TRICARE; TRICARE Sanction Authority for Third-Party Billing Agents, 12953-12955 [2013-03416]
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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
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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
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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.
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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
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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
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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.
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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).
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14:06 Feb 25, 2013
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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
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Frm 00023
Fmt 4700
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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
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]]>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
