[Federal Register: December 30, 2008 (Volume 73, Number 250)]
[Proposed Rules]
[Page 79726-79727]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr30de08-30]
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DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 199
RIN 0720-AB28; DoD-2008-HA-0073
TRICARE; Hospital-Based Psychiatric Partial Hospitalization
Programs
AGENCY: Office of the Secretary, Department of Defense.
ACTION: Proposed rule.
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SUMMARY: This proposed rule will provide that TRICARE approval of a
hospital is sufficient for its psychiatric partial hospitalization
program (PHP) to be an authorized TRICARE provider. Upon implementation
of this provision, separate TRICARE certification of hospital-based
psychiatric PHPs would no longer be required. This rule will establish
uniform requirements for recognizing a hospital-based PHP as an
authorized TRICARE provider.
DATES: Written comments received at the address indicated below by
March 2, 2009 will be accepted.
ADDRESSES: You may submit comments, identified by docket number and/or
Regulatory Information Number (RIN) number and title, by any of the
following methods:
Federal eRulemaking 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: Mr. Tariq Shahid, Office of the
Assistant Secretary of Defense (Health Affairs), TRICARE Management
Activity, at (303) 676-3801.
SUPPLEMENTARY INFORMATION:
I. Background
TRICARE certification standards for psychiatric PHPs are defined in
32 CFR 199.6(b)(4)(xii) and further elaborated upon in the TRICARE
Policy Manual. Currently, TRICARE authorized providers of psychiatric
PHP services must have the Joint Commission accreditation and must
comply with additional, detailed, unique TRICARE certification
standards. Compliance with at least some of the unique TRICARE
certification standards could require significant recurring staffing
costs that psychiatric PHPs would not otherwise incur. Few facilities
are willing or able to undergo this added TRICARE certification
process, and it could adversely impact beneficiaries' access to
psychiatric PHP care. Further, substance use disorder rehabilitation
facilities are required to comply with unique TRICARE certification
standards only if they are free-standing facilities (i.e., not part of
a hospital). TRICARE does not require separate certification of
hospital-based substance abuse PHPs. TRICARE approval of a hospital is
sufficient for its substance abuse PHP to be an authorized TRICARE
provider.
In late 2006, TRICARE established a working group to study the
issues surrounding its behavioral health benefit. Recently, the working
group completed its recommendations and developed several initiatives
to improve TRICARE beneficiaries' access to behavioral health benefits.
One of the recommendations was that TRICARE no longer impose its unique
certification standards upon hospital-based psychiatric PHPs. Rather,
TRICARE approval of a hospital be sufficient to establish the hospital
as an authorized provider of its PHP services to TRICARE beneficiaries.
Through this proposed rule, TRICARE will adopt the above
recommendation. It will establish uniform requirements for recognizing
a hospital-based PHP as an authorized TRICARE provider. It will provide
a better balance between quality of PHP care and access to it than now
exists. It will significantly increase the number of TRICARE authorized
psychiatric PHPs, thereby potentially improving TRICARE beneficiaries'
access to PHP care.
In accordance with the recommendations of the working group, the
above change will be audited for a period of time to ensure no untoward
effects upon the elimination of any unique TRICARE certification
standards.
II. Regulatory Procedures
Section 801 of Title 5, United States Code, and EO 12866 requires
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.
This is not a major rule under 5 U.S.C. 801 and it is not
economically significant. It has been reviewed by the Office of
Management and Budget as required under the provisions of Executive
Order 12866.
It has been certified that this 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.
The Regulatory Flexibility Act 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.
It has been certified that this rule will not significantly affect
a substantial number of small entities.
This rule will not impose additional information collection
requirements on the public under the Paperwork Reduction Act of 1995
(44 U.S.C. Chapter 55).
We have examined the impact of the rule under Executive Order (EO)
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
[[Page 79727]]
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 proposed to be amended 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 199.6 is amended by revising paragraphs
(b)(4)(xii)(A)(2)(i) and (b)(4)(xii)(E)(7) to read as follows:
Sec. 199.6 TRICARE--authorized providers.
* * * * *
(b) * * *
(4) * * *
(xii) * * *
(A) * * *
(2) Eligibility. (i) Every free-standing psychiatric partial
hospitalization program must be certified pursuant to TRICARE
certification standards. Such standards shall incorporate the basic
standards set forth in paragraphs (b)(4)(xii)(A) through (D) of this
section, and shall include such additional elaborative criteria and
standards as the Director, TRICARE Management Activity, determines are
necessary to implement the basic standards. Each psychiatric partial
hospitalization program must be either a distinct part of an otherwise
authorized institutional provider or a free-standing program. Approval
of a hospital by TRICARE is sufficient for its partial hospitalization
program to be an authorized TRICARE provider. Such hospital-based
partial hospitalization programs are not required to be separately
certified pursuant to TRICARE certification standards.
* * * * *
(E) * * *
(7) Free-standing partial hospitalization programs shall certify
that:
* * * * *
Dated: December 22, 2008.
Patricia L. Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. E8-31054 Filed 12-29-08; 8:45 am]
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