TRICARE: Unfortunate Sequelae From Noncovered Services in a Military Treatment Facility, 47519-47520 [2010-19310]

Agencies

• Office of the Secretary
• DEPARTMENT OF DEFENSE

[Federal Register Volume 75, Number 151 (Friday, August 6, 2010)]
[Proposed Rules]
[Pages 47519-47520]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2010-19310]


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DEPARTMENT OF DEFENSE

Office of the Secretary

32 CFR Part 199

[DOD-2010-HA-0033]
RIN 0720-AB44


TRICARE: Unfortunate Sequelae From Noncovered Services in a 
Military Treatment Facility

AGENCY: Office of the Secretary, Department of Defense.

ACTION: Proposed rule.

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SUMMARY: The Department of Defense is publishing this proposed rule to 
allow coverage for otherwise covered services and supplies required in 
the treatment of complications (unfortunate sequelae) resulting from a 
noncovered incident of treatment provided in a Military Treatment 
Facility (MTF), when the initial noncovered service has been authorized 
by the MTF Commander and the MTF is unable to provide the necessary 
treatment of the complications. This proposed rule is necessary to 
protect TRICARE beneficiaries from incurring financial hardships due to 
the current regulatory restrictions that prohibit TRICARE coverage of 
treatment of the complications resulting from noncovered medical 
procedures, even when those procedures were conducted in a Department 
of Defense facility.

DATES: Comments received at the address indicated below by October 5, 
2010 will be accepted.

ADDRESSES: You may submit comments, identified by docket number and/or 
Regulatory Information Number (RIN) and title, by either of the 
following methods:
     Federal Rulemaking 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 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://www.regulations.gov as they are received without 
change, including any personal identifiers or contact information.

FOR FURTHER INFORMATION CONTACT: Ren[eacute] Morrell, Medical Benefits 
and Reimbursement Branch, TRICARE Management Activity, (303) 676-3618.

[[Page 47520]]


SUPPLEMENTARY INFORMATION: In order to support Graduate Medical 
Education and maintain provider skill levels, Military Treatment 
Facility (MTF) providers are frequently required to perform medical 
procedures that may be excluded from coverage under TRICARE. Unexpected 
complications (unfortunate sequelae) from these procedures may result 
and, in those instances where the MTFs are unable to provide the 
appropriate level of care necessary for the proper treatment of these 
complications, the MTF Commander must refer beneficiaries for treatment 
outside the MTF. Under current regulatory provisions, TRICARE is unable 
to cover treatment of the complications resulting from noncovered 
procedures. When beneficiaries require treatment outside the MTF for 
these complications, arising from noncovered procedures, they are 
responsible for payment for this necessary treatment resulting in 
significant financial hardship. This proposed rule will address that 
unfortunate situation by allowing coverage of treatment for the 
complications resulting from noncovered treatment provided in an MTF 
when the original procedure was authorized by the MTF Commander. The 
specific procedures for approval of this treatment will be addressed in 
the TRICARE Policy Manual rather than in the regulation to ensure that 
this information is current and easily accessible. TRICARE manuals may 
be accessed at http//:www.tricare.mil.

Regulatory Procedures

Executive Order 12866, ``Regulatory Planning and Review''

    Section 801 of title 5, United States Code, and Executive Order 
12866 require certain regulatory assessments and procedures for any 
major rule or 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. It has been 
certified that this rule is not a major rule or significant regulatory 
action.

Public Law 104-4, Section 202, ``Unfunded Mandates Reform Act''

    Section 202 of Public Law 104-4, ``Unfunded Mandates Reform Act,'' 
requires that an analysis be performed to determine whether any federal 
mandate may result in the expenditure by State, local and tribal 
governments, in the aggregate, or by the private sector of $100 million 
in any one year. It has been certified that this proposed rule does not 
contain a Federal mandate that may result in the expenditure by State, 
local and tribal governments, in aggregate, or by the private sector, 
of $100 million or more in any one year, and thus this proposed rule is 
not subject to this requirement.

Public Law 96-354, ``Regulatory Flexibility Act'' (RFA) (5 U.S.C. 601)

    Public Law 96-354, ``Regulatory Flexibility Act'' (RFA) (5 U.S.C. 
601), requires that each Federal agency prepare 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 an economically significant regulatory 
action, and it has been certified that it will not have a significant 
impact on a substantial number of small entities. Therefore, this 
proposed rule is not subject to the requirements of the RFA.

Public Law 96-511, ``Paperwork Reduction Act'' (44 U.S.C. Chapter 35)

    This rule does not contain a ``collection of information'' 
requirement, and will not impose additional information collection 
requirements on the public under Public Law 96-511, ``Paperwork 
Reduction Act'' (44 U.S.C. Chapter 35).

Executive Order 13132, ``Federalism''

    Executive Order 13132, ``Federalism,'' requires that an impact 
analysis be performed to determine whether the rule has 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. It has been certified that this proposed rule 
does not have federalism implications, as set forth in Executive Order 
13132.

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--[AMENDED]

    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(e)(9) is revised to read as follows:


Sec.  199.4  Basic program benefits.

* * * * *
    (e) * * *
    (9) Complications (unfortunate sequelae) resulting from noncovered 
initial surgery or treatment.
    (i) Benefits are available for otherwise covered services and 
supplies required in the treatment of complications resulting from a 
noncovered incident of treatment (such as nonadjunctive dental care and 
cosmetic surgery) but only if the later complication represents a 
separate medical condition such as a systemic infection, cardiac 
arrest, and acute drug reaction. Benefits may not be extended for any 
later care or procedures related to the complication that essentially 
is similar to the initial noncovered care. An example of complications 
similar to the initial episode of care (and thus not covered) would be 
repair of facial scarring resulting from dermabrasion for acne.
    (ii) Benefits are available for otherwise covered services and 
supplies required in the treatment of complications (unfortunate 
sequelae) resulting from a noncovered incident of treatment provided in 
a Military Treatment Facility (MTF), when the initial noncovered 
service has been authorized by the MTF Commander and the MTF is unable 
to provide the necessary treatment of the complications, according to 
the guidelines adopted by the Director, TMA, or a designee.
* * * * *

    Dated: July 26, 2010.
Patricia L. Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2010-19310 Filed 8-5-10; 8:45 am]
BILLING CODE 5001-06-P