[Federal Register: August 31, 2005 (Volume 70, Number 168)]
[Proposed Rules]
[Page 51692-51694]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr31au05-32]
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DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 199
RIN 0720-AA92
TRICARE; Revision of Participating Providers Reimbursement Rate;
TRICARE Dental Program (TDP)
AGENCY: Office of the Secretary, DoD.
ACTION: Proposed rule.
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SUMMARY: The Department is publishing this proposed rule to revise the
requirements and procedures for the reimbursement of TRICARE Dental
Program participating providers. Participating providers will no longer
be reimbursed at the equivalent of a percentile of prevailing charges
sufficiently above the 50th percentile of prevailing charges made for
similar services in the same locality (region) or state, or the
provider's actual charge, whichever is lower, less any cost-share
amount due for authorized services. Specifically, the revision will
require TRICARE Dental Program participating providers to be reimbursed
in accordance with the contractor's network agreements, less any cost-
share amount due for authorized services.
Public comments are invited and will be considered for possible
revisions to the final rule.
DATES: Written comments received at the address indicated below by
October 31, 2005 will be accepted.
ADDRESSES: Because of staff and resource limitations, we can only
accept comments by mail or electronic bill (e-mail). We are unable to
accept comments by facsimile (FAX) transmission. Send e-mail comments
to TDP.rule@tma.osd.mil. Mail written comments to the following address
only: TRICARE Management Activity, TRICARE Operations/Dental Division,
Skyline 5, Suite 810, 5111 Leesburg Pike, Falls Church, VA 22041-3206;
Attention: Col. Gary C. Martin, Director. Please allow sufficient time
for mailed
[[Page 51693]]
comments to be timely received in the event of delivery delays.
FOR FURTHER INFORMATION CONTACT: Col. Gary C. Martin, Office of the
Assistant Secretary of Defense (Health Affairs)/TRICARE Management
Activity, telephone (703) 681-0039.
SUPPLEMENTARY INFORMATION:
I. Background
Revision of Participating Providers Reimbursement Rate. Currently,
32 CFR 199.13 requires the TRICARE Dental Program contractor to
reimburse participating providers at the equivalent of a percentile of
prevailing charges sufficiently above the 50th percentile of prevailing
charges made for similar services in the same locality (region) or
state, or the provider's actual charge, whichever is lower, less any
cost-share amount due for authorized services. This provision was
included in the regulation to constitute a significant financial
incentive for participation of providers in the contractor's network
and to ensure a network of quality providers through use of a higher
reimbursement rate. This provision, however, places an unnecessary
restriction on contractors that already have established, high quality
provider networks with reimbursement rates below the 50th percentile
that are of sufficient size to meet the access requirements of the
TRICARE Dental Program. The reimbursement rates that have been
negotiated over the life of the dental contract represent the general
market rates for dental insurance reimbursement, and the proposed rule
change would bring DoD reimbursement rates into line with the broader
insurance market. Elimination of the 50th percentile requirement will
afford the Government and enrollees significant cost savings through
lower provider reimbursement costs by the contractor. Additionally,
contractors have other methods available to ensure the TDP members
receive high quality dental services. These quality assurance methods
include, but are not limited to, licensing and credentialing standards,
patient satisfaction assessments, and provider trend analyses.
II. Regulatory Procedures
The Department of Defense (DoD) has examined the economic
implications of this proposed rule as required by Executive Order
12866. Executive Order 12866 directs agencies to assess costs and
benefits of available regulatory alternatives and, when regulation is
necessary, to select regulatory approaches that maximize net benefits
(including potential economic, environmental, public health and safety,
and other advantages; distributive impacts; and equity). Executive
Order 12866 classifies a rule as significant if it meets any one of a
number of specified conditions, including: having an annual effect on
the economy of $100 million or more, adversely affecting a sector of
the economy in a material way, adversely affecting competition, or
adversely affecting jobs. A regulation is also considered a significant
regulatory action if it raises novel legal or policy issues.
DoD concludes that this proposed rule is a significant regulatory
action under the Executive Order since it raises novel policy issues
under Section 3(f)(4). DoD concludes, however, that this proposed rule
does not meet the significance threshold of $100 million effect on the
economy in any one year under Section 3(f)(1), with an estimated annual
impact on the economy of $5 million (See attachment for details). The
estimate annual impact was determined by comparing the current level of
reimbursement for network dental providers in the TDP with the expected
level of reimbursement under this Proposed Rule. The current rate of
reimbursement was assessed by independent actuarial advisers. This rate
is consistent with a market-driven level of payments that is necessary,
on average, to maintain a large and stable network of dentists. The
difference was multiplied by the projected level of utilization for
network providers in 2006. In the aggregate, for all network TDP
providers, the Proposed Rule is estimated to reduce network dental
provider payments by $0-5 million in 2006. For the approximately 70,000
network dental providers, this impact averages $0-$70 per year per
network dentist, which is less than 0.1 percent of the net income for
the dentists in the U.S. (according to the American Dental
Association's 2002 Survey of Dental Practice). Although the average
impact is minimal, the upper end of the range for a network dentist is
estimated to be as much as $1,700 per year. This assumes a decline of 2
percent in the reimbursement level for a network dentist whose practice
consists of 15 percent TDP patients. The level of reimbursement
required to have a stable network of providers is a percentile less
than the current percentile of billed charges.
The Congressional Review Act establishes certain procedures for
major rules, defined as those with similar major impacts. 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 that would
have significant impact on a substantial number of small entities. This
is not a major rule under 5 U.S.C. 801. It is a significant regulatory
action but not economically significant. In addition, we certify that
this proposed rule will not significantly affect a substantial number
of small entities for the reasons stated above. This rule has been
designated and has been reviewed by the Office of Management and Budget
as required under the provision of E.O. 12866.
Paperwork Reduction Act
This proposed rule contains a new information collection
requirement. DoD has submitted the following proposal to OMB under the
provisions of the Paperwork Reduction Act (44 U.S.C. Chapter 35).
Comments are invited on: (a) Whether the proposed collection of
information is necessary for the proper performance of the functions of
DoD, including whether the information will have practical utility; (b)
the accuracy of the estimate of the burden of the proposed information
collection; (c) ways to enhance the quality, utility, and clarity of
the information to be collected; and (d) ways to minimize the burden of
the information collection on respondents, including the use of
automated collection techniques or other forms of information
technology.
Title: Claim Form.
Type of Request: New requirement.
Number of Respondents: 56,512.
Responses Per Respondent: 62.
Annual Responses: 3,503,744.
Average Burden Per Response: 15 minutes.
Annual Burden Hours: 875,936.
Needs and Uses: The TRICARE Management Activity (TMA) under the
authority of the Office of the Assistant Secretary of Defense (Health
Affairs)/TMA Office of the Deputy Assistant Secretary of Defense has
the responsibility for management of the TRICARE dental program as
established in Title X, United States Code, section 1076a. The TDP
claim form is required to gather information to make payment for
legitimate dental claims, to assist in contractor surveillance and
program integrity investigations and to audit financial transactions
where the Department of Defense has a financial stake. The information
from the claim form is also used to provide important cost share
explanations to the beneficiary.
Affected Public: Business or other for-profit.
Frequency: 5 per month.
[[Page 51694]]
Respondent's Obligation: Voluntary.
Written comments and recommendations on the proposed information
collection should be sent to the TRICARE Management Activity, Attn: Col
Gary Martin, 5111 Leesburg Pike, Suite 810, Falls Church, VA 22041-3206
(703-681-0039). Comments should be received within 60 days of
publication of this notice.
To request more information on this proposed information collection
or to obtain a copy of the proposed and associated collection
instruments, please write to TRICARE Management Activity, Attn: Col
Gary Martin, 5111 Leesburg Pike, Suite 810, Falls Church, VA 22041-
3206, or telephone Col Martin at 703-681-0039.
List of Subjects in 32 CFR Part 199
Claims, Dental health, Health care, Health insurance, Individuals
with disabilities, Military personnel.
For the reasons set out in the preamble, 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 199.13(g)(2)(ii) is proposed to be revised to read as
follows:
Sec. 199.13 TRICARE Dental Program.
* * * * *
(g) * * *
(2) * * *
(ii) Participating providers shall be reimbursed in accordance with
the contractor's network agreements, less any cost-share amount due for
authorized services.
* * * * *
Dated: August 25, 2005.
Jeannette Owings-Ballard,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 05-17299 Filed 8-30-05; 8:45 am]
BILLING CODE 5001-06-M