of pregnancy. [Subparagraph (3) amended, 23 F. R. 8120, Oct. 22, 1958]

(4) "Domiciliary care" means the care which is normally given in a nursing home, convalescent home, or similiar institution to a patient who requires personal care rather than active and definitive treatment in a hospital for an acute medical or surgical condition. It includes but is not limited to nursing care required as a result of old age or chronic disease.

(5) "Elective medical and surgical treatment" means the medical or surgical care that is desired or requested by the patient which, in the opinion of cognizant medical authority, is not medically indicated, e. g., surgery solely for cosmetic purposes.

(6) "Chronic disease" shall be construed to include nonacute conditions and disabilities in which the prognosis indicates long continued duration of the ailment. This term shall include but is not necessarily limited to arthritis, de

generative diseases of the cardiovascular system, residuals of poliomyelitis and other degenerative diseases of the nervous system, severe injuries to the nervous system including quadriplegia, hemiplegia, and paraplegia, and blindness or deafness requiring definitive rehabilitation. This shall not preclude admission for the treatment of acute exacerbations or complications of such chronic diseases wherein active and definitive medical or surgical treatment is required, such as tendon transplant in cases of disability residuals of poliomyelitis, diabetic acidosis, or cardiac decompensation in chronic rheumatic fever.

(7) "Nervous and mental disorders" means those conditions classified as neuroses, psychoneuroses, psychopathies, or psychoses.

(8) "Dental care as a necessary adjunct to medical or surgical treatment" means that dental care which is determined by the cognizant physician and dentist to be required for the proper treatment of a medical or surgical condition. This term includes but is not limited to treatment of fractures of the jaw and the application of appliances necessary to reduce and immobilize such fractures.

§ 577.63 Administration. (a) The Secretary of Defense has jurisdiction over the Army, Navy, Air Force, Marine Corps, and the Coast Guard when operating as a service with the Navy.

(b) The Secretary of Health, Education, and Welfare has jurisdiction over the Public Health Service and for medical care purposes over the Coast and Geodetic Survey, and the Coast Guard when not in service with the Navy.

577.64 Determination of dependents' eligibility. (a) The uniformed services will require dependents (or their sponsors) who request identification for medical care to furnish proof of their eligibility for such care.

(b) Each uniformed service will, by separate directive, prescribe and utilize the following forms as soon as practicable with full implementation to be completed by December 31, 1957:

(1) DD Form 1171 (Application for Dependents Authorization for Medical Care Card by Active Duty or Retired Member).

(2) DD Form 1172 (Application for Dependents Authorization for Medical Care Card (By Survivor of Deceased Member of Uniformed Services or Agent Acting on Their Behalf)).

(3) DD Form 1173 (Uniformed Services Identification and Privilege Card).

CODIFICATION: In paragraph (b) the introductory text and subparagraph (3) were amended to read as set forth above, respectively, 22 F. R. 7074, Sept. 4, 1957.

§ 577.65 Identification for admission to medical treatment facilities. Eligible dependents requesting care at either uniformed services medical facilities or in civilian medical facilities shall be required to show satisfactory identification to the cognizant medical authority or his designee.

(a) Prior to January 1, 1958, any of the following means of identification is acceptable for this purpose:

(1) Dependent's Identification Card (DD Form 720).

(2) Privilege Identification Card (DA Form 999).

(3) Dependent's Identification Card for Medical Care (Nav Pers Form 1343).

(4) Application to U. S. Public Health Service for Treatment of Coast and Geodetic Survey Dependents (CGS Form 832).

(5) Application to U. S. Public Health Service for Treatment of Coast Guard Personnel (Form CG-2533 or CG-2534).

(6) "Uniformed Services Identification and Privilege Card" (DD Form 1173).

(b) On or after January 1, 1958, the "Uniformed Services Identification and Privilege Card" (DD Form 1173) will be primary means of identification.

(c) In circumstances when none of the above means of identification is available, civilian medical facilities may accept execution of DA Form 1863 (Statement of Services Provided by Civilian Medical Sources) and uniformed services medical facilities may accept a statement obtained from the dependent, parent, sponsor, or guardian.

(d) Uniformed services medical facilities may prescribe such additional local verification procedures as are deemed necessary; however, the procedure employed shall not complicate, delay, or preclude the treatment of an eligible

dependent nor discriminate against the dependents of members or retired members of other uniformed services.

CODIFICATION: § 577.65 was amended as follows, 22 F. R. 7074, Sept. 4, 1957:

1. In paragraph (a) the introductory text thereof and subparagraph (6) were amended to read as set forth above, respectively.

2. Paragraph (b) was amended to read as set forth above.

§ 577.66 Determination of sources from which eligible dependents receive medical care-(a) Among uniformed services facilities. Normally, a dependent requesting care at a uniformed service medical facility will be expected to use the facilities servicing the area in which the dependent resides. Exception to this policy may be authorized, subject to local regulations, to permit utilization by the dependent of the facilities of the sponsor's own service. In areas where medical facilities of two or more of the uniformed services are available, the appropriate officials of each service, with due consideration for the relative size and capacities of the facilities, shall jointly prescribe areas of medical responsibility. Delineation of such areas shall include a zone in which dependents are permitted to use either the facility of the sponsor's own service or the facility which has medical responsibility for the area in which the dependent resides.

(b) Between civilian medical facilities and uniformed services medical facilities. Spouses and children, as defined in § 577.62 (e), are the only dependents authorized care in civilian medical facilities at Government expense.

(1) Within the continental United States, Alaska, Hawaii, and Puerto Rico. (i) Spouses and children who are not residing with their sponsors shall have free choice between uniformed services medical facilities and civilian medical facilities.

(ii) Outpatient medical care at Government expense for spouses and children is not authorized from civilian sources except that certain specified treatment for such dependents who are not hospitalized will be authorized in accordance with § 577.69 (d) (4) (i) (c) or (ii).

(iii) On and after October 1, 1958, spouses and children residing with their sponsors may obtain authorized medical care at Government expense from civilian sources only after it has been deter

mined that such care cannot be provided by a uniformed services medical facility located within reasonable distance of the patient's residence, except in emergencies and under other circumstances listed in this section. For purposes of §§ 577.60 to 577.70, the term "spouses and children residing with their sponsor" includes those who reside in an area to which their sponsor is assigned; e. g., those who reside in the household of the sponsor in the area of his permanent duty station, or the home port or home yard of a ship, even though the sponsor may be temporarily away, by reason of temporary duty with his unit or ship, from the permanent duty station or home port or home yard, respectively, or by reason of the sponsor's absence on individual temporary duty or temporary additional duty orders. Therefore, the claim form, DA Form 1863, covering a dependent residing in an area to which the sponsor is assigned should be filled in to show that the dependent is residing with the sponsor.

(iv) Spouses and children who are residing with their sponsors and who are receiving medical care from civilian sources on October 1, 1958 may complete that care without obtaining a Medicare Permit (DD Form 1251) (paragraph (c) of this section). Examples are set forth in (a), (b), and (c) of this subdivision. Additionally, any eligible dependent, either living with or apart from sponsor, who has commenced receiving care authorized from civilian sources prior to October 1, 1958 may complete that care even though that care may have been deleted from the categories of "authorized care" effective October 1, 1958. Examples are set forth in (d), (e), and (ƒ) of this subdivision.

(a) Patients in civilian hospitals will be permitted to complete their current period of hospitalization.

(b) Maternity patients whose expected date of delivery is within the 26-week period following October 1, 1958, and who are under the care of a civilian physician on that date, will be permitted to continue care under that physician, including delivery and postpartum care. However, if for reason of change of station, or other reasons, a change of physicians is made, maternity patients will be required to clear with appropriate uniformed services authorities for determination of whether care will be made available in a medical facility of the uni