TRICARE; Revision of Participating Providers Reimbursement Rate; TRICARE Dental Program (TDP), 1695-1696 [06-219]

Agencies

• Office of the Secretary
• DEPARTMENT OF DEFENSE

[Federal Register Volume 71, Number 7 (Wednesday, January 11, 2006)]
[Rules and Regulations]
[Pages 1695-1696]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 06-219]


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DEPARTMENT OF DEFENSE

Office of the Secretary

32 CFR Part 199

[DOD-2006-OS-002]
RIN 0720-AA92


TRICARE; Revision of Participating Providers Reimbursement Rate; 
TRICARE Dental Program (TDP)

AGENCY: Department of Defense.

ACTION: Final rule.

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SUMMARY: The Department is publishing this final rule to revise the 
requirements and procedures for the reimbursement of TRICARE Dental 
program participating providers. Participating providers will no longer 
be reimbursed at the equivalent of a percentile of prevailing charges 
sufficiently above the 50th percentile of prevailing charges made for 
similar services in the same locality (region) or state, or the 
provider's actual charge, whichever is lower, less any cost-share 
amount due for authorized services. Specifically, the revision will 
require TRICARE Dental Program participating providers to be reimbursed 
in accordance with the contractor's network agreements, less any cost-
share amount due for authorized services.

EFFECTIVE DATE: January 11, 2006.

FOR FURTHER INFORMATION CONTACT: Col. Gary C. Martin, Office of the 
Assistant Secretary of Defense (Health Affairs)/TRICARE Management 
Activity, telephone (703) 681-0039.

SUPPLEMENTARY INFORMATION:

I. Overview of the Rule

    This final rule revises the provision found in 32 CFR 199.13 that 
requires the TRICARE Dental Program contractor to reimburse 
participating providers at the equivalent of a percentile of prevailing 
charges sufficiently above the 50th percentile of prevailing charges 
made for similar services in the same locality (region) or state, or 
the provider's actual charge, whichever is lower, less any cost-share 
amount due for authorized services. This provision was included in the 
regulation to constitute a significant financial incentive for 
participation of providers in the contractor's network and to ensure a 
network of quality providers through use of a higher reimbursement 
rate. This provision, however, places an unnecessary restriction on 
contractors that already have established, high quality provider 
networks with reimbursement rates below the 50th percentile that are of 
sufficient size to meet the access requirements of the TRICARE Dental 
Program. The reimbursement rates that have been negotiated over the 
life of the dental contract represent the general market rates for 
dental insurance reimbursement, and the final rule brings DoD 
reimbursement rates into line with the broader insurance market. 
Elimination of the 50th percentile requirement affords the Government 
and enrollees significant cost savings through lower provider 
reimbursement costs by the contractor. Additionally, contractors have 
other methods available to ensure the TDP members receive high quality 
dental services. These quality assurance methods include, but are not 
limited to, licensing and credentialing standards, patient satisfaction 
assessments, and provider trend analyses.

II. Review of Comments

    The proposed rule was published in the Federal Register on August 
31, 2005

[[Page 1696]]

(70 FR 51692). We received no public comments.

III. Regulatory Procedures

    Executive Order 12866 directs agencies to assess costs and benefits 
of available regulatory alternatives and, when regulation is necessary, 
to select regulatory approaches that maximize net benefits (including 
potential economic, environmental, public health and safety, and other 
advantages; distributive impacts; and equity). Executive Order 12866 
classifies a rule as significant if it meets any one of a number of 
specified conditions, including: Having an annual effect on the economy 
$100 million or more, adversely affecting a sector of the economy in a 
material way, adversely affecting competition, or adversely affecting 
jobs. A regulation is also considered a significant action if it raises 
novel legal or policy issues.
    DoD concludes that this final rule is a significant regulatory 
action under the Executive Order since it raises novel policy issues 
under section 3(f)(4). DoD concludes, however, that this final rule 
does not meet the significance threshold of $100 million effect on the 
economy in any one year under section 3(f)(1).
    The Congressional Review Act establishes certain procedures for 
major rules, defined as those with similar major impacts. The 
Regulatory Flexibility Act (RFA) requires that each Federal agency 
prepare, and make available for public comment, a regulatory 
flexibility analysis when the agency issues a regulation that would 
have significant impact on a substantial number of small entities.
    This is a not a major rule under 5 U.S.C. 801. It is a significant 
regulatory action but not economically significant. This rule has been 
designated as significant and has been reviewed by the Office of 
Management and Budget as required under the provisions of E.O. 12866.

Paperwork Reduction Act

    This final rule contains a new information collection requirement 
that has been submitted to and approved by the Office of Management and 
Budget. This information collection has been assigned OMB Control 
0720-0035.

List of Subjects in 32 CFR Part 199

    Claims, Dental health, Health care, Health insurance, Individuals 
with disabilities, Military personnel.


0
For the reasons set out in the preamble, 32 CFR part 199 is amended as 
follows.

PART 199--[AMENDED]

0
1. The authority citation for part 199 continues to read as follows:

    Authority: 5 U.S.C. 301; 10 U.S.C. chapter 55.


0
2. Section 199.13(g)(2)(ii) is revised to read as follows:


Sec.  199.13  TRICARE Dental Program.

* * * * *
    (g) * * *
    (2) * * *
    (ii) Participating providers shall be reimbursed in accordance with 
the contractor's network agreements, less any cost-share amount due for 
authorized services.
* * * * *

    Dated: January 5, 2006.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 06-219 Filed 1-10-06; 8:45 am]
BILLING CODE 5001-06-M