TRICARE; Changes Included in the John Warner National Defense Authorization Act for Fiscal Year 2007; Authorization of Anesthesia and Other Costs for Dental Care for Children and Certain Other Patients, 13721-13722 [07-1375]

Agencies

• Office of the Secretary
• DEPARTMENT OF DEFENSE

[Federal Register Volume 72, Number 56 (Friday, March 23, 2007)]
[Proposed Rules]
[Pages 13721-13722]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 07-1375]


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DEPARTMENT OF DEFENSE

Office of the Secretary

32 CFR Part 199

[DOD-2007-HA-0026]
RIN 0720-AB14


TRICARE; Changes Included in the John Warner National Defense 
Authorization Act for Fiscal Year 2007; Authorization of Anesthesia and 
Other Costs for Dental Care for Children and Certain Other Patients

AGENCY: Office of the Secretary, DoD.

ACTION: Proposed rule.

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SUMMARY: This proposed rule will implement section 702 of the John 
Warner National Defense Authorization Act for Fiscal Year 2007 (NDAA 
for FY 2007), Pubic Law 109-364. Specifically, that legislation amends 
the coverage of contracted medical care with respect to dental care 
beyond that care required as a necessary adjunct to medical or surgical 
treatment. The entitlement of institutional and anesthesia services is 
authorized in conjunction with non-covered dental treatment for 
patients with developmental, mental, or physical disabilities or for 
pediatric patients age 5 or under. This proposed rule will not 
eliminate any contracted medical care that is currently covered for 
spouses and children. The entitlement of anesthesia services will 
include general anesthesia services only. Institutional services will 
include institutional benefits associated with both hospital and in-out 
surgery settings. Patients with developmental, mental, or physical 
disabilities are those patients with conditions that prohibit dental 
treatment in a safe and effective manner. Therefore, it is medically or 
psychologically necessary for these patients to require general 
anesthesia for dental treatment.

DATES: Written comments received at the address indicated below by May 
22, 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 of 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 identifies 
or contact information.

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. Background

    This proposed rule will amend the coverage of contracted medical 
care with respect to dental care beyond that care required as necessary 
adjunct to medical or surgical treatment. The entitlement of 
institutional and anesthesia services will be authorized in conjunction 
with non-covered dental treatment for patients with developmental, 
mental, or physical disabilities or for pediatric patients age 5 or 
under. This proposed rule will not eliminate any contracted medical 
care that is currently covered for spouses and children. The 
entitlement of anesthesia services will include general anesthesia 
services only. Institutional services will include institutional 
benefits associated with both hospital and in-out surgery settings. 
Patients with developmental, mental, or physical disabilities are those 
patients with conditions that prohibit dental treatment in a safe and 
effective manner. Therefore, it is medically or psychologically 
necessary for these patients to require general anesthesia for dental 
treatment.
    Currently, general anesthesia and institutional services are not 
covered in conjunction with dental treatment for patients with 
developmental, mental, or physical disabilities or for pediatric 
patients of any age through TRICARE medical plan contracts. For 
military families who have children that require extensive dental 
treatment under general anesthesia, the two options available are to 
have the care provided locally at a Department of Defense (DoD) 
facility or a civilian facility. If the care is provided in a DoD 
facility, the total costs to the family are minimal. There are 
locations where this care is not available from a DoD facility due to 
facility constraints (no operating room) and/or lack of dental 
specialists. For dental care provided in a civilian facility, families 
currently enrolled in the TRICARE Dental Program (TDP) or TRICARE 
Retiree Dental Program (TRDP) are provided with coverage for dental 
care with applicable cost-shares. These include a 40% cost-share for

[[Page 13722]]

general anesthesia and varying cost-shares for dental procedures 
(fillings, crowns, root canals) completed in the operating room 
setting. There is an annual maximum benefit for the TDP and TRDP of 
$1,200 per enrollee. This means that the total payments for covered 
services for each enrolled member will not exceed $1,200 in any 
contract year. In addition, the TRDP has a deductible of $50 per 
patient per year, not to exceed $150 per family per year. Frequently, 
the annual maximum is reached for those pediatric patients who require 
extensive dental treatment under general anesthesia. Once the annual 
maximum is reached, the remainder of the billed charges is the 
enrollee's responsibility. The hospital costs (institutional services) 
are covered by neither the TDP nor TRDP. For families with dental 
insurance other than TDP or TRDP, their plan structure will defray some 
costs but out-of-pocket costs will remain significant. Currently, 
families without any dental insurance will incur the total costs of 
dental, anesthesia, and institutional services.

II. Regulatory Procedures

    Executive Order 12866 requires that a comprehensive regulatory 
impact analysis be performed on any economically significant regulatory 
action, defined as one that would result in an annual effect of $100 
million or more on the national economy or which would have other 
substantial 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 
which would have a significant impact on a substantial number of small 
entities. This rule is not an economically significant regulatory 
action and will not have a significant impact on a substantial number 
of small entities for purposes of the RFA, thus this proposed rule is 
not subject to any of these requirements.
    This rule will not impose additional information collection 
requirements on the public under the Paperwork Reduction Act of 1995 
(44 U.S.C. 3501-3511).
    We have examined the impact(s) 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.

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 199.4 is amended by removing the first sentence of 
paragraph (e)(10) introductory text and adding two sentences in its 
place; revising the first sentence of paragraph (e)(10)(iii); and 
adding paragraph (e)(10)(vi) to read as follows:


Sec.  199.4  Basic program benefits.

* * * * *
    (e) * * *
    (10) Dental. TRICARE/CHAMPUS does not include a dental benefit. 
However, in connection with dental treatment for patients with 
developmental, mental, or physical disabilities or for pediatric 
patients age 5 or under, only institutional and anesthesia services may 
be provided as a benefit. * * *
* * * * *
    (iii) Preauthorization required. In order to be covered, adjunctive 
dental care requires preauthorization from the Director, TRICARE 
Management Activity, or a designee, in accordance with paragraph 
(a)(12) of this section. * * *
* * * * *
    (vi) Anesthesia and institutional costs for dental care for 
children and certain other patients. Institutional benefits specified 
in paragraph (b) of this section may be extended for hospital and in-
out surgery settings related to noncovered, nonadjunctive dental care 
when such outpatient care or inpatient stay is in conjunction with 
dental treatment for patients with developmental, mental, or physical 
disabilities or for pediatric patients age 5 or under. For these 
patients, anesthesia services will be limited to the administration of 
general anesthesia only. Patients with developmental, mental, or 
physical disabilities are those patients with conditions that prohibit 
dental treatment in a safe and effective manner. Therefore, it is 
medically or psychologically necessary for these patients to require 
general anesthesia for dental treatment. Patients with physical 
disabilities include those patients having disabilities as defined in 
Sec.  199.2 as serious physical disability. Preauthorization by the 
Director, TRICARE Management Activity, or a designee, is required for 
such outpatient care or inpatient stays to be covered in the same 
manner as required for adjunctive dental care described in paragraph 
(e)(10)(iii) of this section. Regardless of whether or not the 
preauthorization request for outpatient care or hospital admission is 
approved and thus qualifies for institutional benefits, the 
professional service related to the nonadjunctive dental care is not 
covered with the exception of coverage for anesthesia services.
* * * * *

    Dated: March 15, 2007.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 07-1375 Filed 3-22-07; 8:45 am]
BILLING CODE 5001-06-M