[Federal Register Volume 78, Number 38 (Tuesday, February 26, 2013)]
[Rules and Regulations]
[Pages 12951-12953]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2013-03418]
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DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 199
[Docket ID: DOD-2011-HA-0059]
RIN 0720-AB52
TRICARE; Elimination of the Non-Availability Statement (NAS)
Requirement for Non-Emergency Inpatient Mental Health Care
AGENCY: Office of the Secretary, Department of Defense.
ACTION: Final rule.
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SUMMARY: This final rule eliminates the requirement that states a NAS
is needed for non-emergency inpatient mental health care in order for a
TRICARE Standard beneficiary's claim to be paid. Currently, NAS are
required for non-emergency inpatient mental health care for TRICARE
Standard beneficiaries who live within a military treatment facility
catchment area. At this time, the number of NASs issued is negligible
as most mental health admissions are emergency admissions. Requiring a
NAS for a relatively few non-emergency inpatient mental health
admissions is disproportionate to the cost of maintaining the systems
necessary to process and coordinate the NAS.
DATES: Effective March 28, 2013.
FOR FURTHER INFORMATION CONTACT: Mr. Richard Hart, TRICARE Policy and
Operations, TRICARE Management Activity, 5111 Leesburg Pike, Suite 810,
Falls Church, VA 22041, 703-681-0047.
SUPPLEMENTARY INFORMATION:
Executive Summary
I. Purpose of This Regulatory Action
a. Currently, NAS are required for non-emergency inpatient mental
health care for TRICARE Standard beneficiaries who live within a
military treatment facility catchment area. Pursuant to section
1080(c)(2) of title 10, United States Code, the Secretary can waive the
requirement to obtain NASs following an evaluation of the effectiveness
of such statements in optimizing the use of
[[Page 12952]]
facilities of the uniformed services. At this time, the number of NASs
issued is negligible as most mental health admissions are emergency
admissions. Requiring a NAS for a relatively few non-emergency
inpatient mental health admissions is disproportionate to the cost of
maintaining the systems necessary to process and coordinate the NAS.
This final rule eliminates the requirement for a NAS for non-emergency
inpatient mental health care in order for the TRICARE Standard
beneficiary's claim to be paid.
b. Authority: 5 U.S.C. 301; 10 U.S.C. chapter 55.
II. Summary of the Major Provisions of This Regulatory Action
This final rule eliminates the requirement for a NAS for non-
emergency inpatient mental health care in order for the TRICARE
Standard beneficiary's claim to be paid.
The elimination of the requirement for a NAS for non-emergency
inpatient mental health care for TRICARE Standard beneficiaries is
separate and distinct from the ongoing right of first refusal for
specialty services requested by a civilian provider under TRICARE
Prime, if the services are available at the MTF, or the ongoing
statutory requirement for preadmission authorization before inpatient
mental health services may be provided. This final rule does not
eliminate the right of first refusal or requirement for preadmission
authorization.
In reviewing the proposed rule, we discovered that we had
inadvertently deleted not only the requirement to obtain a NAS for non-
emergency inpatient mental health services for TRICARE Standard
beneficiaries living within the 40-mile catchment area of a military
treatment facility, but also the Department's general implementation of
section 721 of Public Law 106-398, as amended by section 735 of Public
Law 107-107, regarding the Secretary's statutory authority to require a
NAS. We have remedied that oversight in this final rule, thereby
preserving the option to impose the requirement to obtain NASs in the
future, consistent with existing statutory authority, should
circumstances change and a demonstration be made that, by performing
specific procedures at affected military medical treatment facilities,
use of such facilities would be optimized and significant costs
avoided. Section 199.4(a)(9) is thereby amended to retain this general
authority while still eliminating the current requirement to obtain a
NAS for non-emergency inpatient mental health services.
III. Costs and Benefits of This Regulatory Action
There are no anticipated budgetary health care cost increases.
Requiring a NAS for a relatively few non-emergency inpatient mental
health admissions is disproportionate to the cost of maintaining the
systems necessary to process and coordinate the NAS.
Public Comments
The proposed rule was published in the Federal Register on
September 16, 2011 (76 FR 57690). No public comments were received.
Regulatory Procedures
Executive Order 12866, ``Regulatory Planning and Review'' and Executive
Order 13563, ``Improving Regulation and Regulatory Review''
Executive Order 12866 requires that a comprehensive regulatory
impact analysis be performed on any economically 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. This final rule is not economically significant
nor a significant regulatory action as defined under these executives
orders.
Sec. 202, Public Law 104-4, ``Unfunded Mandates Reform Act''
This rule does not contain unfunded mandates. It 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 1 year.
Public Law 96-354, ``Regulatory Flexibility Act'' (5 U.S.C. 601)
The Regulatory Flexibility Act (RFA) requires that each Federal
Agency prepare, and make available for public comment, a regulatory
flexibility analysis when the agency issues a regulation which would
have a significant impact on a substantial number of small entities.
This final rule will not have a significant impact on a substantial
number of small entities for purposes of the RFA. Thus this final rule
is not subject to this requirement.
Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3511)
This final rule will not impose additional reporting or
recordkeeping requirements under the Paperwork Reduction Act of 1995.
Executive Order 13132, ``Federalism''
We have examined the impacts of the rule under Executive Order
13132 and it does not have policies that have federalism implications
that would have substantial direct effects on the States, on the
relationship between the National Government and the States, or on the
distribution of power and responsibilities among the various levels of
government, therefore, consultation with State and local officials is
not required.
List of Subjects in 32 CFR Part 199
Claims, Dental health, Health care, Health insurance, Individuals
with disabilities, Military personnel.
Accordingly, 32 CFR part 199 is amended as follows:
PART 199--[AMENDED]
0
1. The authority citation for part 199 continues to read as follows:
Authority: 5 U.S.C. 301; 10 U.S.C. chapter 55.
0
2. Section 199.4 is amended by revising paragraph (a)(9) to read as
follows:
Sec. 199.4 Basic program benefits.
* * * * *
(a) * * *
(9) Nonavailability Statements within a 40-mile catchment area.
Unless required by action of the Assistant Secretary of Defense for
Health Affairs (ASD(HA)) under this paragraph (a)(9), nonavailability
statements are not required. If they are required by ASD(HA) action, in
some geographic locations, CHAMPUS beneficiaries not enrolled in
TRICARE Prime may be required to obtain a nonavailability statement
from a military medical treatment facility in order to receive
specifically identified health care services from a civilian provider.
If the required care cannot be provided through the Uniformed Service
facility, the hospital commander, or a designee, will issue a
Nonavailability Statement (NAS) (DD Form 1251). Failure to secure such
a statement may waive the beneficiary's rights to benefits under
CHAMPUS/TRICARE.
(i) With the exception of maternity services, the ASD(HA) may
require an NAS prior to TRICARE cost-sharing for additional services
from civilian sources if such services are to be provided to a
beneficiary who lives within a 40-mile catchment area of an MTF where
such services are available and the ASD(HA):
(A) Demonstrates that significant costs would be avoided by
performing specific procedures at the affected MTF or MTFs; or
(B) Determines that a specific procedure must be provided at the
[[Page 12953]]
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 40-mile 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 Sec. 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 preadmission (or other pre-
service) authorization requirement under Sec. 199.4 or Sec. 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