TRICARE; TRICARE Sanction Authority for Third-Party Billing Agents, 12953-12955 [2013-03416]

Download as PDF wreier-aviles on DSK5TPTVN1PROD with RULES Federal Register / Vol. 78, No. 38 / Tuesday, February 26, 2013 / Rules and Regulations affected MTF or MTFs to ensure the proficiency levels of the practitioners at the MTF or MTFs; or (C) Determines that the lack of NAS data would significantly interfere with TRICARE contract administration; and (D) Provides notification of the ASD(HA)’s intent to require an NAS under this authority to covered beneficiaries who receive care at the MTF or MTFs that will be affected by the decision to require an NAS under this authority; and (E) Provides at least 60-day notification to the Committees on Armed Services of the House of Representatives and the Senate of the ASD(HA)’s intent to require an NAS under this authority, the reason for the NAS requirement, and the date that an NAS will be required. (ii) Rules in effect at the time civilian medical care is provided apply. The applicable rules and regulations regarding Nonavailability Statements in effect at the time the civilian care is rendered apply in determining whether a NAS is required. (iii) The Director, TMA is responsible for issuing the procedural rules and regulations regarding Nonavailability Statements. Such rules and regulations should address: (A) When and for what services a NAS is required. However, a NAS may not be required for services otherwise available at an MTF located within a 40mile radius of the beneficiary’s residence when another insurance plan or program provides the beneficiary’s primary coverage for the services. This requirement for an NAS does not apply to beneficiaries enrolled in TRICARE Prime, even when those beneficiaries use the point-of-service option under § 199.17(n)(3) of this part; and (B) When and how notifications will be made to a beneficiary who is not enrolled in TRICARE Prime as to whether or not he or she resides in a geographic area that requires obtaining a NAS; and (C) What information relating to claims submissions, including the documentation, if any, that is required to document that a valid NAS was issued. However, when documentation of a NAS is required, then that documentation shall be valid for the adjudication of CHAMPUS claims for all related care otherwise authorized by this part which is received from a civilian source while the beneficiary resided within the Uniformed Service facility catchment area which issued the NAS. (iv) In the case of any service subject to a NAS requirement under this paragraph (a)(9) and also subject to a VerDate Mar<15>2010 14:06 Feb 25, 2013 Jkt 229001 preadmission (or other pre-service) authorization requirement under § 199.4 or § 199.15 of this part, the administrative processes for the NAS and pre-service authorization may be combined. * * * * * Dated: February 1, 2013. Patricia L. Toppings, OSD Federal Register Liaison Officer, Department of Defense. [FR Doc. 2013–03418 Filed 2–25–13; 8:45 am] BILLING CODE 5001–06–P 12953 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 § 402.1(e) (and further described in § 402.1(c)). However, TRICARE had no independent regulatory authority to sanction or exclude third-party billing agents. This final rule provides that authority. DEPARTMENT OF DEFENSE B. Summary of Major Provisions Office of the Secretary This final rule establishes 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. 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: Final rule. AGENCY: SUMMARY: This final rule will 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 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: Effective date: This rule is effective March 28, 2013. FOR FURTHER INFORMATION CONTACT: Ms. Ann N. Fazzini, Medical Benefits and Reimbursement Branch, TMA, telephone, (303) 676–3803. SUPPLEMENTARY INFORMATION: I. Executive Summary and Overview A. Purpose of the Regulatory Action As stated in the proposed rule, TRICARE has regulatory authority under 32 Code of Federal Regulations (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 § 199.6 of this part.’’ Thirdparty billing agents do not meet the definition of a provider as stated in 32 CFR 199.2, nor do TRICARE regulations PO 00000 Frm 00021 Fmt 4700 Sfmt 4700 C. Summary of Costs and Benefits By expanding the scope of sanctioning authority to include thirdparty billing agents, TRICARE costs are not anticipated to increase in this area. Rather, by expanding the sanctioning authority to include third-party billing agents in situations of fraud or abuse, the program is safeguarding benefit dollars from being expended for fraudulent or abusive charges. The anticipated result of this final rule is a savings benefit to the program. 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. E:\FR\FM\26FER1.SGM 26FER1 wreier-aviles on DSK5TPTVN1PROD with RULES 12954 Federal Register / Vol. 78, No. 38 / Tuesday, February 26, 2013 / Rules and Regulations III. Review of Public Comments In the Federal Register of September 20, 2011, (76 FR 58202), the Office of the Secretary of Defense published for public comment a Proposed Rule regarding sanction authority for thirdparty billing agents. We received one comment on the proposed rule. The commenter recommended that the Code of Federal Regulations (CFR) rule be expanded to prohibit sanctioned providers or third party billing agents from pursing collection activities against patients in the event that sanctions are implemented. We appreciate this comment and note that there is presently policy and regulations that address this issue. By their very nature, third-party billing agents have a contractual relationship with the health care provider that requires them to file claims on behalf of the provider. This should normally require that the thirdparty billing agreement meet the claims filing requirements of the entity or agency that would be paying the claim. In the case of a DoD beneficiary, claims must be filed in accordance with the Code of Federal Regulations, including the requirements relating to the maximum allowable payments and any balance billing limitations. Additionally, TRICARE benefit payments are payable directly to the provider, not the third-party billing agent, as federal regulations prohibit the general assignment of claims. The agent has no independent right to payment from either TRICARE or the beneficiary. Per 32 CFR 199.9(h)(4)(i)(c), participating providers are considered to have forfeited or waived any right or entitlement to bill TRICARE beneficiaries for care involved in claims for services furnished on or after the effective date of the provider’s exclusion or suspension. As a result, any thirdparty billing agent purporting to act on behalf of a sanctioned provider would also be prohibited from billing TRICARE beneficiaries on behalf of that provider. Additionally, if the proposed authority to sanction third-party billing agents is invoked, a suspended or excluded thirdparty billing agent would also be prohibited from submitting a claim to TRICARE on behalf of any authorized provider or to bill any TRICARE beneficiary directly. Any claim received from an excluded third-party billing agent would be returned to the provider with instructions to resubmit the claim directly or through another third-party billing agent. As long as the provider of services has not been sanctioned and remains an authorized TRICARE provider pursuant to the requirements VerDate Mar<15>2010 14:06 Feb 25, 2013 Jkt 229001 in 32 CFR 199.6, the provider remains entitled to reimbursement for covered services. Under either of these scenarios, TRICARE beneficiaries should not be subject to collection actions. It is also important to note that the authority sought under the proposed rule to sanction third-party billing agents by invoking administrative remedies under 32 CFR 199.9 is in addition to, and not in lieu of, any other remedies or sanctions authorized by law or regulation, including potential criminal convictions and civil judgments for fraud and abuse. IV. Regulatory Procedures Executive Order 12866, ‘‘Regulatory Planning and Review’’ and Executive Order 13563, ‘‘Improving Regulation and Regulatory Review’’ Sec. 801 of Title 5, United States Code (U.S.C.), and Executive Orders 12866 and 13563 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 of which would have other substantial impacts. This final 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 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 rule is not subject to this requirement. Public Law 96–354, ‘‘Regulatory Flexibility Act’’ (RFA) (5 U.S.C. 601) Public Law 96–351, ‘‘Regulatory Flexibility Act’’ (RFA) (5 U.S.C. 601), requires each Federal agency to 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 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 final rule is not subject to the requirements of RFA. PO 00000 Frm 00022 Fmt 4700 Sfmt 4700 Public Law 96–511, ‘‘Paperwork Reduction Act’’ (44 U.S.C. Chapter 35) This final rule does not contain a ‘‘collection of information’’ requirement, and will not impose additional information collection requirement 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 final 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, DoD amends 32 CFR part 199 as follows: PART 199—CIVILIAN HEALTH AND MEDICAL PROGRAM OF THE UNIFORMED SERVICES (CHAMPUS) 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 in alphabetical order to paragraph (b), a definition of ‘‘Third-party billing agent’’ to read as follows: ■ § 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: ■ § 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. E:\FR\FM\26FER1.SGM 26FER1 Federal Register / Vol. 78, No. 38 / Tuesday, February 26, 2013 / Rules and Regulations Dated: February 1, 2013. Patricia L. Toppings, OSD Federal Register Liaison Officer, Department of Defense. [FR Doc. 2013–03416 Filed 2–25–13; 8:45 am] BILLING CODE 5001–06–P DEPARTMENT OF EDUCATION 34 CFR Chapter IV [Docket ID ED–2012–OVAE–0053] Final Requirements, Definitions, and Selection Criteria—Native American Career and Technical Education Program (NACTEP) [Catalog of Federal Domestic Assistance (CFDA) Number: 84.101A.] Office of Vocational and Adult Education, Department of Education. ACTION: Final requirements, definitions, and selection criteria. wreier-aviles on DSK5TPTVN1PROD with RULES AGENCY: SUMMARY: The Assistant Secretary for Vocational and Adult Education announces requirements, definitions, and selection criteria under the Native American Career and Technical Education Program (NACTEP). The Assistant Secretary may use these requirements, definitions, and selection criteria for a competition in fiscal year (FY) 2013 and possibly in later years. We take this action to notify all interested parties and eligible applicants in particular, of the requirements, definitions, and selection criteria that we may use in upcoming competitions under section 116 of the Carl D. Perkins Career and Technical Education Act of 2006 (the Act). DATES: Effective Date: March 28, 2013. FOR FURTHER INFORMATION CONTACT: Gwen Washington, by telephone: (202) 245–7790, or by email: gwen.washingon@ed.gov; or Linda Mayo, by telephone: (202) 245–7792, or by email: linda.mayo@ed.gov. If you use a telecommunications device for the deaf (TDD) or a text telephone (TTY), call the Federal Relay Service (FRS), toll free, at 1–800–877– 8339. SUPPLEMENTARY INFORMATION: Purpose of Program: Under NACTEP, the Secretary provides grants, cooperative agreements, or enters into contracts with Indian tribes, tribal organizations, or Alaska Native entities to improve career and technical education programs that are consistent with the purposes of the Act and that benefit Native Americans and Alaska Natives. Program Authority: 20 U.S.C. 2301 et seq., particularly 2326(a)–(g). VerDate Mar<15>2010 14:06 Feb 25, 2013 Jkt 229001 We published a notice of proposed requirements, definitions, and selection criteria for this program in the Federal Register on November 20, 2012 (77 FR 69579) (November 20, 2012 Notice), which contained background information and our reasons for proposing our requirements, definitions, and selection criteria. Except for minor technical changes, there are no differences between the proposed requirements, definitions, and selection criteria and the final requirements, definitions and selection criteria. Public Comment: In response to our invitation in the November 20, 2012 Notice, we received three comments in support of our proposals and one request for clarification of certain elements of our Notice. The following is a discussion of those comments with our responses. We made no changes in response to comments we received. Analysis of Comments: Comment: Two comments we received were from current NACTEP grantees supporting our proposed requirements, definitions, and selection criteria. These commenters indicated that their current NACTEP grants had enabled them to serve the career and technical education needs of their Indian student populations in the face of high unemployment rates and great need for career and technical education. One of the commenters represented a reservation with an unemployment rate of 66 percent where most reservation inhabitants are living in poverty. This commenter indicated that its current NACTEP grant had had a considerable positive effect on the reservation and members of the commenters’ tribe by preparing the tribe’s students to fulfill expected local workforce needs during the period covered by the current grant. Both commenters agreed with the Department’s proposed approach of retaining programmatic elements developed for the first NACTEP competition following enactment of the Act for grant competitions funded with appropriations under this statute. Discussion: We agree with the commenters, and in this notice we announce as final the NACTEP requirements, definitions, and selection criteria we proposed in our November 20, 2012 Notice. Change: None. Comment: We received one comment saying that the approach of retaining current requirements developed following the 2006 reauthorization of the Act was one of consistency and strength and would provide for program continuity. This commenter expressed the view that the Department’s approach PO 00000 Frm 00023 Fmt 4700 Sfmt 4700 12955 had worked well for NACTEP and that there was no need to make changes. The commenter also requested that the Department not impose a page limit for applications in the next competition so as to allow applicants the greatest flexibility in their applications. Discussion: With regard to the comment about our overall approach, we agree with the commenter, and in this notice we announce as final the NACTEP requirements, definitions, and selection criteria we proposed in our November 20, 2012 Notice. The commenter requested that we not impose application page limitations. We do not do so through these requirements, definitions, or selection criteria. Change: None. Comment: We received one comment requesting clarification of the November 20, 2012 Notice’s ‘‘Authorized Programs, Services, and Activities’’ section, (subsection II within the ‘‘Proposed Requirements’’ section), asking whether applicants would be required to meet all three elements under ‘‘Authorized programs’’ or any combination of those elements. Also with regard to ‘‘Authorized Programs, Services, and Activities,’’ the commenter asked for clarification on challenging academic standards in reading/language arts and in mathematics, stating that the November 20, 2012 Notice proposed the integration of academics with career and technical education only at the secondary level. This commenter also asked where the term ‘‘special population’’ is defined. Discussion: Yes, applicants are required to meet all three elements under ‘‘Authorized programs.’’ To ensure consistency with the Act, in the ‘‘Authorized Programs, Services, and Activities’’ section of our November 20, 2012 Notice, we require alignment of NACTEP projects with other programs authorized under the Act, including requirements that recipients of Perkins funds provide individuals with coherent and rigorous content aligned with challenging academic standards and relevant technical knowledge and skills and improve career and technical education programs. Section 116(e) of the Act requires the Assistant Secretary to ensure that activities funded under NACTEP will improve career and technical education programs. And, section 3(5) of the Act defines the term ‘‘career and technical education’’ as requiring certain elements. Therefore, we require that NACTEP programs meet all of the elements of the Act’s definition of ‘‘career and technical education.’’ In addition, we require E:\FR\FM\26FER1.SGM 26FER1

Agencies

[Federal Register Volume 78, Number 38 (Tuesday, February 26, 2013)]
[Rules and Regulations]
[Pages 12953-12955]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2013-03416]


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

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: Final rule.

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

SUMMARY: This final rule will 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 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: Effective date: This rule is effective March 28, 2013.

FOR FURTHER INFORMATION CONTACT: Ms. Ann N. Fazzini, Medical Benefits 
and Reimbursement Branch, TMA, telephone, (303) 676-3803.

SUPPLEMENTARY INFORMATION:

I. Executive Summary and Overview

A. Purpose of the Regulatory Action

    As stated in the proposed rule, TRICARE has regulatory authority 
under 32 Code of Federal Regulations (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 
had no independent regulatory authority to sanction or exclude third-
party billing agents. This final rule provides that authority.

B. Summary of Major Provisions

    This final rule establishes 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.

C. Summary of Costs and Benefits

    By expanding the scope of sanctioning authority to include third-
party billing agents, TRICARE costs are not anticipated to increase in 
this area. Rather, by expanding the sanctioning authority to include 
third-party billing agents in situations of fraud or abuse, the program 
is safeguarding benefit dollars from being expended for fraudulent or 
abusive charges. The anticipated result of this final rule is a savings 
benefit to the program.

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.

[[Page 12954]]

III. Review of Public Comments

    In the Federal Register of September 20, 2011, (76 FR 58202), the 
Office of the Secretary of Defense published for public comment a 
Proposed Rule regarding sanction authority for third-party billing 
agents.
    We received one comment on the proposed rule. The commenter 
recommended that the Code of Federal Regulations (CFR) rule be expanded 
to prohibit sanctioned providers or third party billing agents from 
pursing collection activities against patients in the event that 
sanctions are implemented. We appreciate this comment and note that 
there is presently policy and regulations that address this issue. By 
their very nature, third-party billing agents have a contractual 
relationship with the health care provider that requires them to file 
claims on behalf of the provider. This should normally require that the 
third-party billing agreement meet the claims filing requirements of 
the entity or agency that would be paying the claim. In the case of a 
DoD beneficiary, claims must be filed in accordance with the Code of 
Federal Regulations, including the requirements relating to the maximum 
allowable payments and any balance billing limitations. Additionally, 
TRICARE benefit payments are payable directly to the provider, not the 
third-party billing agent, as federal regulations prohibit the general 
assignment of claims. The agent has no independent right to payment 
from either TRICARE or the beneficiary.
    Per 32 CFR 199.9(h)(4)(i)(c), participating providers are 
considered to have forfeited or waived any right or entitlement to bill 
TRICARE beneficiaries for care involved in claims for services 
furnished on or after the effective date of the provider's exclusion or 
suspension. As a result, any third-party billing agent purporting to 
act on behalf of a sanctioned provider would also be prohibited from 
billing TRICARE beneficiaries on behalf of that provider. Additionally, 
if the proposed authority to sanction third-party billing agents is 
invoked, a suspended or excluded third-party billing agent would also 
be prohibited from submitting a claim to TRICARE on behalf of any 
authorized provider or to bill any TRICARE beneficiary directly. Any 
claim received from an excluded third-party billing agent would be 
returned to the provider with instructions to resubmit the claim 
directly or through another third-party billing agent. As long as the 
provider of services has not been sanctioned and remains an authorized 
TRICARE provider pursuant to the requirements in 32 CFR 199.6, the 
provider remains entitled to reimbursement for covered services. Under 
either of these scenarios, TRICARE beneficiaries should not be subject 
to collection actions.
    It is also important to note that the authority sought under the 
proposed rule to sanction third-party billing agents by invoking 
administrative remedies under 32 CFR 199.9 is in addition to, and not 
in lieu of, any other remedies or sanctions authorized by law or 
regulation, including potential criminal convictions and civil 
judgments for fraud and abuse.

IV. Regulatory Procedures

Executive Order 12866, ``Regulatory Planning and Review'' and Executive 
Order 13563, ``Improving Regulation and Regulatory Review''

    Sec. 801 of Title 5, United States Code (U.S.C.), and Executive 
Orders 12866 and 13563 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 of which would have other substantial impacts. 
This final 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 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 rule is not subject 
to this requirement.

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

    Public Law 96-351, ``Regulatory Flexibility Act'' (RFA) (5 U.S.C. 
601), requires each Federal agency to 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 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 final rule is not 
subject to the requirements of RFA.

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

    This final rule does not contain a ``collection of information'' 
requirement, and will not impose additional information collection 
requirement 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 final 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, DoD amends 32 CFR part 199 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 199.2 is amended by adding in alphabetical order to 
paragraph (b), 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.
* * * * *

0
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.


[[Page 12955]]


    Dated: February 1, 2013.
Patricia L. Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2013-03416 Filed 2-25-13; 8:45 am]
BILLING CODE 5001-06-P