TRICARE; TRICARE Sanction Authority for Third-Party Billing Agents, 58202-58204 [2011-23763]
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58202
Federal Register / Vol. 76, No. 182 / Tuesday, September 20, 2011 / Proposed Rules
suggested actions and motivational
counseling to enhance the chances of a
successful quit attempt. When
appropriate, quit line counselors will
refer beneficiaries to a TRICAREauthorized provider for medical
intervention. The quit line may, at the
discretion of the Director, TMA, include
the opportunity for the beneficiary to
request individual follow-up contact
initiated by quit line personnel;
however, the beneficiary is not required
to participate in the quit line initiated
follow-up. Printed educational materials
on the effects of tobacco use will be
provided to the beneficiary upon
request. This benefit may be made
available to overseas Prime beneficiaries
should the ASD(HA) exercise his
authority to do so and provide
appropriate notice in the Federal
Register.
(D) Web-based resources.
Downloadable educational materials on
the effects of tobacco use will be
available through the Internet or other
electronic media. This service may be
made available to overseas Prime
beneficiaries in all locations where Web
based resources are available. There
shall be no requirement to create Web
based resources in any geographic area
in order to make this service available.
(iii) Limitations of smoking cessation
program. Eligible beneficiaries are
entitled to two quit attempts per year
(consecutive 12 month period). A third
quit attempt may be covered per year
with physician justification and preauthorization. A quit attempt is defined
as up to eighteen face-to-face counseling
sessions over a 120 consecutive day
period and/or 120 days of
pharmacologic intervention for the
purpose of smoking cessation.
Counseling and pharmacological
treatment periods that overlap by at
least 60-days are considered a single
quit attempt.
*
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*
(g) Exclusions and limitations.
*
*
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*
*
(39) Counseling. Educational,
vocational, and nutritional counseling
and counseling for socioeconomic
purposes, stress management, and/or
lifestyle modification purposes, except
that the following are not excluded:
(i) Services provided by a certified
marriage and family therapist, pastoral
or mental health counselor in the
treatment of a mental disorder as
specifically provided in paragraph
(c)(3)(ix) of this section and in section
199.6 of this Part.
(ii) Diabetes self-management training
(DSMT) as specifically provided in
paragraph (d)(3)(ix) of this section.
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(iii) Smoking cessation counseling
and education as specifically provided
in paragraph (e)(28) of this section.
(iv) Services provided by alcoholism
rehabilitation counselors 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.
*
*
*
*
*
(65) [Reserved]
*
*
*
*
*
3. Section 199.21 is amended by:
a. Revising paragraph (a)(2);
b. Revising paragraph (h)(2)(i);
c. Adding a new paragraph (h)(2)(iii);
and
d. Adding a new (i)(2)(v)(D).
The additions and revisions read as
follows:
§ 199.21 TRICARE—Pharmacy Benefits
Program.
(a) General.
(1) * * *
(2) Pharmacy benefits program. (i)
Applicability. The pharmacy benefits
program, which includes the uniform
formulary and its associated tiered copayment structure, is applicable to all of
the uniformed services. Geographically,
except as specifically provided in
paragraph (a)(2)(ii) of this section, this
program is applicable to all 50 states
and the District of Columbia, Guam,
Puerto Rico, and the Virgin Islands. In
addition, if authorized by the Assistant
Secretary of Defense (Health Affairs)
(ASD(HA)), the TRICARE pharmacy
benefits program may be implemented
in areas outside the 50 states and the
District of Columbia, Guam, Puerto
Rico, and the Virgin Islands. In such
case, the ASD (HA) may also authorize
modifications to the pharmacy benefits
program rules and procedures as may be
appropriate to the area involved.
(ii) Applicability exception. The
pharmaceutical benefit under the
TRICARE smoking cessation program
under section 199.4(e)(28) of this Part is
available to TRICARE beneficiaries who
are not entitled to Medicare benefits
authorized under Title XVIII of the
Social Security Act. Except as noted in
section 199.4(e)(28) of this Part, the
smoking cessation program, including
the pharmaceutical benefit, is not
applicable or available to beneficiaries
who reside overseas, including the U.S.
territories of Guam, Puerto Rico, and the
Virgin Islands, except that under the
authority of section 199.17 of this part
active duty service members and active
duty dependents enrolled in TRICARE
Prime residing overseas, including the
U.S. territories of Guam, Puerto Rico,
and the Virgin Islands, shall have access
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to smoking cessation pharmaceuticals
through either an MTF or the TMOP
program where available.
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(h) Obtaining pharmacy services
under the retail network pharmacy
benefits program.
(1) * * *
(2) Availability of formulary
pharmaceutical agents. (i) General.
Subject to paragraphs (h)(2)(ii) and
(h)(2)(iii) of this section, formulary
pharmaceutical agents are available
under the Pharmacy Benefits Program
from all points of service identified in
paragraph (h)(1) of this section.
(ii) * * *
(iii) Pharmaceutical agents prescribed
for smoking cessation are not available
for coverage when obtained through a
retail pharmacy. This includes network
and non-network retail pharmacies.
*
*
*
*
*
(i) Cost-sharing requirements under
the pharmacy benefits program.
(1) * * *
(2) * * *
(v) For pharmaceutical agents
obtained under the TMOP program
there is a:
(A) * * *
(B) * * *
(C) * * *
(D) $0.00 co-payment for smoking
cessation pharmaceutical agents covered
under the smoking cessation program.
*
*
*
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*
Dated: August 24, 2011.
Patricia L. Toppings,
OSD Federal Register Liaison Officer,
Department of Defense.
[FR Doc. 2011–23764 Filed 9–19–11; 8:45 am]
BILLING CODE 5001–06–P
DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 199
[Docket ID: DOD–2011–HA–0035]
RIN 0720–AB49
TRICARE; TRICARE Sanction
Authority for Third-Party Billing Agents
Office of the Secretary,
Department of Defense.
ACTION: Proposed rule.
AGENCY:
The rule proposes to provide
the Director, TRICARE Management
Activity (TMA), or designee, with the
authority to sanction third-party billing
agents by invoking the administrative
remedy of exclusion or suspension from
the TRICARE program. Such sanctions
SUMMARY:
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Federal Register / Vol. 76, No. 182 / Tuesday, September 20, 2011 / Proposed Rules
mstockstill on DSK4VPTVN1PROD with PROPOSALS
may be invoked in situations involving
fraud or abuse on the part of third-party
billing agents that prepare or submit
claims presented to TRICARE for
payment.
DATES: Written comments received at
the address indicated below by
November 21, 2011 will be accepted.
ADDRESSES: You may submit comments,
identified by docket number and or
Regulatory Information Number (RIN)
number and title, by either of the
following methods:
• Federal eRulemaking Portal: https://
www.regulations.gov. Follow the
instructions for submitting comments.
• Mail: Federal Docket Management
System Office, 4800 Mark Center Drive,
2nd Floor, East Tower, Suite 02G09,
Alexandria, VA 22350–3100.
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: Ms.
Joy Saly, TRICARE Management
Activity, Medical Benefits and
Reimbursement Branch, telephone (303)
676–3742.
SUPPLEMENTARY INFORMATION:
I. Background
TRICARE has regulatory authority
under 32 CFR 199.9 to invoke sanctions
in situations involving fraud or abuse on
the part of providers of TRICARE
services. A provider is defined in 32
CFR 199.2 as, ‘‘A hospital or other
institutional provider, a physician, or
other individual professional provider,
or other provider of services or supplies
as specified in Sec 199.6 of this part.’’
Third-party billing agents do not meet
the definition of a provider as stated in
32 CFR 199.2, nor do TRICARE
regulations currently define third-party
billing agents.
Title 42 of the CFR subpart C—
Exclusions at 42 CFR 402.200(b)(1)
provides for the imposition of an
exclusion from the Medicare and
Medicaid programs (and, where
applicable, other Federal health care
programs) against persons that violate
the provisions provided in Sec. 402.1(e)
(and further described in Sec. 402.1(c)).
However, TRICARE has to date
established no independent regulatory
authority to sanction or exclude thirdparty billing agents.
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When TRICARE identifies submission
of improper claims by a third-party
billing agent not identified by the
Centers for Medicare and Medicaid
Services (CMS), TRICARE must refer the
case to another Federal agency (Defense
Criminal Investigative Service,
Department of Justice, etc.) for action. In
addition, CMS’ authority extends only
to those third-party billing agents in the
United States because Medicare only
covers care received in the U.S. or its
territories.
II. Department of Defense Inspector
General Report on TRICARE Controls
Over Claims Prepared by Third-party
Billing Agents
The Department of Defense, Office of
Inspector General (DoD IG) initiated an
audit in February 2008 to review
TRICARE controls over claims
submitted by third-party billing agents
(Department of Defense Inspector
General Report No. D–2009–037—
‘‘TRICARE Controls Over Claims
Prepared by Third-Party Billing
Agencies’’). The DoD IG published a
report on December 31, 2008. The report
included a recommendation that the
Director, TMA strengthen internal
controls by initiating action to obtain
statutory or regulatory authority to
sanction billing agencies or any entities
that prepare or submit improper health
care claims to TRICARE contractors.
Statutory authority already exists that
provides the Secretary with the
authority to administer the TRICARE
program to ensure quality of care for
program beneficiaries, including
sanctioning entities determined to be
involved fraud, abuse, or conflict of
interest. TRICARE already has
regulatory authority to invoke sanctions
on providers under 32 CFR 199.9. Based
on the existing statutory authority, TMA
is pursuing a regulatory change that will
provide the authority to ensure both
providers and third-party billing agents
are held accountable for the submission
of correct and proper billings. The
regulatory change proposes to
implement the DoD IG recommendation
by adding third-party billing agents as
another entity under the regulation that
can be sanctioned in situations where
fraud and abuse are identified on the
part of third-party billing agents that
prepare or submit claims presented to
TRICARE for payment.
TRICARE program policy
acknowledges a participating provider
may arrange for a third-party to act on
its behalf in the submission and the
monitoring of third-party claims,
including TRICARE claims. There must
be an agency relationship established in
which the third-party billing agent is
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58203
reimbursed for the submission and
monitoring of claims, but the claim
remains that of the provider and the
proceeds of any third-party payments,
including TRICARE payments, are paid
to the provider. TRICARE contractors
may deal with these agents in much the
same manner as they deal with the
provider’s accounts receivable
department. This proposed rule does
not intend to change the current
acknowledgment of a provider’s right to
use a third-party billing agent as a
separate billing resource.
This rule seeks to establish that such
entities, when acting on behalf of a
provider, are held to an equal standard
in regard to accuracy and honesty when
filing claims for services and supplies
under the TRICARE program. As such,
these entities should be subject to the
same administrative controls applied to
providers in ensuring that funds are
disbursed appropriately. This rule will
allow TRICARE to sanction third-party
billing agents to prevent the payment of
false or improper billings.
Regulatory Procedures
Executive Order 12866, ‘‘Regulatory
Planning and Review’’ and Executive
Order 13563, ‘‘Improving Regulation
and Regulatory Review’’
Section (Sec.) 801 of title 5, United
States Code, 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 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),
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58204
Federal Register / Vol. 76, No. 182 / Tuesday, September 20, 2011 / Proposed Rules
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)
§ 199.9 Administrative Remedies for
Fraud, Abuse, and Conflict of Interest.
*
*
*
*
*
(n) * * * Third-party billing agents as
defined in § 199.2(b) of this part, while
not considered providers, are subject to
the provisions of this section to the
same extent as such provisions apply to
providers.
*
*
*
*
*
Dated: August 24, 2011.
Patricia L. Toppings,
OSD Federal Register Liaison Officer,
Department of Defense.
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).
[FR Doc. 2011–23763 Filed 9–19–11; 8:45 am]
Executive Order 13132, ‘‘Federalism’’
32 CFR Part 199
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 proposed rule does
not have federalism implications, as set
forth in E.O. 13132.
[DOD–2011–HA–0058; RIN 0720–AB51]
List of Subjects in 32 CFR part 199
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 is amended by
adding to paragraph (b), to appear in
alphabetical order, a definition of
‘‘Third-party billing agent,’’ to read as
follows:
Definitions.
mstockstill on DSK4VPTVN1PROD with PROPOSALS
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(b) * * *
Third-party billing agent. Any entity
that acts on behalf of a provider to
prepare, submit and monitor claims,
excluding those entities that act solely
as a collection agency.
*
*
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*
*
3. Section 199.9 is amended by
adding paragraph (n) to read as follows:
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DEPARTMENT OF DEFENSE
Office of the Secretary
TRICARE; Changes Included in the
National Defense Authorization Act for
Fiscal Year 2010; Constructive
Eligibility for TRICARE Benefits of
Certain Persons Otherwise Ineligible
Under Retroactive Determination of
Entitlement to Medicare Part A
Hospital Insurance Benefits
Office of the Secretary,
Department of Defense.
ACTION: Proposed rule.
AGENCY:
The Department is publishing
this proposed rule to implement section
706 of the National Defense
Authorization Act (NDAA) for Fiscal
Year 2010, Public Law 111–84.
Specifically section 706 exempts
TRICARE beneficiaries under the age of
65 who become disabled from the
requirement to enroll in Medicare Part
B for the retroactive months of
entitlement to Medicare Part A in order
to maintain TRICARE coverage. This
statutory amendment and proposed rule
only impact eligibility for the period in
which the beneficiary’s disability
determination is pending before the
Social Security Administration. Eligible
beneficiaries would still be required to
enroll in Medicare Part B in order to
maintain their TRICARE coverage for
future months, but would be considered
to have coverage under the TRICARE
program for the months retroactive to
their entitlement to Medicare Part A.
This proposed rule also amends the
eligibility section of the TRICARE
regulation to more clearly address
reinstatement of TRICARE eligibility
following a gap in coverage due to lack
of enrollment in Medicare Part B.
SUMMARY:
Claims, Dental health, Health care,
Health insurance, Individuals with
disabilities, Military personnel.
Accordingly, 32 CFR part 199 is
proposed to be amended as follows:
§ 199.2
BILLING CODE 5001–06–P
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Written comments received at
the address indicated below by
November 21, 2011 will be accepted.
ADDRESSES: You may submit comments,
identified by docket number or
Regulatory Information Number (RIN)
and title, by any of the following
methods:
The Web site https://
www.regulations.gov. Follow the
instructions for submitting comments.
Mail: Federal Docket Management
System Office, 4800 Mark Center Drive,
2nd Floor, East Tower, Suite 02G09,
Alexandria, VA 22350–3100.
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: Ms.
Anne Breslin, TRICARE Management
Activity (TMA), TRICARE Operations
Branch, telephone (703) 681–0039.
SUPPLEMENTARY INFORMATION: Prior to
the enactment of section 706 of the
National Defense Authorization Act for
Fiscal Year 2010 (Pub. L. 111–84), 10
U.S.C. 1086(d) provided that a person
who would otherwise receive benefits
under section 1086 who is entitled to
Medicare Part A hospital insurance is
not eligible for TRICARE unless the
individual is enrolled in Medicare Part
B. When a TRICARE beneficiary
becomes eligible for Medicare, Medicare
becomes the primary payer and
TRICARE is the secondary payer.
Retroactive Medicare eligibility
determinations therefore caused DoD
and Medicare to reprocess claims.
Section 706 of the Fiscal Year 2010
National Defense Authorization Act
amended 10 U.S.C. 1086(d) to exempt
TRICARE beneficiaries under the age of
65 who became Medicare eligible due to
a retroactive disability determination
from the requirement to enroll in
Medicare Part B for the retroactive
months of entitlement to Medicare Part
A in order to maintain TRICARE
coverage. This statutory amendment
became effective upon enactment of the
Fiscal Year 2010 National Defense
Authorization Act on October 28, 2009.
Prior to this amendment, beneficiaries
who did not purchase Medicare Part B
to cover the retroactive period lost their
TRICARE eligibility during that period
of time. As a result, beneficiaries and
providers were then subject to TRICARE
DATES:
E:\FR\FM\20SEP1.SGM
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]]>Agencies
[Federal Register Volume 76, Number 182 (Tuesday, September 20, 2011)]
[Proposed Rules]
[Pages 58202-58204]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-23763]
-----------------------------------------------------------------------
DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 199
[Docket ID: DOD-2011-HA-0035]
RIN 0720-AB49
TRICARE; TRICARE Sanction Authority for Third-Party Billing
Agents
AGENCY: Office of the Secretary, Department of Defense.
ACTION: Proposed rule.
-----------------------------------------------------------------------
SUMMARY: The rule proposes to provide the Director, TRICARE Management
Activity (TMA), or designee, with the authority to sanction third-party
billing agents by invoking the administrative remedy of exclusion or
suspension from the TRICARE program. Such sanctions
[[Page 58203]]
may be invoked in situations involving fraud or abuse on the part of
third-party billing agents that prepare or submit claims presented to
TRICARE for payment.
DATES: Written comments received at the address indicated below by
November 21, 2011 will be accepted.
ADDRESSES: You may submit comments, identified by docket number and or
Regulatory Information Number (RIN) number and title, by either of the
following methods:
Federal eRulemaking Portal: https://www.regulations.gov.
Follow the instructions for submitting comments.
Mail: Federal Docket Management System Office, 4800 Mark
Center Drive, 2nd Floor, East Tower, Suite 02G09, Alexandria, VA 22350-
3100.
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: Ms. Joy Saly, TRICARE Management
Activity, Medical Benefits and Reimbursement Branch, telephone (303)
676-3742.
SUPPLEMENTARY INFORMATION:
I. Background
TRICARE has regulatory authority under 32 CFR 199.9 to invoke
sanctions in situations involving fraud or abuse on the part of
providers of TRICARE services. A provider is defined in 32 CFR 199.2
as, ``A hospital or other institutional provider, a physician, or other
individual professional provider, or other provider of services or
supplies as specified in Sec 199.6 of this part.'' Third-party billing
agents do not meet the definition of a provider as stated in 32 CFR
199.2, nor do TRICARE regulations currently define third-party billing
agents.
Title 42 of the CFR subpart C--Exclusions at 42 CFR 402.200(b)(1)
provides for the imposition of an exclusion from the Medicare and
Medicaid programs (and, where applicable, other Federal health care
programs) against persons that violate the provisions provided in Sec.
402.1(e) (and further described in Sec. 402.1(c)). However, TRICARE has
to date established no independent regulatory authority to sanction or
exclude third-party billing agents.
When TRICARE identifies submission of improper claims by a third-
party billing agent not identified by the Centers for Medicare and
Medicaid Services (CMS), TRICARE must refer the case to another Federal
agency (Defense Criminal Investigative Service, Department of Justice,
etc.) for action. In addition, CMS' authority extends only to those
third-party billing agents in the United States because Medicare only
covers care received in the U.S. or its territories.
II. Department of Defense Inspector General Report on TRICARE Controls
Over Claims Prepared by Third-party Billing Agents
The Department of Defense, Office of Inspector General (DoD IG)
initiated an audit in February 2008 to review TRICARE controls over
claims submitted by third-party billing agents (Department of Defense
Inspector General Report No. D-2009-037--``TRICARE Controls Over Claims
Prepared by Third-Party Billing Agencies''). The DoD IG published a
report on December 31, 2008. The report included a recommendation that
the Director, TMA strengthen internal controls by initiating action to
obtain statutory or regulatory authority to sanction billing agencies
or any entities that prepare or submit improper health care claims to
TRICARE contractors.
Statutory authority already exists that provides the Secretary with
the authority to administer the TRICARE program to ensure quality of
care for program beneficiaries, including sanctioning entities
determined to be involved fraud, abuse, or conflict of interest.
TRICARE already has regulatory authority to invoke sanctions on
providers under 32 CFR 199.9. Based on the existing statutory
authority, TMA is pursuing a regulatory change that will provide the
authority to ensure both providers and third-party billing agents are
held accountable for the submission of correct and proper billings. The
regulatory change proposes to implement the DoD IG recommendation by
adding third-party billing agents as another entity under the
regulation that can be sanctioned in situations where fraud and abuse
are identified on the part of third-party billing agents that prepare
or submit claims presented to TRICARE for payment.
TRICARE program policy acknowledges a participating provider may
arrange for a third-party to act on its behalf in the submission and
the monitoring of third-party claims, including TRICARE claims. There
must be an agency relationship established in which the third-party
billing agent is reimbursed for the submission and monitoring of
claims, but the claim remains that of the provider and the proceeds of
any third-party payments, including TRICARE payments, are paid to the
provider. TRICARE contractors may deal with these agents in much the
same manner as they deal with the provider's accounts receivable
department. This proposed rule does not intend to change the current
acknowledgment of a provider's right to use a third-party billing agent
as a separate billing resource.
This rule seeks to establish that such entities, when acting on
behalf of a provider, are held to an equal standard in regard to
accuracy and honesty when filing claims for services and supplies under
the TRICARE program. As such, these entities should be subject to the
same administrative controls applied to providers in ensuring that
funds are disbursed appropriately. This rule will allow TRICARE to
sanction third-party billing agents to prevent the payment of false or
improper billings.
Regulatory Procedures
Executive Order 12866, ``Regulatory Planning and Review'' and Executive
Order 13563, ``Improving Regulation and Regulatory Review''
Section (Sec.) 801 of title 5, United States Code, 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 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),
[[Page 58204]]
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''
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 proposed rule does not have
federalism implications, as set forth in E.O. 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 199.2 is amended by adding to paragraph (b), to appear
in alphabetical order, a definition of ``Third-party billing agent,''
to read as follows:
Sec. 199.2 Definitions.
* * * * *
(b) * * *
Third-party billing agent. Any entity that acts on behalf of a
provider to prepare, submit and monitor claims, excluding those
entities that act solely as a collection agency.
* * * * *
3. Section 199.9 is amended by adding paragraph (n) to read as
follows:
Sec. 199.9 Administrative Remedies for Fraud, Abuse, and Conflict of
Interest.
* * * * *
(n) * * * Third-party billing agents as defined in Sec. 199.2(b)
of this part, while not considered providers, are subject to the
provisions of this section to the same extent as such provisions apply
to providers.
* * * * *
Dated: August 24, 2011.
Patricia L. Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2011-23763 Filed 9-19-11; 8:45 am]
BILLING CODE 5001-06-P
