TRICARE: Unfortunate Sequelae From Noncovered Services in a Military Treatment Facility, 57642-57643 [2011-23762]
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Federal Register / Vol. 76, No. 180 / Friday, September 16, 2011 / Rules and Regulations
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
Office of the Secretary,
Department of Defense.
ACTION: Final rule.
AGENCY:
The Department of Defense is
publishing this final 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 final 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 procedures, even when
those procedures were conducted in a
Department of Defense facility.
DATES: Effective Date: This rule is
effective October 17, 2011.
FOR FURTHER INFORMATION CONTACT: Ms.
´
Rene Morrell, TRICARE Management
Activity, Medical Benefits and
Reimbursement Branch, telephone (303)
676–3618.
SUPPLEMENTARY INFORMATION:
erowe on DSK2VPTVN1PROD with RULES
SUMMARY:
I. Background
In the Federal Register of August 6,
2010, (75 FR 47519–47520), the Office
of the Secretary of Defense published for
public comment a 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.
In order to support Graduate Medical
Education and maintain provider skill
levels, MTF providers are frequently
required to perform medical procedures
that may be excluded from coverage
VerDate Mar<15>2010
13:06 Sep 15, 2011
Jkt 223001
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 final
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 https://
www.tricare.mil.
II. Public Comments
We provided a 60-day public
comment period following publication
of the Proposed Rule in the Federal
Register (75 FR 47519–47520) on
August 6, 2010. One comment was
received in full support of the rule.
III. Regulatory Procedures
Executive Order 12866, ‘‘Regulatory
Planning and Review’’ and Executive
Order 13563, ‘‘Improving Regulation
and Regulatory 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 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’’
Section 202 of Public Law 104–4,
‘‘Unfunded Mandates Reform Act,’’
requires that an analysis be performed
PO 00000
Frm 00018
Fmt 4700
Sfmt 4700
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 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 to
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 will
not significantly impact 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 significant
additional information collection
requirements on the public under the
Paperwork Reduction Act of 1995 (44
U.S.C. 3501–3511).
Executive Order 13132, ‘‘Federalism’’
This rule has been examined for its
impact under E.O. 13132 and 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 in the
distribution of power and
responsibilities among the various
levels of government; therefore,
consultation with the 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 199.4 is amended by:
a. Redesignating paragraph (e)(9) as
paragraph (e)(9)(i)
■ b. Adding new paragraph (e)(9)(ii)
■
■
§ 199.4
*
Basic program benefits.
*
*
(e) * * *
E:\FR\FM\16SER1.SGM
16SER1
*
*
Federal Register / Vol. 76, No. 180 / Friday, September 16, 2011 / Rules and Regulations
(9) * * *
(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 an 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: August 24, 2011.
Patricia L. Toppings,
OSD Federal Register Liaison Officer,
Department of Defense.
[FR Doc. 2011–23762 Filed 9–15–11; 8:45 am]
BILLING CODE 5001–06–P
DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 199
[Docket ID: DOD–2010–HA–0071; RIN 0720–
AB40]
TRICARE; Changes Included in the
National Defense Authorization Act for
Fiscal Year 2010; Expansion of
Survivor Eligibility Under the TRICARE
Dental Program
Office of the Secretary, DoD.
Final rule.
AGENCY:
ACTION:
The Department is publishing
this final rule to implement the National
Defense Authorization Act for Fiscal
Year 2010 (NDAA for FY10), as
amended by the National Defense
Authorization Act for Fiscal Year 2011
(NDAA for FY11). Specifically, that
legislation expands the survivor
eligibility under the TRICARE Dental
Program (TDP). The 2011 amendment to
the legislation entitles the surviving
spouse and child(ren) continuation of
eligibility for the TDP regardless of
whether they were previously enrolled
in the TDP. Prior enrollment in the TDP
had been a requirement of the 2010
legislation for both the spouse and
children. The period of continued
eligibility for a spouse will be 3 years
beginning on the date of the member’s
death. The legislation entitles a child to
continuation of eligibility for the TDP
for the longer of three years or until age
21 (or 23 for most full-time students).
Survivors, who meet the new eligibility
requirements, will obtain TDP eligibility
as of the publishing of the final rule in
the Federal Register. Retroactive
erowe on DSK2VPTVN1PROD with RULES
SUMMARY:
VerDate Mar<15>2010
13:06 Sep 15, 2011
Jkt 223001
payment of premiums or claims paid for
dental treatment during the time of loss
of TDP eligibility will not be reimbursed
to surviving dependents.
DATES: Effective Date: This rule is
effective October 17, 2011.
FOR FURTHER INFORMATION CONTACT: Col.
Jeffrey Chaffin, TRICARE Management
Activity, telephone (703) 681–0039.
SUPPLEMENTARY INFORMATION: This final
rule implements section 704 of the
National Defense Authorization Act for
Fiscal Year 2010 (NDAA for FY10),
Public Law 111–84, as amended by
Section 703 of the National Defense
Authorization Act for Fiscal Year 2011
(NDAA for FY11), Public Law 111–83.
I. Background
This final rule expands the survivor
eligibility under the TRICARE Dental
Program (TDP). The legislation entitles
the surviving spouse and child(ren)
continuation of eligibility for the TDP
regardless of whether they were
previously enrolled in the TDP. Prior
enrollment in the TDP had been a
requirement of the 2010 legislation for
both the spouse and children. The
period of continued eligibility for
spouse will be 3 years beginning on the
date of the member’s death. The period
of continued eligibility for children will
be 3 years beginning on the date of the
member’s death or until age 21 (or age
23 for most full-time students).
The final rule will maintain the
government’s payment of both the
government and dependent’s portion of
the premium share during the period of
continuous enrollment.
II. Public Comments
The proposed rule was published in
the Federal Register on August 18,
2010, for a 60-day comment period. We
received one comment expressing
support of the extended eligibilities.
III. Regulatory Procedures
Executive Orders 12866 and 13563 and
Regulatory Flexibility Act
Executive Orders 12866 and 13563
require that a comprehensive regulatory
impact analysis be performed on any
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 a significant regulatory
PO 00000
Frm 00019
Fmt 4700
Sfmt 4700
57643
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.
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).
EO 13132, ‘‘Federalism’’
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:
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 199.13 is amended by
revising paragraph (c)(3)(ii)(E)(2) to read
as follows:
■
§ 199.13
TRICARE Dental Program.
*
*
*
*
*
(c) * * *
(3) * * *
(ii) * * *
(E) * * *
(2) Continuation of eligibility. Eligible
dependents of active duty members who
die while on active duty for a period of
more than 30 days and eligible
dependents of members of the Ready
Reserve (i.e., Selected Reserve or
Individual Ready Reserve, as specified
in 10 U.S.C. 10143 and 10144(b)
respectively) who die, shall be eligible
for continued enrollment in the TDP.
This continued enrollment shall be up
to (3) three years from the date of the
member’s death, except that, in the case
of a dependent of the deceased who is
described in 10 U.S.C. section 1072(2)
by subparagraph (D) or (I), the period of
continued enrollment shall be the
longer of the following periods
E:\FR\FM\16SER1.SGM
16SER1
]]>Agencies
[Federal Register Volume 76, Number 180 (Friday, September 16, 2011)]
[Rules and Regulations]
[Pages 57642-57643]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-23762]
[[Page 57642]]
-----------------------------------------------------------------------
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: Final rule.
-----------------------------------------------------------------------
SUMMARY: The Department of Defense is publishing this final 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 final 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 procedures,
even when those procedures were conducted in a Department of Defense
facility.
DATES: Effective Date: This rule is effective October 17, 2011.
FOR FURTHER INFORMATION CONTACT: Ms. Ren[eacute] Morrell, TRICARE
Management Activity, Medical Benefits and Reimbursement Branch,
telephone (303) 676-3618.
SUPPLEMENTARY INFORMATION:
I. Background
In the Federal Register of August 6, 2010, (75 FR 47519-47520), the
Office of the Secretary of Defense published for public comment a
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.
In order to support Graduate Medical Education and maintain
provider skill levels, 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 final 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 https://www.tricare.mil.
II. Public Comments
We provided a 60-day public comment period following publication of
the Proposed Rule in the Federal Register (75 FR 47519-47520) on August
6, 2010. One comment was received in full support of the rule.
III. Regulatory Procedures
Executive Order 12866, ``Regulatory Planning and Review'' and Executive
Order 13563, ``Improving Regulation and Regulatory 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 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''
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 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 to 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 will not significantly impact 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 significant additional information
collection requirements on the public under the Paperwork Reduction Act
of 1995 (44 U.S.C. 3501-3511).
Executive Order 13132, ``Federalism''
This rule has been examined for its impact under E.O. 13132 and
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 in the distribution
of power and responsibilities among the various levels of government;
therefore, consultation with the 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]
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:
0
a. Redesignating paragraph (e)(9) as paragraph (e)(9)(i)
0
b. Adding new paragraph (e)(9)(ii)
Sec. 199.4 Basic program benefits.
* * * * *
(e) * * *
[[Page 57643]]
(9) * * *
(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
an 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: August 24, 2011.
Patricia L. Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2011-23762 Filed 9-15-11; 8:45 am]
BILLING CODE 5001-06-P
