TRICARE Program; Clarification of Benefit Coverage of Durable Equipment and Ordering or Prescribing Durable Equipment; Clarification of Benefit Coverage of Assistive Technology Devices Under the Extended Care Health Option Program, 27328-27329 [2016-10265]

Download as PDF 27328 Federal Register / Vol. 81, No. 88 / Friday, May 6, 2016 / Rules and Regulations (3) Revocation. If an organization’s certification as a CPEO is revoked, the organization will not be considered a CPEO for purposes of section 3511 unless and until it again applies to be certified as a CPEO in accordance with paragraph (a) of this section and is again certified by the IRS as meeting the requirements of this section. An organization whose certification as a CPEO has been revoked may not reapply to be certified as a CPEO until one year has passed since the effective date of its revocation. (4) Disclosure of suspension and revocation—(i) Notification by the CPEO. An organization whose certification as a CPEO has been suspended or revoked must notify its customers of such suspension or revocation in the time and manner prescribed by the Commissioner in further guidance. (ii) Disclosure by the IRS. If the IRS suspends or revokes an organization’s certification as a CPEO, the IRS will make available to the public the fact of such suspension or revocation in the time and manner described in further guidance. The IRS may also individually notify the organization’s customers of such suspension or revocation. (o) Effective/applicability date—(1) In general. This section applies on and after July 1, 2016. (2) Expiration date. The applicability of this section expires on or before May 3, 2019. PART 602—OMB CONTROL NUMBERS UNDER THE PAPERWORK REDUCTION ACT Par. 3. The authority citation for part 602 continues to read in part as follows: ■ Authority: 26 U.S.C. 7805 * * * Par. 4. In § 602.101, paragraph (b) is amended by adding the following entries in numerical order to the table to read as follows: ■ § 602.101 * OMB Control numbers. * * (b) * * * * * Lhorne on DSK30JT082PROD with RULES CFR Part or section where identified and described * * * 301.7705–1T ......................... 301.7705–2T ......................... * VerDate Sep<11>2014 * * 13:56 May 05, 2016 Current OMB Control No. * * 1545–2266 1545–2266 * Jkt 238001 * Kirsten B. Wielobob, Acting Deputy Commissioner for Services and Enforcement. Approved: April 28, 2016. Mark J. Mazur, Assistant Secretary of the Treasury (Tax Policy). [FR Doc. 2016–10700 Filed 5–4–16; 4:15 pm] BILLING CODE 4830–01–P DEPARTMENT OF DEFENSE Office of the Secretary 32 CFR Part 199 [DOD–2013–HA–0053] RIN 0720–AB59 TRICARE Program; Clarification of Benefit Coverage of Durable Equipment and Ordering or Prescribing Durable Equipment; Clarification of Benefit Coverage of Assistive Technology Devices Under the Extended Care Health Option Program Office of the Secretary, Department of Defense (DoD). ACTION: Correcting amendments. AGENCY: The DoD published a final rule on December 31, 2014 (79 FR 78707–78714). This rule makes correcting amendments to the previously published final rule to clarify that only the replacement of lost or stolen rental durable equipment is excluded from coverage. Additionally, in the final rule, DoD mistakenly used asterisks in a paragraph it was revising in its entirety. To correct this mistake and ensure that all revisions are appropriately codified, these correcting amendments set out the full text of the impacted paragraph. DATES: This rule is effective May 6, 2016. These correcting amendments are applicable January 30, 2015. FOR FURTHER INFORMATION CONTACT: Gail L. Jones, (303) 676–3401. SUPPLEMENTARY INFORMATION: SUMMARY: Executive Order 12866, ‘‘Regulatory Planning and Review’’ and Executive Order 13563, ‘‘Improving Regulation and Regulatory Review’’ It has been determined that these correcting amendments are not significant regulatory actions. These correcting amendments do not meet the criteria in these Executive Orders. Unfunded Mandates Reform Act (Sec. 202, Pub. L. 104–4) It has been determined that these correcting amendments do not contain a PO 00000 Frm 00034 Fmt 4700 Sfmt 4700 Federal mandate that may result in the expenditure by State, local and tribal governments, in aggregate, or by the private sector, of $100 million or more in any one year. Public Law 96–354, ‘‘Regulatory Flexibility Act’’ (5 U.S.C. 601) It has been certified that these correcting amendments are subject to the Regulatory Flexibility Act (5 U.S.C. 601) because they would not, if promulgated, have a significant economic impact on a substantial number of small entities. These are correcting amendments to the existing regulation. Public Law 96–511, ‘‘Paperwork Reduction Act’’ (44 U.S.C. Chapter 35) It has been determined that these correcting amendments do not impose reporting or recordkeeping requirements under the Paperwork Reduction Act of 1995. Executive Order 13132, Federalism It has been determined that these correcting amendments do not have federalism implications, as set forth in Executive Order 13132. This rule does not have substantial direct effects on: (1) The States; (2) The relationship between the National Government and the States; or (3) The distribution of power and responsibilities among the various levels of Government. List of Subjects in 32 CFR Part 199 Claims, Dental health, Health care, Health insurance, Individuals with disabilities, and Military personnel. Accordingly, 32 CFR part 199 is corrected by making the following correcting amendments: 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. In § 199.4, paragraph (d)(3)(ii) is revised to read as follows: ■ § 199.4 Basic program benefits. * * * * * (d) * * * (3) * * * (ii) Durable equipment—(A) Scope of benefit. (1) Durable equipment, which is for the specific use of the beneficiary and is ordered by an authorized individual professional provider listed in § 199.6(c)(3)(i), (ii) or (iii), acting within his or her scope of licensure shall be covered if the durable equipment meets the definition in § 199.2 and— E:\FR\FM\06MYR1.SGM 06MYR1 Lhorne on DSK30JT082PROD with RULES Federal Register / Vol. 81, No. 88 / Friday, May 6, 2016 / Rules and Regulations (i) Provides the medically appropriate level of performance and quality for the medical condition present and (ii) Is not otherwise excluded by this part. (2) Items that may be provided to a beneficiary as durable equipment include: (i) Durable medical equipment as defined in § 199.2; (ii) Wheelchairs. A wheelchair, which is medically appropriate to provide basic mobility, including reasonable additional costs for medically appropriate modifications to accommodate a particular physiological or medical need, may be covered as durable equipment. An electric wheelchair, or TRICARE approved alternative to an electric wheelchair (e.g., scooter) may be provided in lieu of a manual wheelchair when it is medically indicated and appropriate to provide basic mobility. Luxury or deluxe wheelchairs, as described in paragraph (d)(3)(ii)(A)(3) of this section, include features beyond those required for basic mobility of a particular beneficiary are not authorized. (iii) Iron lungs. (iv) Hospital beds. (v) Cardiorespiratory monitors under conditions specified in paragraph (d)(3)(ii)(B) of this section. (3) Whether a prescribed item of durable equipment provides the medically appropriate level of performance and quality for the beneficiary’s condition must be supported by adequate documentation. Luxury, deluxe, immaterial, or nonessential features, which increase the cost of the item relative to a similar item without those features, based on industry standards for a particular item at the time the equipment is prescribed or replaced for a beneficiary, are not authorized. Only the ‘‘base’’ or ‘‘basic’’ model of equipment (or more costeffective alternative equipment) shall be covered, unless customization of the equipment, or any accessory or item of supply for any durable medical equipment, is essential, as determined by the Director (or designee), for— (i) Achieving therapeutic benefit for the patient; (ii) Making the equipment serviceable; or (iii) Otherwise assuring the proper functioning of the equipment. (B) Cardiorespiratory monitor exception. (1) When prescribed by a physician who is otherwise eligible as a CHAMPUS individual professional provider, or who is on active duty with a United States Uniformed Service, an electronic cardiorespiratory monitor, including technical support necessary VerDate Sep<11>2014 13:56 May 05, 2016 Jkt 238001 for the proper use of the monitor, may be cost-shared as durable medical equipment when supervised by the prescribing physician for in-home use by: (i) An infant beneficiary who has had an apparent life-threatening event, as defined in guidelines issued by the Director, OCHAMPUS, or a designee, or (ii) An infant beneficiary who is a subsequent or multiple birth biological sibling of a victim of sudden infant death syndrome (SIDS), or (iii) An infant beneficiary whose birth weight was 1,500 grams or less, or (iv) An infant beneficiary who is a pre-term infant with pathologic apnea, as defined in guidelines issued by the Director, OCHAMPUS, or a designee, or (v) Any beneficiary who has a condition or suspected condition designated in guidelines issued by the Director, OCHAMPUS, or a designee, for which the in-home use of the cardiorespiratory monitor otherwise meets Basic Program requirements. (2) The following types of services and items may be cost-shared when provided in conjunction with an otherwise authorized cardiorespiratory monitor: (i) Trend-event recorder, including technical support necessary for the proper use of the recorder. (ii) Analysis of recorded physiological data associated with monitor alarms. (iii) Professional visits for services otherwise authorized by this part, and for family training on how to respond to an apparent life threatening event. (iv) Diagnostic testing otherwise authorized by this part. (C) Exclusions. Durable equipment, which is otherwise qualified as a benefit is excluded from coverage under the following circumstances: (1) Durable equipment for a beneficiary who is a patient in a type of facility that ordinarily provides the same type of durable equipment item to its patients at no additional charge in the usual course of providing its services. (2) Durable equipment, which is available to the beneficiary from a Uniformed Services Medical Treatment Facility. (D) Basis for reimbursement. (1) Durable equipment may be provided on a rental or purchase basis. Coverage of durable equipment will be based on the price most advantageous to the government taking into consideration the anticipated duration of the medically necessary need for the equipment and current price information for the type of item. The cost analysis must include a comparison of the total price of the item as a PO 00000 Frm 00035 Fmt 4700 Sfmt 9990 27329 monthly rental charge, a lease-purchase price, and a lump-sum purchase price and a provision for the time value of money at the rate determined by the U.S. Department of Treasury. If a beneficiary wishes to obtain an item of durable equipment with deluxe, luxury, immaterial or non-essential features, the beneficiary may agree to accept TRICARE coverage limited to the allowable amount that would have otherwise been authorized for a similar item without those features. In that case, the TRICARE coverage is based upon the allowable amount for the kind of durable equipment normally used to meet the intended purpose (i.e., the standard item least costly). The provider shall not hold the beneficiary liable for deluxe, luxury, immaterial, or nonessential features that cannot be considered in determining the TRICARE allowable costs. However, the beneficiary shall be held liable if the provider has a specific agreement in writing from the beneficiary (or his or her representative) accepting liability for the itemized difference in costs of the durable equipment with deluxe, luxury, or immaterial features and the TRICARE allowable costs for an otherwise authorized item without such features. (2) In general, repairs of beneficiary owned durable equipment are covered when necessary to make the equipment serviceable and replacement of durable equipment is allowed when the durable equipment is not serviceable because of normal wear, accidental damage or when necessitated by a change in the beneficiary’s condition. However, repairs of durable equipment damaged while using the equipment in a manner inconsistent with its common use, and replacement of lost or stolen rental durable equipment are excluded from coverage. In addition, repairs of deluxe, luxury, or immaterial features of durable equipment are excluded from coverage. * * * * * § 199.5 [Amended] 3. In § 199.5: a. Paragraph (c)(2)(v) is amended by removing the phrase ‘‘as well as lost or stolen devices’’. ■ b. Paragraph (c)(8)(iii) is amended by adding the word ‘‘rental’’ after the word ‘‘stolen’’, and by removing the second occurrence of ‘‘and/or AT devices’’. ■ ■ Dated: April 27, 2016. Aaron Siegel, Alternate OSD Federal Register Liaison Officer, Department of Defense. [FR Doc. 2016–10265 Filed 5–5–16; 8:45 am] BILLING CODE 5001–06–P E:\FR\FM\06MYR1.SGM 06MYR1

Agencies

[Federal Register Volume 81, Number 88 (Friday, May 6, 2016)]
[Rules and Regulations]
[Pages 27328-27329]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-10265]


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DEPARTMENT OF DEFENSE

Office of the Secretary

32 CFR Part 199

[DOD-2013-HA-0053]
RIN 0720-AB59


TRICARE Program; Clarification of Benefit Coverage of Durable 
Equipment and Ordering or Prescribing Durable Equipment; Clarification 
of Benefit Coverage of Assistive Technology Devices Under the Extended 
Care Health Option Program

AGENCY: Office of the Secretary, Department of Defense (DoD).

ACTION: Correcting amendments.

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

SUMMARY: The DoD published a final rule on December 31, 2014 (79 FR 
78707-78714). This rule makes correcting amendments to the previously 
published final rule to clarify that only the replacement of lost or 
stolen rental durable equipment is excluded from coverage. 
Additionally, in the final rule, DoD mistakenly used asterisks in a 
paragraph it was revising in its entirety. To correct this mistake and 
ensure that all revisions are appropriately codified, these correcting 
amendments set out the full text of the impacted paragraph.

DATES: This rule is effective May 6, 2016. These correcting amendments 
are applicable January 30, 2015.

FOR FURTHER INFORMATION CONTACT: Gail L. Jones, (303) 676-3401.

SUPPLEMENTARY INFORMATION: 

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

    It has been determined that these correcting amendments are not 
significant regulatory actions. These correcting amendments do not meet 
the criteria in these Executive Orders.

Unfunded Mandates Reform Act (Sec. 202, Pub. L. 104-4)

    It has been determined that these correcting amendments do not 
contain a Federal mandate that may result in the expenditure by State, 
local and tribal governments, in aggregate, or by the private sector, 
of $100 million or more in any one year.

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

    It has been certified that these correcting amendments are subject 
to the Regulatory Flexibility Act (5 U.S.C. 601) because they would 
not, if promulgated, have a significant economic impact on a 
substantial number of small entities. These are correcting amendments 
to the existing regulation.

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

    It has been determined that these correcting amendments do not 
impose reporting or recordkeeping requirements under the Paperwork 
Reduction Act of 1995.

Executive Order 13132, Federalism

    It has been determined that these correcting amendments do not have 
federalism implications, as set forth in Executive Order 13132. This 
rule does not have substantial direct effects on:
    (1) The States;
    (2) The relationship between the National Government and the 
States; or
    (3) The distribution of power and responsibilities among the 
various levels of Government.

List of Subjects in 32 CFR Part 199

    Claims, Dental health, Health care, Health insurance, Individuals 
with disabilities, and Military personnel.

    Accordingly, 32 CFR part 199 is corrected by making the following 
correcting amendments:

PART 199--[AMENDED]

0
1. The authority citation for part 199 continues to read as follows:

    Authority: 5 U.S.C. 301; 10 U.S.C. chapter 55.


0
2. In Sec.  199.4, paragraph (d)(3)(ii) is revised to read as follows:


Sec.  199.4  Basic program benefits.

* * * * *
    (d) * * *
    (3) * * *
    (ii) Durable equipment--(A) Scope of benefit. (1) Durable 
equipment, which is for the specific use of the beneficiary and is 
ordered by an authorized individual professional provider listed in 
Sec.  199.6(c)(3)(i), (ii) or (iii), acting within his or her scope of 
licensure shall be covered if the durable equipment meets the 
definition in Sec.  199.2 and--

[[Page 27329]]

    (i) Provides the medically appropriate level of performance and 
quality for the medical condition present and
    (ii) Is not otherwise excluded by this part.
    (2) Items that may be provided to a beneficiary as durable 
equipment include:
    (i) Durable medical equipment as defined in Sec.  199.2;
    (ii) Wheelchairs. A wheelchair, which is medically appropriate to 
provide basic mobility, including reasonable additional costs for 
medically appropriate modifications to accommodate a particular 
physiological or medical need, may be covered as durable equipment. An 
electric wheelchair, or TRICARE approved alternative to an electric 
wheelchair (e.g., scooter) may be provided in lieu of a manual 
wheelchair when it is medically indicated and appropriate to provide 
basic mobility. Luxury or deluxe wheelchairs, as described in paragraph 
(d)(3)(ii)(A)(3) of this section, include features beyond those 
required for basic mobility of a particular beneficiary are not 
authorized.
    (iii) Iron lungs.
    (iv) Hospital beds.
    (v) Cardiorespiratory monitors under conditions specified in 
paragraph (d)(3)(ii)(B) of this section.
    (3) Whether a prescribed item of durable equipment provides the 
medically appropriate level of performance and quality for the 
beneficiary's condition must be supported by adequate documentation. 
Luxury, deluxe, immaterial, or non- essential features, which increase 
the cost of the item relative to a similar item without those features, 
based on industry standards for a particular item at the time the 
equipment is prescribed or replaced for a beneficiary, are not 
authorized. Only the ``base'' or ``basic'' model of equipment (or more 
cost- effective alternative equipment) shall be covered, unless 
customization of the equipment, or any accessory or item of supply for 
any durable medical equipment, is essential, as determined by the 
Director (or designee), for--
    (i) Achieving therapeutic benefit for the patient;
    (ii) Making the equipment serviceable; or
    (iii) Otherwise assuring the proper functioning of the equipment.
    (B) Cardiorespiratory monitor exception. (1) When prescribed by a 
physician who is otherwise eligible as a CHAMPUS individual 
professional provider, or who is on active duty with a United States 
Uniformed Service, an electronic cardiorespiratory monitor, including 
technical support necessary for the proper use of the monitor, may be 
cost-shared as durable medical equipment when supervised by the 
prescribing physician for in-home use by:
    (i) An infant beneficiary who has had an apparent life-threatening 
event, as defined in guidelines issued by the Director, OCHAMPUS, or a 
designee, or
    (ii) An infant beneficiary who is a subsequent or multiple birth 
biological sibling of a victim of sudden infant death syndrome (SIDS), 
or
    (iii) An infant beneficiary whose birth weight was 1,500 grams or 
less, or
    (iv) An infant beneficiary who is a pre-term infant with pathologic 
apnea, as defined in guidelines issued by the Director, OCHAMPUS, or a 
designee, or
    (v) Any beneficiary who has a condition or suspected condition 
designated in guidelines issued by the Director, OCHAMPUS, or a 
designee, for which the in-home use of the cardiorespiratory monitor 
otherwise meets Basic Program requirements.
    (2) The following types of services and items may be cost-shared 
when provided in conjunction with an otherwise authorized 
cardiorespiratory monitor:
    (i) Trend-event recorder, including technical support necessary for 
the proper use of the recorder.
    (ii) Analysis of recorded physiological data associated with 
monitor alarms.
    (iii) Professional visits for services otherwise authorized by this 
part, and for family training on how to respond to an apparent life 
threatening event.
    (iv) Diagnostic testing otherwise authorized by this part.
    (C) Exclusions. Durable equipment, which is otherwise qualified as 
a benefit is excluded from coverage under the following circumstances:
    (1) Durable equipment for a beneficiary who is a patient in a type 
of facility that ordinarily provides the same type of durable equipment 
item to its patients at no additional charge in the usual course of 
providing its services.
    (2) Durable equipment, which is available to the beneficiary from a 
Uniformed Services Medical Treatment Facility.
    (D) Basis for reimbursement. (1) Durable equipment may be provided 
on a rental or purchase basis. Coverage of durable equipment will be 
based on the price most advantageous to the government taking into 
consideration the anticipated duration of the medically necessary need 
for the equipment and current price information for the type of item. 
The cost analysis must include a comparison of the total price of the 
item as a monthly rental charge, a lease-purchase price, and a lump-sum 
purchase price and a provision for the time value of money at the rate 
determined by the U.S. Department of Treasury. If a beneficiary wishes 
to obtain an item of durable equipment with deluxe, luxury, immaterial 
or non-essential features, the beneficiary may agree to accept TRICARE 
coverage limited to the allowable amount that would have otherwise been 
authorized for a similar item without those features. In that case, the 
TRICARE coverage is based upon the allowable amount for the kind of 
durable equipment normally used to meet the intended purpose (i.e., the 
standard item least costly). The provider shall not hold the 
beneficiary liable for deluxe, luxury, immaterial, or non- essential 
features that cannot be considered in determining the TRICARE allowable 
costs. However, the beneficiary shall be held liable if the provider 
has a specific agreement in writing from the beneficiary (or his or her 
representative) accepting liability for the itemized difference in 
costs of the durable equipment with deluxe, luxury, or immaterial 
features and the TRICARE allowable costs for an otherwise authorized 
item without such features.
    (2) In general, repairs of beneficiary owned durable equipment are 
covered when necessary to make the equipment serviceable and 
replacement of durable equipment is allowed when the durable equipment 
is not serviceable because of normal wear, accidental damage or when 
necessitated by a change in the beneficiary's condition. However, 
repairs of durable equipment damaged while using the equipment in a 
manner inconsistent with its common use, and replacement of lost or 
stolen rental durable equipment are excluded from coverage. In 
addition, repairs of deluxe, luxury, or immaterial features of durable 
equipment are excluded from coverage.
* * * * *


Sec.  199.5  [Amended]

0
3. In Sec.  199.5:
0
a. Paragraph (c)(2)(v) is amended by removing the phrase ``as well as 
lost or stolen devices''.
0
b. Paragraph (c)(8)(iii) is amended by adding the word ``rental'' after 
the word ``stolen'', and by removing the second occurrence of ``and/or 
AT devices''.

    Dated: April 27, 2016.
Aaron Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2016-10265 Filed 5-5-16; 8:45 am]
BILLING CODE 5001-06-P