TRICARE; TRICARE Retiree Dental Program (TRDP) Basic Benefit Descriptions and Administrative Corrections, 68496-68498 [E6-19975]

Agencies

• Office of the Secretary
• DEPARTMENT OF DEFENSE

[Federal Register Volume 71, Number 227 (Monday, November 27, 2006)]
[Proposed Rules]
[Pages 68496-68498]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E6-19975]


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DEPARTMENT OF DEFENSE

Office of the Secretary

[DOD-2006-HA-0210; RIN 0720-AB12]

32 CFR Part 199


TRICARE; TRICARE Retiree Dental Program (TRDP) Basic Benefit 
Descriptions and Administrative Corrections

AGENCY: Office of the Secretary, DoD.

ACTION: Proposed rule.

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SUMMARY: This proposed rule amends TRICARE Retiree Dental Program 
(TRDP) Basic benefit descriptions by replacing specific American Dental 
Association (ADA) dental procedure codes and nomenclature with general 
benefit categories and descriptions. This revision is necessary to keep 
the regulation current, since dental procedure codes are added, 
revised, and deleted on a regular basis. This proposed rule does not 
change or eliminate any benefits that are currently available under the 
TRDP program. This proposed rule also revises several incorrect, 
obsolete, or historical terms pertaining to the TRICARE program.

DATES: Written comments received at the address indicated below by 
January 26, 2007 will be accepted.

ADDRESSES: You may submit comments, identified by docket number and/or 
RIN number and title, by any of the following methods:
     Federal eRulemaking Portal: https://www.regulations.gov. 
Follow the instructions for submitting comments.
     Mail: Federal Docket Management System Office, 1160 
Defense Pentagon, Washington, DC 20301-1160.
    Instructions: All submissions received must include the agency name 
and docket number or Regulatory Information Number (RIN) for this 
Federal Register document. The general policy for comments and other 
submissions from members of the public is to make these submissions 
available for public viewing on the Internet at https://regulations.gov 
as they are received without change, including any personal identifiers 
or contact information.

FOR FURTHER INFORMATION CONTACT: Debra Hatzel, Program Requirements 
Division, TRICARE Management Activity, telephone (303) 676-3572.

SUPPLEMENTARY INFORMATION: This proposed rule amends TRICARE Retiree 
Dental Program (TRDP) Basic benefit descriptions by removing specific 
American Dental Association (ADA) dental procedure codes and 
nomenclature, and replacing them with general benefit categories and 
descriptions from the most recent Current Dental Terminology (CDT) 
Manual (CDT-2005). This action is required because dental procedure 
codes and nomenclature are added, revised, and deleted by the ADA every 
two years; when this occurs, the regulation must also be revised to 
reflect the new codes and nomenclature. Maintaining specific procedure 
codes and nomenclature in the regulation is unnecessary, since the TRDP 
contract and TRDP marketing materials (available at https://
www.tricare.osd.mil/dental/dm2.cfm) already contain detailed benefit 
descriptions. Also, the TRDP contractor and enrollees are notified when 
the Government directs any changes to TRDP benefits, limits, or 
exclusions. The TRDP contract and TRDP marketing materials will 
continue to be the primary vehicles for communicating specific benefit 
information to the TRDP contractor and beneficiaries. Removal of 
specific procedure codes and nomenclature from this section does not 
change or eliminate any benefits that are currently available under the 
TRDP. The general categories of benefits that are listed in this 
proposed rule will be adjusted periodically to conform to the current 
CDT Manual.
    Although there are many similarities between the TRDP and the 
TRICARE Dental Program (TDP), the benefits are not identical. Also, 
there are different

[[Page 68497]]

dental benefits available under the TRDP Basic program and the TRDP 
Enhanced program. The general benefit categories in this TRDP proposed 
rule differ from the TDP benefit categories listed in 32 CFR 199.13. 
This variance exists because some of the benefits offered under the TDP 
are not benefits under the TRDP Basic program (e.g., prosthodontic and 
orthodontic services), and because the TDP benefit categories were 
derived from an earlier version of the CDT Manual.
    This proposed rule also revises several incorrect, obsolete or 
historical terms; specifically, ``Director, OCHAMPUS'' is revised to 
``Director, TRICARE Management Activity''; ``Assistant Secretary of 
Defense (Human Affairs)'' is revised to ``Assistant Secretary of 
Defense (Health Affairs)''; ``Active Duty Dependents Dental Program'' 
is revised to ``TRICARE Dental Program''; ``CHAMPUS'' is revised to 
``TRICARE/CHAMPUS''; and ``OCHAMPUS'' is revised to ``TRICARE 
Management Activity.''

Regulatory Procedures

    Executive Order 12866 directs agencies to assess all costs and 
benefits 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. The Order 
classifies a rule as a significant regulatory action requiring review 
by the Office of Management and Budget if it meets any one of a number 
of specified conditions, including having an annual effect on the 
national economy of $100 million or more, creating a serious 
inconsistency or interfering with an action of another agency, 
materially altering the budgetary impact of entitlements or the rights 
of entitlement recipients, or raising novel legal or policy issues. DoD 
has examined the economic, legal, and policy implications of this 
proposed rule and has concluded that it is not a significant regulatory 
action. The changes set forth in the proposed rule are minor 
administrative revisions to the existing regulation which do not change 
the basic TRDP benefit structure. This is neither a significant 
regulatory action under Executive Order 12866, nor would it have a 
significant impact on small entities.
    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 which would have a 
significant impact on a substantial number of small entities.
    This proposed rule is not a major rule under the Congressional 
Review Act because its economic impact will be less than $100 million.
    Executive Order 13132 requires that each Federal Agency shall 
consult with State and local officials and obtain their input if a rule 
has federalism implications which have substantial direct effects on 
the States, on the relationship between the national government and the 
States, or on the distribution of power and responsibilities among the 
various levels of government. We have examined the impact of the 
proposed rule under Executive Order 13132 and it does not have policies 
that have federalism implications that would have substantial direct 
effects on the States, on the relationship between the national 
government and the States, or on the distribution of power and 
responsibilities among the various levels of government; therefore, 
consultation with State and local officials is not required. In 
addition, this proposed rule does not impose new information collection 
requirements for purposes of the Paperwork Reduction Act of 1995 (44 
U.S.C. 3501-3511).

List of Subjects in 32 CFR Part 199

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

    Accordingly, 32 CFR part 199 is proposed to be amended as follows:

PART 199--CIVILIAN HEALTH AND MEDICAL PROGRAM OF THE UNIFORMED 
SERVICES (CHAMPUS)

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

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

    2. Section 199.22 is proposed to be amended by revising the last 
sentence of paragraph (b)(1), paragraph (b)(4), paragraph (c), 
paragraph (d)(1)(v), the first sentence of paragraph (d)(4)(ii), 
paragraph (f) introductory text, paragraph (f)(1) introductory text, 
paragraphs (f)(1)(i) through (f)(1)(vii), first sentence of paragraph 
(f)(3) introductory text, paragraph (g), and the first sentence of 
paragraph (k); and by removing paragraphs (f)(1)(viii) and (f)(1)(ix) 
to read as follows:


Sec.  199.22  TRICARE Retiree Dental Program (TRDP).

* * * * *
    (b) * * *
    (1) * * * Additional services comparable to those contained in 
paragraph (e)(2) of Sec.  199.13 may be covered pursuant to benefit 
policy decisions made by the Director, TRICARE Management Activity, or 
designee.
* * * * *
    (4) Except as otherwise provided in this section or by the 
Assistant Secretary of Defense (Health Affairs) or designee, the TRDP 
is administered in a manner similar to the TRICARE Dental Program under 
Sec.  199.13 of this part.
* * * * *
    (c) Except as may be specifically provided in this section, to the 
extent terms defined in Sec.  199.2 and Sec.  199.13(b) are relevant to 
the administration of the TRICARE Retiree Dental Program, the 
definitions contained in Sec.  199.2 and Sec.  199.13(b) shall apply to 
the TRDP as they do to TRICARE/CHAMPUS and the TRICARE Dental Program.
    (d) * * *
    (1) * * *
    (v) The unremarried surviving spouse and eligible child dependents 
of a deceased member who died while in status described in paragraph 
(d)(1)(i) or paragraph (d)(1)(ii) of this section; the unremarried 
surviving spouse and eligible child dependents who receive a surviving 
spouse annuity; or the unremarried surviving spouse and eligible child 
dependents of a deceased member who died while on active duty for a 
period of more than 30 days and whose eligible dependents are not 
eligible or no longer eligible for the TRICARE Dental Program.
* * * * *
    (4) * * *
    (ii) Enrollment period for enhanced benefits. The initial 
enrollment period for enhanced benefit coverage described in paragraph 
(f)(2) of this section shall be established by the Director, TRICARE 
Management Activity, or designee, when such coverage is offered, to be 
a period of not less than 12 months and not more than 24 months. * * *
* * * * *
    (f) Plan benefits. The Director, TRICARE Management Activity, or 
designee, may modify the services covered by the TRDP to the extent 
determined appropriate based on developments in common dental care 
practices and standard dental programs. In addition, the Director, 
TRICARE Management Activity, or designee, may establish such exclusions 
and limitations as are consistent with those established by dental 
insurance and prepayment plans to control utilization and quality of 
care for the services and items covered by the TRDP.
    (1) The minimum TRDP benefit is basic dental care to include 
diagnostic

[[Page 68498]]

services, preventive services, restorative services, endodontic 
services, periodontic services, oral surgery services, and other 
general services. The following is the minimum TRDP covered dental 
benefit:
    (i) Diagnostic services.
    (A) Clinical oral examinations.
    (B) Radiographs and diagnostic imaging.
    (C) Tests and laboratory examinations.
    (ii) Preventive services.
    (A) Dental prophylaxis.
    (B) Topical fluoride treatment (office procedure).
    (C) Sealants.
    (D) Other preventive services.
    (E) Space maintenance.
    (iii) Restorative services.
    (A) Amalgam restorations.
    (B) Resin-based composite restorations.
    (C) Other restorative services.
    (iv) Endodontic services.
    (A) Pulp capping.
    (B) Pulpotomy and pulpectomy.
    (C) Root canal therapy.
    (D) Apexification and recalcification procedures.
    (E) Apicoectomy and periradicular services.
    (F) Other endodontic procedures.
    (v) Periodontic Services.
    (A) Surgical services.
    (B) Periodontal services.
    (vi) Oral surgery.
    (A) Extractions.
    (B) Surgical extractions.
    (C) Alveoloplasty.
    (D) Biopsy.
    (E) Other surgical procedures.
    (vii) Other general services.
    (A) Palliative (emergency) treatment of dental pain.
    (B) Therapeutic drug injection.
    (C) Other drugs and/or medicaments.
    (D) Treatment of postsurgical complications.
* * * * *
    (3) Alternative course of treatment policy. The Director, TRICARE 
Management Activity, or designee, may establish, in accordance with 
generally accepted dental benefit practices, an alternative course of 
treatment policy which provides reimbursement in instances where the 
dentist and TRDP enrollee select a more expensive service, procedure, 
or course of treatment than is customarily provided. * * *
* * * * *
    (g) Maximum coverage amounts. Each enrollee is subject to an annual 
maximum coverage amount for non-orthodontic dental benefits and, if an 
orthodontic benefit is offered, a lifetime maximum coverage amount for 
orthodontics as established by the Director, TRICARE Management 
Activity, or designee.
* * * * *
    (k) All levels of appeals and grievances established by the 
Contractor for internal review shall be exhausted prior to forwarding 
to TRICARE Management Activity for a final review. * * *
* * * * *

    Dated: November 20, 2006.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. E6-19975 Filed 11-24-06; 8:45 am]
BILLING CODE 5001-06-P