TRICARE; TRICARE Delivery of Health Care in Alaska, 50883-50884 [2010-20391]

Download as PDF Federal Register / Vol. 75, No. 159 / Wednesday, August 18, 2010 / Rules and Regulations 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 199.3 is amended by adding paragraphs (e)(1)(v) and (e)(1)(vi) to read as follows: ■ § 199.3 Eligibility. * * * * * (e) * * * (1) * * * (v) A member who receives a sole survivorship discharge (as defined in section 1174(i) of this title). (vi) A member who is separated from Active Duty who agrees to become a member of the Selected Reserve of the Ready Reserve of a reserve component. * * * * * Dated: August 10, 2010. Patricia L. Toppings, OSD Federal Register Liaison Officer, Department of Defense. [FR Doc. 2010–20393 Filed 8–17–10; 8:45 am] BILLING CODE 5001–06–P DEPARTMENT OF DEFENSE Office of the Secretary 32 CFR Part 199 [Docket ID: DoD–2008–HA–0123] RIN 0720–AB29 TRICARE; TRICARE Delivery of Health Care in Alaska Office of the Secretary, Department of Defense. ACTION: Final rule. erowe on DSK5CLS3C1PROD with RULES AGENCY: TRICARE has recognized the unique circumstances existing in Alaska which make the provision of medical care to TRICARE beneficiaries through the TRICARE program operated in the other 49 states unrealistic. Recognizing SUMMARY: VerDate Mar<15>2010 15:12 Aug 17, 2010 Jkt 220001 50883 these unique conditions and circumstances, the Department of Defense has conducted a demonstration project in the state of Alaska since implementation of the TRICARE program under which certain exceptions have been made for administration of the program in Alaska. This rule incorporates the waiver of the requirement for financial underwriting by a TRICARE contractor as a permanent change to the administration of the TRICARE program in Alaska. This rule proposes no change to the TRICARE benefit or to those who are eligible for it. However, the rule does eliminate the financial underwriting of health care costs in the state of Alaska by a TRICARE contractor. DATES: Effective Date: September 17, 2010. FOR FURTHER INFORMATION CONTACT: LTC Stephen Oates, TRICARE Policy and Operations Directorate, TRICARE Management Activity, 5111 Leesburg Pike, Suite 810, Falls Church, VA 22041, telephone (703) 681–0039. SUPPLEMENTARY INFORMATION: designate civilian primary care managers (PCMs) would improve the access to care for eligible beneficiaries. Policies are currently being reviewed to assess the feasibility of incorporating such practices without adversely affecting the local community. Comment: Certified Nurse Midwives and state-licensed direct-entry midwives are underutilized alternatives to physician-led care for pregnant women. Also, TRICARE’s authorized providers should be expanded to include state-licensed midwives. Response: We understand the limited choices available to beneficiaries in the state of Alaska; however, the ultimate decision remains with the beneficiary on provider selection. In order for a Certified Nurse Midwife to become a TRICARE-authorized provider, he/she must be licensed, when required, by a local licensing agency and certified by the American College of Nurse Midwives. I. Introduction and Background In recognition of the unique geographical and environmental characteristics of the state of Alaska, the Department of Defense has conducted a demonstration project which tested the viability of implementing the TRICARE program differently in Alaska (see Federal Register, Vol. 69, No. 96/ Tuesday, May 18, 2004/Notices). To date that demonstration has supported the impracticability and lack of cost effectiveness to impose on a TRICARE contractor the financial underwriting of the delivery of health care resulting from costs associated with the TRICARE program over which the contractor has no control. The demonstration is authorized until March 31, 2011. This rule will make permanent the waiver of the financial underwriting requirement by the TRICARE contractor in the delivery of health care in Alaska. 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 an economically significant rule, however, it is a regulatory action which has been reviewed by the Office of Management and Budget as required under the provisions of E.O. 12866. II. Public Comments The proposed rule was published in the Federal Register (74 FR 62270– 62271) on November 27, 2009, for a 60day comment period. Two comments were submitted and are responded to below. Comment: Alaska TRICARE managers need authorization, as do other states, to designate civilian primary care managers (PCMs) for care unavailable or too distant for the members who are in TRICARE Prime. Response: We agree that allowing TRICARE managers the ability to PO 00000 Frm 00039 Fmt 4700 Sfmt 4700 II. Regulatory Procedures Executive Order 12866, ‘‘Regulatory Planning and Review’’ Section 202, Public Law, 104–4, ‘‘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 tribal governments, in aggregate, or by the private sector, of $100 million or more in any one year. 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 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 E:\FR\FM\18AUR1.SGM 18AUR1 50884 Federal Register / Vol. 75, No. 159 / Wednesday, August 18, 2010 / Rules and Regulations the other 49 states and the District of Columbia. * * * * * proposed rule is not subject to any of these requirements. Paperwork Reduction Act of 1995 (44 U.S.C. 3501–3511) This rule will not impose additional information collection requirements on the public. Executive Order 13132, ‘‘Federalism’’ Dated: August 10, 2010. Patricia L. Toppings, OSD Federal Register Liaison Officer, Department of Defense. [FR Doc. 2010–20391 Filed 8–17–10; 8:45 am] BILLING CODE 5001–06–P We have examined the impact of the 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. DEPARTMENT OF HOMELAND SECURITY Coast Guard 33 CFR Parts 3 and 165 [Docket No. USCG–2010–0351] RIN 1625–ZA25 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: Navigation and Navigable Waters; Technical, Organizational, and Conforming Amendments, Sector Columbia River; Correction AGENCY: ACTION: 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 199.17 is amended by revising the second sentence of paragraph (a)(3), redesignating paragraph (v) as paragraph (w), and by adding a new paragraph (v) to read as follows: ■ TRICARE program erowe on DSK5CLS3C1PROD with RULES * * * * * (a) * * * (3) * * * Its geographical applicability is to all 50 states (except as modified for the state of Alaska under paragraph (v) of this section) and the District of Columbia. * * * * * * * * (v) Administration of the TRICARE program in the state of Alaska. In view of the unique geographical and environmental characteristics impacting the delivery of health care in the state of Alaska, administration of the TRICARE program in the state of Alaska will not include financial underwriting of the delivery of health care by a TRICARE contractor. All other provisions of this section shall apply to administration of the TRICARE program in the state of Alaska as they apply to VerDate Mar<15>2010 15:12 Aug 17, 2010 Jkt 220001 The Coast Guard published in the Federal Register of August 11, 2010, a document concerning non-substantive changes to Title 33 Parts 3 and 165 of the Code of Federal Regulations. That publication contained several errors regarding the name of the Sector that was being disestablished and one being established in its place. In addition, there was an error in amendatory instruction 5. This document corrects these errors. DATES: This correction is effective August 18, 2010. FOR FURTHER INFORMATION CONTACT: If you have questions on this rule, call or e-mail Lt. Matthew Jones, Coast Guard; telephone 206–220–7110, e-mail Matthew.m.jones@uscg.mil. If you have questions on viewing the docket, call Renee V. Wright, Program Manager, Docket Operations, telephone 202–366– 9826. SUPPLEMENTARY INFORMATION: In FR doc 2010–19754 appearing on page 48564 in the issue of Wednesday, August 11, 2010, the following corrections are made: 1. In the document heading on page 48564, correct the subject heading to read ‘‘Navigation and Navigable Waters; Technical, Organizational, and Conforming Amendments, Sector Columbia River.’’ 2. On page 48564, in the first column, revise the summary section to read as follows: ‘‘This rule makes non-substantive changes throughout our regulations. The SUMMARY: PART 199—CIVILIAN HEALTH AND MEDICAL PROGRAM OF THE UNIFORMED SERVICES (CHAMPUS) § 199.17 Coast Guard, DHS. Final rule; correction. PO 00000 Frm 00040 Fmt 4700 Sfmt 4700 purpose of this rule is to make conforming amendments and technical corrections to reflect the combination and renaming of Sector Portland and Group/Air Station Astoria to Sector Columbia River as part of the Coast Guard reorganization.’’ 3. On page 48564, in the second column, revise the discussion of rule section to read as follows: ‘‘This rule revises 33 CFR parts 3 and 165 to reflect changes in Coast Guard internal organizational structure. Sector Portland and Group/Air Station Astoria have been disestablished and Sector Columbia River has been established in their place. The new Sector begins operations on August 23, 2010. This rule revises 33 CFR parts 3 and 165 to reflect the Sector Columbia River and Captain of the Port Zone name change in current regulations. This rule is a technical revision reflecting changes in agency procedure and organization, and does not indicate new authorities nor create any substantive requirements.’’ 4. On page 48565, in the third column, revise amendatory instruction number 5 to read as follows: ‘‘In § 165.1312(b), remove the phrase ‘‘Coast Guard Captain of the Port, Portland’’ and add, in its place, the phrase ‘‘Captain of the Port Columbia River’’.’’ Dated: August 13, 2010. Steve Venckus, Chief, Office of Regulations and Administrative Law, United States Coast Guard. [FR Doc. 2010–20509 Filed 8–17–10; 8:45 am] BILLING CODE P ENVIRONMENTAL PROTECTION AGENCY 40 CFR Part 180 [EPA–HQ–OPP–2008–0601 and EPA–HQ– OPP–2008–0602; FRL–8836–3] 2-(2’-hydroxy-3’, 5’-di-tert-amylphenyl) benzotriazole and Phenol, 2-(2Hbenzotriazole-2-yl)-6-dodecyl-4-methyl; Exemption from the Requirement of a Tolerance Environmental Protection Agency (EPA). ACTION: Final rule. AGENCY: This regulation establishes an exemption from the requirement of a tolerance for residues of 2-(2’-hydroxy3’, 5’-di-tert-amylphenyl) benzotriazole (CAS Reg. No. 25973–55–1) and Phenol, 2-(2H-benzotriazole-2-yl)-6-dodecyl-4methyl; (CAS Reg. No. 23328–53–2) when used as a ultraviolet (UV) SUMMARY: E:\FR\FM\18AUR1.SGM 18AUR1

Agencies

[Federal Register Volume 75, Number 159 (Wednesday, August 18, 2010)]
[Rules and Regulations]
[Pages 50883-50884]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2010-20391]


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DEPARTMENT OF DEFENSE

Office of the Secretary

32 CFR Part 199

[Docket ID: DoD-2008-HA-0123]
RIN 0720-AB29


TRICARE; TRICARE Delivery of Health Care in Alaska

AGENCY: Office of the Secretary, Department of Defense.

ACTION: Final rule.

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

SUMMARY: TRICARE has recognized the unique circumstances existing in 
Alaska which make the provision of medical care to TRICARE 
beneficiaries through the TRICARE program operated in the other 49 
states unrealistic. Recognizing these unique conditions and 
circumstances, the Department of Defense has conducted a demonstration 
project in the state of Alaska since implementation of the TRICARE 
program under which certain exceptions have been made for 
administration of the program in Alaska. This rule incorporates the 
waiver of the requirement for financial underwriting by a TRICARE 
contractor as a permanent change to the administration of the TRICARE 
program in Alaska. This rule proposes no change to the TRICARE benefit 
or to those who are eligible for it. However, the rule does eliminate 
the financial underwriting of health care costs in the state of Alaska 
by a TRICARE contractor.

DATES: Effective Date: September 17, 2010.

FOR FURTHER INFORMATION CONTACT: LTC Stephen Oates, TRICARE Policy and 
Operations Directorate, TRICARE Management Activity, 5111 Leesburg 
Pike, Suite 810, Falls Church, VA 22041, telephone (703) 681-0039.

SUPPLEMENTARY INFORMATION: 

I. Introduction and Background

    In recognition of the unique geographical and environmental 
characteristics of the state of Alaska, the Department of Defense has 
conducted a demonstration project which tested the viability of 
implementing the TRICARE program differently in Alaska (see Federal 
Register, Vol. 69, No. 96/Tuesday, May 18, 2004/Notices). To date that 
demonstration has supported the impracticability and lack of cost 
effectiveness to impose on a TRICARE contractor the financial 
underwriting of the delivery of health care resulting from costs 
associated with the TRICARE program over which the contractor has no 
control. The demonstration is authorized until March 31, 2011. This 
rule will make permanent the waiver of the financial underwriting 
requirement by the TRICARE contractor in the delivery of health care in 
Alaska.

II. Public Comments

    The proposed rule was published in the Federal Register (74 FR 
62270-62271) on November 27, 2009, for a 60-day comment period. Two 
comments were submitted and are responded to below.
    Comment: Alaska TRICARE managers need authorization, as do other 
states, to designate civilian primary care managers (PCMs) for care 
unavailable or too distant for the members who are in TRICARE Prime.
    Response: We agree that allowing TRICARE managers the ability to 
designate civilian primary care managers (PCMs) would improve the 
access to care for eligible beneficiaries. Policies are currently being 
reviewed to assess the feasibility of incorporating such practices 
without adversely affecting the local community.
    Comment: Certified Nurse Midwives and state-licensed direct-entry 
midwives are underutilized alternatives to physician-led care for 
pregnant women. Also, TRICARE's authorized providers should be expanded 
to include state-licensed midwives.
    Response: We understand the limited choices available to 
beneficiaries in the state of Alaska; however, the ultimate decision 
remains with the beneficiary on provider selection. In order for a 
Certified Nurse Midwife to become a TRICARE-authorized provider, he/she 
must be licensed, when required, by a local licensing agency and 
certified by the American College of Nurse Midwives.

II. 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 an economically significant 
rule, however, it is a regulatory action which has been reviewed by the 
Office of Management and Budget as required under the provisions of 
E.O. 12866.

Section 202, Public Law, 104-4, ``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 tribal 
governments, in aggregate, or by the private sector, of $100 million or 
more in any one year.

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 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

[[Page 50884]]

proposed rule is not subject to any of these requirements.

Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3511)

    This rule will not impose additional information collection 
requirements on the public.

Executive Order 13132, ``Federalism''

    We have examined the impact of the 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 199.17 is amended by revising the second sentence of 
paragraph (a)(3), redesignating paragraph (v) as paragraph (w), and by 
adding a new paragraph (v) to read as follows:


Sec.  199.17  TRICARE program

* * * * *
    (a) * * *
    (3) * * * Its geographical applicability is to all 50 states 
(except as modified for the state of Alaska under paragraph (v) of this 
section) and the District of Columbia. * * *
* * * * *
    (v) Administration of the TRICARE program in the state of Alaska. 
In view of the unique geographical and environmental characteristics 
impacting the delivery of health care in the state of Alaska, 
administration of the TRICARE program in the state of Alaska will not 
include financial underwriting of the delivery of health care by a 
TRICARE contractor. All other provisions of this section shall apply to 
administration of the TRICARE program in the state of Alaska as they 
apply to the other 49 states and the District of Columbia.
* * * * *

    Dated: August 10, 2010.
Patricia L. Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2010-20391 Filed 8-17-10; 8:45 am]
BILLING CODE 5001-06-P