[Federal Register Volume 75, Number 151 (Friday, August 6, 2010)]
[Proposed Rules]
[Pages 47519-47520]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-19310]
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DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 199
[DOD-2010-HA-0033]
RIN 0720-AB44
TRICARE: Unfortunate Sequelae From Noncovered Services in a
Military Treatment Facility
AGENCY: Office of the Secretary, Department of Defense.
ACTION: Proposed rule.
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SUMMARY: The Department of Defense is publishing this proposed rule to
allow coverage for otherwise covered services and supplies required in
the treatment of complications (unfortunate sequelae) resulting from a
noncovered incident of treatment provided in a Military Treatment
Facility (MTF), when the initial noncovered service has been authorized
by the MTF Commander and the MTF is unable to provide the necessary
treatment of the complications. This proposed rule is necessary to
protect TRICARE beneficiaries from incurring financial hardships due to
the current regulatory restrictions that prohibit TRICARE coverage of
treatment of the complications resulting from noncovered medical
procedures, even when those procedures were conducted in a Department
of Defense facility.
DATES: Comments received at the address indicated below by October 5,
2010 will be accepted.
ADDRESSES: You may submit comments, identified by docket number and/or
Regulatory Information Number (RIN) and title, by either of the
following methods:
Federal Rulemaking Portal: http://www.regulations.gov.
Follow the instructions for submitting comments.
Mail: Federal Docket Management System Office, 1160
Defense Pentagon, Washington, DC 20301-1160.
Instructions: All submissions received must include the agency name
and docket number or RIN for this Federal Register document. The
general policy for comments and other submissions from members of the
public is to make these submissions available for public viewing on the
Internet at http://www.regulations.gov as they are received without
change, including any personal identifiers or contact information.
FOR FURTHER INFORMATION CONTACT: Ren[eacute] Morrell, Medical Benefits
and Reimbursement Branch, TRICARE Management Activity, (303) 676-3618.
[[Page 47520]]
SUPPLEMENTARY INFORMATION: In order to support Graduate Medical
Education and maintain provider skill levels, Military Treatment
Facility (MTF) providers are frequently required to perform medical
procedures that may be excluded from coverage under TRICARE. Unexpected
complications (unfortunate sequelae) from these procedures may result
and, in those instances where the MTFs are unable to provide the
appropriate level of care necessary for the proper treatment of these
complications, the MTF Commander must refer beneficiaries for treatment
outside the MTF. Under current regulatory provisions, TRICARE is unable
to cover treatment of the complications resulting from noncovered
procedures. When beneficiaries require treatment outside the MTF for
these complications, arising from noncovered procedures, they are
responsible for payment for this necessary treatment resulting in
significant financial hardship. This proposed rule will address that
unfortunate situation by allowing coverage of treatment for the
complications resulting from noncovered treatment provided in an MTF
when the original procedure was authorized by the MTF Commander. The
specific procedures for approval of this treatment will be addressed in
the TRICARE Policy Manual rather than in the regulation to ensure that
this information is current and easily accessible. TRICARE manuals may
be accessed at http//:www.tricare.mil.
Regulatory Procedures
Executive Order 12866, ``Regulatory Planning and Review''
Section 801 of title 5, United States Code, and Executive Order
12866 require certain regulatory assessments and procedures for any
major rule or significant regulatory action, defined as one that would
result in an annual effect of $100 million or more on the national
economy or which would have other substantial impacts. It has been
certified that this rule is not a major rule or significant regulatory
action.
Public Law 104-4, Section 202, ``Unfunded Mandates Reform Act''
Section 202 of Public Law 104-4, ``Unfunded Mandates Reform Act,''
requires that an analysis be performed to determine whether any federal
mandate may result in the expenditure by State, local and tribal
governments, in the aggregate, or by the private sector of $100 million
in any one year. It has been certified that this proposed rule does not
contain a Federal mandate that may result in the expenditure by State,
local and tribal governments, in aggregate, or by the private sector,
of $100 million or more in any one year, and thus this proposed rule is
not subject to this requirement.
Public Law 96-354, ``Regulatory Flexibility Act'' (RFA) (5 U.S.C. 601)
Public Law 96-354, ``Regulatory Flexibility Act'' (RFA) (5 U.S.C.
601), requires that each Federal agency prepare a regulatory
flexibility analysis when the agency issues a regulation which would
have a significant impact on a substantial number of small entities.
This proposed rule is not an economically significant regulatory
action, and it has been certified that it will not have a significant
impact on a substantial number of small entities. Therefore, this
proposed rule is not subject to the requirements of the RFA.
Public Law 96-511, ``Paperwork Reduction Act'' (44 U.S.C. Chapter 35)
This rule does not contain a ``collection of information''
requirement, and will not impose additional information collection
requirements on the public under Public Law 96-511, ``Paperwork
Reduction Act'' (44 U.S.C. Chapter 35).
Executive Order 13132, ``Federalism''
Executive Order 13132, ``Federalism,'' requires that an impact
analysis be performed to determine whether the rule has federalism
implications that would have substantial direct effects on the States,
on the relationship between the national government and the States, or
on the distribution of power and responsibilities among the various
levels of government. It has been certified that this proposed rule
does not have federalism implications, as set forth in Executive Order
13132.
List of Subjects in 32 CFR Part 199
Claims, Dental health, Health care, Health insurance, Individuals
with disabilities, Military personnel.
Accordingly, 32 CFR part 199 is proposed to be amended as follows:
PART 199--[AMENDED]
1. The authority citation for part 199 continues to read as
follows:
Authority: 5 U.S.C. 301; 10 U.S.C. Chapter 55.
2. Section 199.4(e)(9) is revised to read as follows:
Sec. 199.4 Basic program benefits.
* * * * *
(e) * * *
(9) Complications (unfortunate sequelae) resulting from noncovered
initial surgery or treatment.
(i) Benefits are available for otherwise covered services and
supplies required in the treatment of complications resulting from a
noncovered incident of treatment (such as nonadjunctive dental care and
cosmetic surgery) but only if the later complication represents a
separate medical condition such as a systemic infection, cardiac
arrest, and acute drug reaction. Benefits may not be extended for any
later care or procedures related to the complication that essentially
is similar to the initial noncovered care. An example of complications
similar to the initial episode of care (and thus not covered) would be
repair of facial scarring resulting from dermabrasion for acne.
(ii) Benefits are available for otherwise covered services and
supplies required in the treatment of complications (unfortunate
sequelae) resulting from a noncovered incident of treatment provided in
a Military Treatment Facility (MTF), when the initial noncovered
service has been authorized by the MTF Commander and the MTF is unable
to provide the necessary treatment of the complications, according to
the guidelines adopted by the Director, TMA, or a designee.
* * * * *
Dated: July 26, 2010.
Patricia L. Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2010-19310 Filed 8-5-10; 8:45 am]
BILLING CODE 5001-06-P