TRICARE; Diabetic Education, 47458-47460 [2010-19311]
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47458
Federal Register / Vol. 75, No. 151 / Friday, August 6, 2010 / Rules and Regulations
of the Federal Food, Drug and Cosmetic
Act (21 U.S.C. 360bb(a)(2)), provides, in
part, that the term ‘‘rare disease or
condition’’ means any disease or
condition which affects less than
200,000 persons in the United States.
This rule modification will result in the
definition used by the TRICARE
program for a rare disease to be
consistent with the definition used by
the National Institutes of Health and the
Food and Drug Administration.
DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 199
[DOD–2008–HA–0060]
RIN 0720–AB26
TRICARE; Rare Diseases Definition
Office of the Secretary, DoD.
Final rule.
AGENCY:
ACTION:
This final rule revises the
definition of rare diseases to adopt the
definition of a rare disease as
promulgated by the National Institutes
of Health, Office of Rare Diseases. The
rule modification will result in the
definition used by the TRICARE
program for a rare disease to be
consistent with the definition used by
the National Institutes of Health and the
Food and Drug Administration.
TRICARE has generally been applying
the broader National Institutes of Health
and Food and Drug Administration
definitions when making coverage
decisions for treatments; therefore, there
will be no practical changes for
beneficiaries.
DATES: Effective Date: This rule is
effective September 7, 2010.
FOR FURTHER INFORMATION CONTACT:
Commander James Ellzy, TRICARE
Management Activity, Office of the
Chief Medical Officer, telephone (703)
681–0064.
SUPPLEMENTARY INFORMATION:
erowe on DSK5CLS3C1PROD with RULES
SUMMARY:
A. Background
On January 6, 1997, the Office of the
Secretary of Defense published a final
rule in the Federal Register (62 FR 627–
631) clarifying the TRICARE exclusion
of unproven drugs, devices and medical
treatments and procedures and adding a
definition of rare diseases to be used in
the TRICARE Program. TRICARE
defined a rare disease as one which
affects fewer than one in 200,000
Americans. Upon further review,
TRICARE is revising the definition to be
in compliance with the definition of
other federal agencies. The Office of
Rare Diseases was initially established
as part of the National Institutes of
Health in 1993 to promote research and
collaboration on rare and orphan
diseases. The Rare Diseases Act of 2002
(Pub. L. 107–280) codified the
establishment of the Office of Rare
Diseases by adding a section 404F to the
Public Health Service Act (42 U.S.C.
283h). This statute defines a rare disease
as ‘‘any disease or condition that affects
less than 200,000 persons in the United
States.’’ Additionally, Section 526(a)(2)
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B. Public Comments
The Department of Defense published
a proposed rule on July 24, 2009 (74 FR
36639–36640). No comments were
received on the proposed rule before the
comment period closed.
C. Regulatory Procedures
Executive Order 12866, ‘‘Regulatory
Planning and Review’’
Section 801 of title 5, United States
Code (U.S.C.), and Executive Order
(E.O.) 12866 requires 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 an
economically significant rule, or a
significant regulatory action under the
provisions of E.O. 12866.
Section 202, Public Law 104–4,
‘‘Unfunded Mandates Reform Act’’
It has been certified that his 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.
Executive Order 13132, ‘‘Federalism’’
This final rule has been examined for
its impact under E.O. 13132 and it does
not contain 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:
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 199.2(b) is amended by
revising the definition of ‘‘Rare diseases’’
as follows:
■
§ 199.2
Definitions.
*
*
*
*
*
(b) * * *
Rare diseases. TRICARE/CHAMPUS
defines a rare disease as any disease or
condition that has a prevalence of less
than 200,000 persons in the United
States.
*
*
*
*
*
Dated: July 26, 2010.
Patricia Toppings,
OSD Federal Register Liaison Officer,
Department of Defense.
[FR Doc. 2010–19308 Filed 8–5–10; 8:45 am]
BILLING CODE 5001–06–P
Public Law 96–354, ‘‘Regulatory
Flexibility Act’’ (5 U.S.C. 601)
The Regulatory Flexibility Act (RFA)
requires 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 final rule will not significantly
affect a substantial number of small
entities for purposes of the RFA.
Public Law 96–511, ‘‘Paperwork
Reduction Act’’ (44 U.S.C. Chapter 35)
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).
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DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 199
[DOD–2009–HA–0094]
RIN 0720–AB32
TRICARE; Diabetic Education
Office of the Secretary,
Department of Defense.
ACTION: Final rule.
AGENCY:
The Department of Defense is
publishing this final rule to clarify
TRICARE coverage for diabetic
education. This rule introduces new
definitions and addresses revisions or
SUMMARY:
E:\FR\FM\06AUR1.SGM
06AUR1
erowe on DSK5CLS3C1PROD with RULES
Federal Register / Vol. 75, No. 151 / Friday, August 6, 2010 / Rules and Regulations
omissions in policy or procedure
inadvertently missed in previous
regulatory changes pertaining to
diabetic education.
DATES: Effective Date: This final rule is
effective September 7, 2010.
FOR FURTHER INFORMATION CONTACT: Joy
Saly, Medical Benefits and
Reimbursement Branch, TRICARE
Management Activity, telephone (303)
676–3742. Questions regarding payment
of specific claims should be addressed
to the appropriate TRICARE contractor.
SUPPLEMENTARY INFORMATION: This final
rule introduces new definitions and
addresses revisions or omissions in
policy or procedure inadvertently
missed in previous regulatory changes
pertaining to diabetic education.
Diabetes self-management training
(DSMT) is an interactive, collaborative
process involving beneficiaries with
diabetes, their physician(s), and their
educators. The educational process
should provide the beneficiary with the
knowledge and skills needed to perform
self-care, manage crises, and make
lifestyle changes required to manage the
diabetes successfully.
TRICARE had previously classified
DSMT as a counseling service that was
not medically necessary. Since all
services provided under the TRICARE
program must be medically necessary
and appropriate, DSMT was excluded
from coverage. In developing the
TRICARE policy on self-management,
however, it was determined that
diabetes educational services are
consistent with the medically necessary
and appropriate provision and it was
decided to conform with Medicare’s
policy on DSMT. As such, TRICARE
removed ‘‘diabetic self-management
training’’ programs as an excluded
benefit effective July 1, 1998. Although
the policy change conflicted with
existing regulation language, TRICARE
determined to move forward with the
policy change because TRICARE was
expanding and not restricting a benefit,
and the change was in line with
Medicare’s benefit. This final rule
corrects the failure to amend the
language of the regulation and brings
the regulation into conformance with
the current policy.
Section 199.4 provides basic program
benefits.
Section 199.4(d)(3)(ix) Diabetic selfmanagement training (DSMT) is added
as a benefit under other covered services
and supplies. This addition brings the
regulation into conformance with the
current policy.
Section 199.4(g)(39) is revised to
remove diabetic self-education programs
as an exclusion.
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14:05 Aug 05, 2010
Jkt 220001
Section 199.6 addresses authorized
providers.
Section 199.6(c)(3)(iii)(L) adds
Nutritionist to the list of individual
professional providers of medical care
authorized to provide services to
CHAMPUS beneficiaries.
Section 199.6(c)(3)(iii)(M) adds
Registered Dietitian to the list of
individual professional providers of
medical care authorized to provide
services to CHAMPUS beneficiaries.
Public Comments
A proposed rule (74 FR 44798–44800)
was published on August 31, 2009, and
provided a 60-day comment period. No
comments were received.
Regulatory Procedures
Executive Order 12866, ‘‘Regulatory
Planning and Review’’
Section 801 of Title 5, United States
Code (U.S.C.), and Executive Order
(E.O.) 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
significant regulatory action.
Public Law 96–354, ‘‘Regulatory
Flexibility Act’’ (RFA) (5 U.S.C. 601)
Public Law (Pub. L.) 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 final rule
will not have a significant impact on a
substantial number of small entities.
Therefore, this final 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 Pub. L. 96–511,
‘‘Paperwork Reduction Act’’ (44 U.S.C.
Chapter 35).
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
PO 00000
Frm 00025
Fmt 4700
Sfmt 4700
47459
been certified that this final 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
final rule is not subject to this
requirement.
Executive Order 13132, ‘‘Federalism’’
E.O. 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 final rule does not
have federalism implications, as set
forth in E.O. 13132.
List of Subjects in 32 Part 199
Claims, Dental health, Health care,
Health insurance, Individuals with
disabilities, Military personnel.
■ Accordingly, 32 CFR Part 199, is
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 is amended by adding
paragraph (d)(3)(ix), and revising
paragraph (g)(39) to read as follows:
■
§ 199.4
Basic program benefits.
*
*
*
*
*
(d) * * *
(3) * * *
(ix) Diabetes Self-Management
Training (DSMT). A training service or
program that educates diabetic patients
about the successful self-management of
diabetes. It includes the following
criteria: Education about self-monitoring
of blood glucose, diet, and exercise; an
insulin treatment plan developed
specifically for the patient who is
insulin-dependent; and motivates the
patient to use the skills for selfmanagement. The DSMT service or
program must be accredited by the
American Diabetes Association.
Coverage limitations on the provision
of this benefit will be as determined by
the Director, TRICARE Management
Activity, or designee.
*
*
*
*
*
(g) * * *
(39) Counseling. Counseling services
that are not medically necessary in the
treatment of a diagnosed medical
E:\FR\FM\06AUR1.SGM
06AUR1
47460
Federal Register / Vol. 75, No. 151 / Friday, August 6, 2010 / Rules and Regulations
condition: For example, educational
counseling, vocational counseling,
nutritional counseling, and counseling
for socioeconomic purposes, stress
management, lifestyle modification.
Services provided by a certified
marriage and family therapist, pastoral,
or mental health counselor in the
treatment of a mental disorder are
covered only as specifically provided in
Section 199.6. Services provided by
alcoholism rehabilitation counselors are
covered only when rendered in a
CHAMPUS-authorized treatment setting
and only when the cost of those services
is included in the facility’s CHAMPUSdetermined allowable cost rate.
*
*
*
*
*
■ 3. Section 199.6 is amended by adding
paragraphs (c)(3)(iii)(L) and (M) to read
as follows:
§ 199.6
TRICARE-authorized providers.
*
*
*
*
*
(c) * * *
(3) * * *
(iii) * * *
(L) Nutritionist. A nutritionist may
provide DSMT via an accredited DSMT
program. The nutritionist must be
licensed by the State in which the care
is provided, and must be under the
supervision of a physician who is
overseeing the DSMT program.
(M) Registered Dietitian. A dietitian
may provide DSMT via an accredited
DSMT program. The dietitian must be
licensed by the State in which the care
is provided, and must be under the
supervision of a physician who is
overseeing the DSMT program.
*
*
*
*
*
Dated: July 26, 2010.
Patricia L. Toppings,
OSD Federal Register Liaison Officer,
Department of Defense.
[FR Doc. 2010–19311 Filed 8–5–10; 8:45 am]
BILLING CODE 5001–06–P
DEPARTMENT OF DEFENSE
Office of the Secretary
[DOD–2008–HA–0025; 0720–AB20]
erowe on DSK5CLS3C1PROD with RULES
32 CFR Part 199
TRICARE: Changes Included in the
National Defense Authorization Act for
Fiscal Year 2007; Improvements to
Descriptions of Cancer Screening for
Women
Office of the Secretary, DoD.
Final rule.
AGENCY:
ACTION:
The Department is publishing
this final rule to implement section 703
SUMMARY:
VerDate Mar<15>2010
14:05 Aug 05, 2010
Jkt 220001
of the National Defense Authorization
Act (NDAA) for Fiscal Year 2007
(FY07), Public Law 109–364.
Specifically, that legislation authorizes
breast cancer screening and cervical
cancer screening for female beneficiaries
of the Military Health System, instead of
constraining such testing to
mammograms and Papanicolaou smears.
The rule allows coverage for ‘‘breast
cancer screening’’ and ‘‘cervical cancer
screening’’ for female beneficiaries of the
Military Health System, instead of
constraining such testing to
mammograms and Papanicolaou tests.
This rule ensures new breast and
cervical cancer screening procedures
can be added to the TRICARE benefit as
such procedures are proven to be a safe,
effective, and nationally accepted
medical practice. This amends the
cancer specific recommendations for
breast and cervical cancer screenings to
be brought in line with the processes for
updating other cancer screening
recommendations. In response to public
comment on the proposed rule, this
final rule includes a clarification that
the benefit encompasses screening
based on Health and Human Services
guidelines.
DATES: Effective Date: This rule is
effective September 7, 2010.
FOR FURTHER INFORMATION CONTACT:
Commander James Ellzy, Office of the
Chief Medical Officer, TRICARE
Management Activity, telephone (703)
681–0064.
SUPPLEMENTARY INFORMATION:
A. Background
The Department of Defense updated
coverage for screening with the use of
the breast MRI for women in a
designated high risk category as advised
by the American Cancer Society. In the
process of providing this additional
coverage, it was discovered that because
of statutory wording, there was a group
of high risk women that are standard
beneficiaries under the age of 35 for
whom this coverage could not be
provided without an amendment in the
Code of Federal Regulations (CFR).
Amending the CFR will provide
coverage for breast MRI screening for all
Department of Defense beneficiaries in
the high risk category recommended by
the American Cancer Society.
B. Public Comments
The Department of Defense published
a proposed rule on July 24, 2009 (74 FR
36638–36639). A single comment was
received asking that the language be
written more clearly. The final rule
includes language in section (g)(37)(viii)
that is more precise in terms of which
PO 00000
Frm 00026
Fmt 4700
Sfmt 4700
cancers will be covered and notes that
cervical and breast cancer screenings
will be provided in accordance with the
standards based on the guidelines from
the U.S. Department of Health and
Human Services.
C. Regulatory Procedures
Executive Order (EO) 12866 and
Regulatory Flexibility Act
E.O. 12866 requires 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 each
Federal agency prepare, and make
available for public comment, a
regulatory flexibility analysis when the
agency issues a regulation that 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, although not
economically significant, is a significant
rule under E.O. 12866 and has been
reviewed by the Office of Management
and Budget. Amending the CFR will
provide coverage for breast MRI
screening for all Department of Defense
beneficiaries in the high risk category, if
necessary. It is critically important that
we eliminate any potential gaps in
coverage for high risk individuals as
quickly as possible.
Paperwork Reduction Act
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).
Unfunded Mandates Reform Act
It has been certified that this rule does
not contain a Federal mandate that may
result in the expenditure by State, local
and tribunal governments, in aggregate,
or by the private section, of $100
million or more in any one year.
Executive Order (EO) 13132
We have examined the impact(s) of
the final rule under E.O. 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
E:\FR\FM\06AUR1.SGM
06AUR1
]]>Agencies
[Federal Register Volume 75, Number 151 (Friday, August 6, 2010)]
[Rules and Regulations]
[Pages 47458-47460]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2010-19311]
-----------------------------------------------------------------------
DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 199
[DOD-2009-HA-0094]
RIN 0720-AB32
TRICARE; Diabetic Education
AGENCY: Office of the Secretary, Department of Defense.
ACTION: Final rule.
-----------------------------------------------------------------------
SUMMARY: The Department of Defense is publishing this final rule to
clarify TRICARE coverage for diabetic education. This rule introduces
new definitions and addresses revisions or
[[Page 47459]]
omissions in policy or procedure inadvertently missed in previous
regulatory changes pertaining to diabetic education.
DATES: Effective Date: This final rule is effective September 7, 2010.
FOR FURTHER INFORMATION CONTACT: Joy Saly, Medical Benefits and
Reimbursement Branch, TRICARE Management Activity, telephone (303) 676-
3742. Questions regarding payment of specific claims should be
addressed to the appropriate TRICARE contractor.
SUPPLEMENTARY INFORMATION: This final rule introduces new definitions
and addresses revisions or omissions in policy or procedure
inadvertently missed in previous regulatory changes pertaining to
diabetic education.
Diabetes self-management training (DSMT) is an interactive,
collaborative process involving beneficiaries with diabetes, their
physician(s), and their educators. The educational process should
provide the beneficiary with the knowledge and skills needed to perform
self-care, manage crises, and make lifestyle changes required to manage
the diabetes successfully.
TRICARE had previously classified DSMT as a counseling service that
was not medically necessary. Since all services provided under the
TRICARE program must be medically necessary and appropriate, DSMT was
excluded from coverage. In developing the TRICARE policy on self-
management, however, it was determined that diabetes educational
services are consistent with the medically necessary and appropriate
provision and it was decided to conform with Medicare's policy on DSMT.
As such, TRICARE removed ``diabetic self-management training'' programs
as an excluded benefit effective July 1, 1998. Although the policy
change conflicted with existing regulation language, TRICARE determined
to move forward with the policy change because TRICARE was expanding
and not restricting a benefit, and the change was in line with
Medicare's benefit. This final rule corrects the failure to amend the
language of the regulation and brings the regulation into conformance
with the current policy.
Section 199.4 provides basic program benefits.
Section 199.4(d)(3)(ix) Diabetic self-management training (DSMT) is
added as a benefit under other covered services and supplies. This
addition brings the regulation into conformance with the current
policy.
Section 199.4(g)(39) is revised to remove diabetic self-education
programs as an exclusion.
Section 199.6 addresses authorized providers.
Section 199.6(c)(3)(iii)(L) adds Nutritionist to the list of
individual professional providers of medical care authorized to provide
services to CHAMPUS beneficiaries.
Section 199.6(c)(3)(iii)(M) adds Registered Dietitian to the list
of individual professional providers of medical care authorized to
provide services to CHAMPUS beneficiaries.
Public Comments
A proposed rule (74 FR 44798-44800) was published on August 31,
2009, and provided a 60-day comment period. No comments were received.
Regulatory Procedures
Executive Order 12866, ``Regulatory Planning and Review''
Section 801 of Title 5, United States Code (U.S.C.), and Executive
Order (E.O.) 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 significant regulatory
action.
Public Law 96-354, ``Regulatory Flexibility Act'' (RFA) (5 U.S.C. 601)
Public Law (Pub. L.) 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 final rule will not have a significant impact on a substantial
number of small entities. Therefore, this final 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 Pub. L. 96-511, ``Paperwork Reduction
Act'' (44 U.S.C. Chapter 35).
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 final 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 final rule is
not subject to this requirement.
Executive Order 13132, ``Federalism''
E.O. 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 final rule does not have
federalism implications, as set forth in E.O. 13132.
List of Subjects in 32 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--[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 199.4 is amended by adding paragraph (d)(3)(ix), and
revising paragraph (g)(39) to read as follows:
Sec. 199.4 Basic program benefits.
* * * * *
(d) * * *
(3) * * *
(ix) Diabetes Self-Management Training (DSMT). A training service
or program that educates diabetic patients about the successful self-
management of diabetes. It includes the following criteria: Education
about self-monitoring of blood glucose, diet, and exercise; an insulin
treatment plan developed specifically for the patient who is insulin-
dependent; and motivates the patient to use the skills for self-
management. The DSMT service or program must be accredited by the
American Diabetes Association.
Coverage limitations on the provision of this benefit will be as
determined by the Director, TRICARE Management Activity, or designee.
* * * * *
(g) * * *
(39) Counseling. Counseling services that are not medically
necessary in the treatment of a diagnosed medical
[[Page 47460]]
condition: For example, educational counseling, vocational counseling,
nutritional counseling, and counseling for socioeconomic purposes,
stress management, lifestyle modification. Services provided by a
certified marriage and family therapist, pastoral, or mental health
counselor in the treatment of a mental disorder are covered only as
specifically provided in Section 199.6. Services provided by alcoholism
rehabilitation counselors are covered only when rendered in a CHAMPUS-
authorized treatment setting and only when the cost of those services
is included in the facility's CHAMPUS-determined allowable cost rate.
* * * * *
0
3. Section 199.6 is amended by adding paragraphs (c)(3)(iii)(L) and (M)
to read as follows:
Sec. 199.6 TRICARE-authorized providers.
* * * * *
(c) * * *
(3) * * *
(iii) * * *
(L) Nutritionist. A nutritionist may provide DSMT via an accredited
DSMT program. The nutritionist must be licensed by the State in which
the care is provided, and must be under the supervision of a physician
who is overseeing the DSMT program.
(M) Registered Dietitian. A dietitian may provide DSMT via an
accredited DSMT program. The dietitian must be licensed by the State in
which the care is provided, and must be under the supervision of a
physician who is overseeing the DSMT program.
* * * * *
Dated: July 26, 2010.
Patricia L. Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2010-19311 Filed 8-5-10; 8:45 am]
BILLING CODE 5001-06-P
