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, 54353-54355 [07-4655]

Download as PDF 54353 yshivers on PROD1PC62 with RULES Federal Register / Vol. 72, No. 185 / Tuesday, September 25, 2007 / Rules and Regulations The (j)(2) exemption was initially applied to this system which was the database used for all Inspection (now the Treasury Inspector General for Tax Administration [TIGTA]) investigations. TIGTA is not a part of IRS and no Inspection investigations are maintained in this system, with the exception of personnel security investigations. Under 5 U.S.C. 552a(k)(5), the head of any agency may promulgate rules to exempt any system of records within the agency from certain provisions of the Privacy Act of 1974 if the system is investigatory material compiled solely for the purpose of determining suitability, eligibility, or qualifications for Federal civilian employment, military service, Federal contracts, or access to classified information. This is applicable only to the extent that the disclosure of such material would reveal the identity of a source who furnished information to the Government under an express promise that the identity of the source would be held in confidence, or, prior to September 27, 1975, under an implied promise that the identity of the source would be held in confidence. Thus to the extent that the records in this system can be disclosed without revealing the identity of a confidential source, they are not within the scope of this exemption and are subject to all the requirements of the Privacy Act. The sections of 5 U.S.C. 552a from which the systems of records are exempt include in general those providing for individuals’ access to or amendment of records. When such access or amendment would cause the identity of a confidential source to be revealed, it would impair the future ability of the Department to compile investigatory material for the purpose of determining suitability, eligibility, or qualifications for Federal civilian employment, Federal contracts, or access to classified information. In addition, the systems should be exempt from 5 U.S.C. 552a(e)(1) which requires that an agency maintain in its records only such information about an individual as is relevant and necessary to accomplish a purpose of the agency required to be accomplished by statute or executive order. The Department believes that to fulfill the requirements of 5 U.S.C. 552a(e)(1) would unduly restrict the agency in its information gathering inasmuch as it is often not until well after the investigation that it is possible to determine the relevance and necessity of particular information. A separate notice revising the system of records entitled ‘‘IRS 34.022— National Background Investigations Center Management Information System’’ was published in the Federal VerDate Aug<31>2005 15:17 Sep 24, 2007 Jkt 211001 Register on November 28, 2005, at 70 FR 71376. Among other changes, the name of the system of records was changed to ‘‘Automated Background Investigations System (ABIS).’’ As required by Executive Order 12866, it has been determined that this final rule is not a significant regulatory action, and therefore, does not require a regulatory impact analysis. The regulation will not have a substantial direct effect on the States, on the relationship between the Federal Government and the States, or on the distribution of power and responsibilities among the various levels of government. Therefore, it is determined that this rule does not have federalism implications under Executive Order 13132. Pursuant to the requirements of the Regulatory Flexibility Act, 5 U.S.C. 601– 612, it is hereby certified that these regulations will not significantly affect a substantial number of small entities. The final rule imposes no duties or obligations on small entities. In accordance with the provisions of the Paperwork Reduction Act of 1995, the Department of the Treasury has determined that this final rule would not impose new record keeping, application, reporting, or other types of information collection requirements. List of Subjects in 31 CFR Part 1 Privacy. I Part 1 subpart C of Title 31 of the Code of Federal Regulations amended as follows: PART 1—[AMENDED] 1. The authority citation for part 1 continues to read as follows: I Authority: 5 U.S.C. 301, 31 U.S.C. 321, subpart A also issued under 5 U.S.C. 552, as amended. Subpart C also issued under 5 U.S.C. 552a. 2. Section 1.36 of subpart C is amended as follows: I a. Paragraph (c)(1)(viii) is amended by removing ‘‘IRS 34.022—National Background Investigations Center Management Information System’’ from the table. I b. Paragraph (m)(1)(viii) is amended by adding the following text to the table in numerical order: I § 1.36 Systems exempt in whole or in part from provisions of 5 U.S.C. 522a and this part. * * * (m) * * * (1) * * * (viii) * * * PO 00000 Frm 00013 * Fmt 4700 * Sfmt 4700 Number Name of system * * * * * IRS 34.022 ................ Automated Background Investigations System (ABIS) * * * * * * * * * * Dated: September 18, 2007. Peter B. McCarthy, Assistant Secretary for Management and Chief Financial Officer. [FR Doc. E7–18859 Filed 9–24–07; 8:45 am] BILLING CODE 4830–01–P 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 Office of the Secretary, Department of Defense. ACTION: Final rule. AGENCY: SUMMARY: This final rule implements section 702 of the John Warner National Defense Authorization Act for Fiscal Year 2007, Public Law 109–364. The rule provides 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 final rule does not eliminate any contracted medical care that is currently covered for spouses and children. The entitlement of anesthesia services includes general anesthesia services only. Institutional services 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. E:\FR\FM\25SER1.SGM 25SER1 54354 Federal Register / Vol. 72, No. 185 / Tuesday, September 25, 2007 / Rules and Regulations This is rule is effective September 25, 2007. ADDRESSES: TRICARE Management Activity, Skyline 5, Suite 810, 5111 Leesburg Pike, Falls Church, VA 22041. 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: yshivers on PROD1PC62 with RULES EFFECTIVE DATE: I. Summary of Final Rule Provisions This final rule 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 noncovered dental treatment for patients with developmental, mental, or physical disabilities or for pediatric patients age 5 or under. This final rule does not eliminate any contracted medical care that is currently covered for spouses and children. The entitlement of anesthesia services includes general anesthesia services only. Institutional services includes 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. Prior to section 702 of the John Warner National Defense Authorization Act for Fiscal Year 2007, general anesthesia and institutional services were 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 unless it qualified as adjunctive dental care. For military families who have children that require extensive dental treatment under general anesthesia, the two options available were to have the care provided locally at a Department of Defense (DoD) facility or a civilian facility. If the care was provided in a DoD facility, the total costs to the family are minimal.This option remains available. There are, however, 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 VerDate Aug<31>2005 15:17 Sep 24, 2007 Jkt 211001 (TRDP) are provided with coverage for dental care with applicable cost-shares. These include a 40-percent cost-share for general anesthesia and varying costshares 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 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 the TRDP. For families with dental insurance other the TDP or TRDP, their plan structure may have defrayed some costs but out-ofpocket costs remained significant. Families without any dental insurance incurred the total costs of dental, anesthesia, and institutional services. II. Review of Public Comments We provided a 60-day comment period on the proposed rule which was published in the Federal Register on March 23, 2007 (72 FR 13721). We received one document with joint comments from the American Dental Association (ADA) and the American Academy of Pediatric Dentists (AAPD). All comments were in support of the proposed rule. The ADA and AAPD concurred that the proposed rule accurately interpreted section 702 of the John Warner National Defense Authorization Act for Fiscal Year 2007, Public Law 109–364. They also concurred with the definitions and requirements as stated in the proposed rule. A waiver of the preauthorization requirement will be provided for beneficiaries receiving care in the transition period between October 17, 2006, the effective date of the change in the law upon which this final rule is based, and the implementation date, by applying the same criteria in a postauthorization. The ADA and AAPD recommended that post-authorization reviews utilize the same criteria as preauthorization reviews, and that this transition plan be referenced in the final rule. Post authorization review procedures will utilize the same criteria as preauthorization reviews; however, post authorization procedures will be addressed and outlined in detail in the PO 00000 Frm 00014 Fmt 4700 Sfmt 4700 TRICARE Manuals and are not included in this final rule. III. 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 final 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 final 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 amended as follows: I PART 199—CIVILIAN HEALTH AND MEDICAL PROGRAM OF THE UNIFORMED SERVICES (CHAMPUS) 1. The authority citation for part 199 continues to read as follows: I 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: I § 199.4 * E:\FR\FM\25SER1.SGM Basic Program Benefits. * * 25SER1 * * Federal Register / Vol. 72, No. 185 / Tuesday, September 25, 2007 / Rules and Regulations yshivers on PROD1PC62 with RULES (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 § 199.2 as a 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: September 13, 2007. L.M. Bynum, Alternate OSD Federal Register Liaison Officer, Department of Defense. [FR Doc. 07–4655 Filed 9–24–07; 8:45 am] BILLING CODE 5001–06–M VerDate Aug<31>2005 15:17 Sep 24, 2007 Jkt 211001 DEPARTMENT OF HOMELAND SECURITY Coast Guard 33 CFR Part 100 [Docket No. CGD05–07–045] RIN 1625–AA08 Special Local Regulations for Marine Events; John H. Kerr Reservoir, Clarksville, VA Coast Guard, DHS. Temporary final rule. AGENCY: ACTION: SUMMARY: The Coast Guard is establishing temporary special local regulations for the ‘‘Clarksville Hydroplane Challenge’’, a power boat race to be held on the waters of the John H. Kerr Reservoir adjacent to Clarksville, Virginia. These special local regulations are necessary to provide for the safety of life on navigable waters during the event. This action is intended to restrict vessel traffic in portions of the John H. Kerr Reservoir adjacent to Clarksville, Virginia during the power boat race. DATES: This rule is effective from 7:30 a.m. on October 6, 2007 to 6:30 p.m. on October 7, 2007. ADDRESSES: Comments and material received from the public, as well as documents indicated in this preamble as being available in the docket, are part of docket CGD05–07–045 and are available for inspection or copying at Commander (dpi), Fifth Coast Guard District, 431 Crawford Street, Portsmouth, Virginia 23704–5004 between 9 a.m. and 2 p.m., Monday through Friday, except Federal holidays. FOR FURTHER INFORMATION CONTACT: Dennis Sens, Project Manager, Inspections and Investigations Branch, at (757) 398–6204. SUPPLEMENTARY INFORMATION: Regulatory Information On July 16, 2007, we published a notice of proposed rulemaking (NPRM) entitled Special Local Regulations for Marine Events; John H. Kerr Reservoir, Clarksville, VA, in the Federal Register (72 FR 38808). We received no letters commenting on the proposed rule. No public meeting was requested, and none was held. Under 5 U.S.C. 553(d)(3), the Coast Guard finds that good cause exists for making this rule effective less than 30 days after publication in the Federal Register. Delaying the effective date would be contrary to the public interest, since immediate action is needed to ensure the safety of the event PO 00000 Frm 00015 Fmt 4700 Sfmt 4700 54355 participants, support vessels, spectator craft and other vessels transiting the event area. However, advance notifications will be made to users of John H. Kerr Reservoir via, local notice to mariners, commercial radio stations, and area newspapers. Background and Purpose On October 6 and 7, 2007, the Virginia Boat Racing Association will sponsor the ‘‘Clarksville Hydroplane Challenge’’, on the waters of the John H. Kerr Reservoir. The event will consist of approximately 70 inboard hydroplanes racing in heats counter-clockwise around an oval racecourse. A fleet of spectator vessels is anticipated to gather nearby to view the competition. Due to the need for vessel control during the event, vessel traffic will be temporarily restricted to provide for the safety of participants, spectators and transiting vessels. Discussion of Comments and Changes The Coast Guard did not receive comments in response to the notice of proposed rulemaking (NPRM) published in the Federal Register. Accordingly, the Coast Guard is establishing temporary special local regulations on specified waters of the John H. Kerr Reservoir, Clarksville, Virginia. Regulatory Evaluation This rule is not a ‘‘significant regulatory action’’ under section 3(f) of Executive Order 12866, Regulatory Planning and Review, and does not require an assessment of potential costs and benefits under section 6(a)(3) of that Order. The Office of Management and Budget has not reviewed it under that Order. We expect the economic impact of this rule to be so minimal that a full Regulatory Evaluation is unnecessary. Although this regulation will prevent traffic from transiting a portion of the John H. Kerr Reservoir adjacent to Clarksville, Virginia, during the event, the effect of this regulation will not be significant due to the limited duration that the regulated area will be in effect. Extensive advance notifications will be made to the maritime community via Local Notice to Mariners, marine information broadcasts, area newspapers, and local radio stations, so mariners can adjust their plans accordingly. Vessel traffic will be able to transit the regulated area between heats, when the Coast Guard Patrol Commander deems it is safe to do so. Small Entities Under the Regulatory Flexibility Act (5 U.S.C. 601–612), we have considered E:\FR\FM\25SER1.SGM 25SER1

Agencies

[Federal Register Volume 72, Number 185 (Tuesday, September 25, 2007)]
[Rules and Regulations]
[Pages 54353-54355]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 07-4655]


=======================================================================
-----------------------------------------------------------------------

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, Department of Defense.

ACTION: Final rule.

-----------------------------------------------------------------------

SUMMARY: This final rule implements section 702 of the John Warner 
National Defense Authorization Act for Fiscal Year 2007, Public Law 
109-364. The rule provides 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 final rule 
does not eliminate any contracted medical care that is currently 
covered for spouses and children. The entitlement of anesthesia 
services includes general anesthesia services only. Institutional 
services 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.

[[Page 54354]]


EFFECTIVE DATE: This is rule is effective September 25, 2007.

ADDRESSES: TRICARE Management Activity, Skyline 5, Suite 810, 5111 
Leesburg Pike, Falls Church, VA 22041.

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. Summary of Final Rule Provisions

    This final rule 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 final rule 
does not eliminate any contracted medical care that is currently 
covered for spouses and children. The entitlement of anesthesia 
services includes general anesthesia services only. Institutional 
services includes 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.
    Prior to section 702 of the John Warner National Defense 
Authorization Act for Fiscal Year 2007, general anesthesia and 
institutional services were 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 unless it qualified as adjunctive dental care. 
For military families who have children that require extensive dental 
treatment under general anesthesia, the two options available were to 
have the care provided locally at a Department of Defense (DoD) 
facility or a civilian facility. If the care was provided in a DoD 
facility, the total costs to the family are minimal.This option remains 
available. There are, however, 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-percent cost-share for 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 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 the TRDP. 
For families with dental insurance other the TDP or TRDP, their plan 
structure may have defrayed some costs but out-of-pocket costs remained 
significant. Families without any dental insurance incurred the total 
costs of dental, anesthesia, and institutional services.

II. Review of Public Comments

    We provided a 60-day comment period on the proposed rule which was 
published in the Federal Register on March 23, 2007 (72 FR 13721). We 
received one document with joint comments from the American Dental 
Association (ADA) and the American Academy of Pediatric Dentists 
(AAPD). All comments were in support of the proposed rule. The ADA and 
AAPD concurred that the proposed rule accurately interpreted section 
702 of the John Warner National Defense Authorization Act for Fiscal 
Year 2007, Public Law 109-364. They also concurred with the definitions 
and requirements as stated in the proposed rule. A waiver of the 
preauthorization requirement will be provided for beneficiaries 
receiving care in the transition period between October 17, 2006, the 
effective date of the change in the law upon which this final rule is 
based, and the implementation date, by applying the same criteria in a 
post-authorization. The ADA and AAPD recommended that post-
authorization reviews utilize the same criteria as preauthorization 
reviews, and that this transition plan be referenced in the final rule. 
Post authorization review procedures will utilize the same criteria as 
preauthorization reviews; however, post authorization procedures will 
be addressed and outlined in detail in the TRICARE Manuals and are not 
included in this final rule.

III. 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 final 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 final 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.


0
Accordingly, 32 CFR part 199 is amended as follows:

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

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 199.4 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.

* * * * *

[[Page 54355]]

    (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 a 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: September 13, 2007.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 07-4655 Filed 9-24-07; 8:45 am]
BILLING CODE 5001-06-M