[Federal Register: July 17, 2009 (Volume 74, Number 136)]
[Rules and Regulations]
[Page 34694-34696]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr17jy09-4]
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DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 199
[DOD-2007-HA-0127; RIN 0720-AB18]
TRICARE: Civilian Health and Medical Program of the Uniformed
Services (CHAMPUS) Changes Included in the John Warner National Defense
Authorization Act (NDAA) for Fiscal Year (FY) 2007; Authorization of
Forensic Examinations
AGENCY: Office of the Secretary, Department of Defense.
ACTION: Final rule.
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SUMMARY: This final rule implements section 701 of the John Warner
National Defense Authorization Act for FY 2007, Public Law 109-364.
Section 701 amends Title 10 of the United States Code (U.S.C.), Chapter
55, Section 1079(a) by authorizing coverage for
[[Page 34695]]
forensic examinations following a sexual assault or domestic violence
for eligible beneficiaries. This authorizes forensic examinations
provided in civilian health care facilities (e.g., civilian rape crisis
facilities) following sexual assault or domestic violence, which is
consistent with the services that are authorized in Military Medical
Treatment Facilities for all beneficiaries who are victims of sexual
assault or domestic violence.
DATES: Effective Dates: This rule is effective August 17, 2009.
Applicability date: This amendment applies to services provided on
or after October 17, 2006.
FOR FURTHER INFORMATION CONTACT: Joy Saly, Office of Medical Benefits
and Reimbursement Branch, TRICARE Management Activity, telephone (303)
676-3742. Questions regarding payment of specific claims should be
addressed to the appropriate TRICARE contractor.
SUPPLEMENTARY INFORMATION:
I. Summary of Final Rule Provisions
This final rule implements section 701 of the John Warner National
Defense Authorization Act for Fiscal Year 2007, which establishes
coverage of contracted medical care with respect to forensic
examinations following a sexual assault or domestic violence. TRICARE
pays for and will continue to pay for all emergency room services
delivered to a victim.
Prior to section 701, forensic examinations were not covered for
beneficiaries in civilian health care facilities through TRICARE
medical plan contracts because TRICARE, under 10 U.S.C. 1079(a)(13),
may cost share only medically or psychologically necessary services or
supplies. Forensic examinations are conducted primarily for
preservation of evidence for use in any future criminal investigation
and/or prosecution. However, there is a dual purpose for the
examination process. One purpose is to address the needs of the justice
system, which include: Obtaining a history of the assault; documenting
examination findings; properly collecting, handling, and preserving
evidence; interpreting and analyzing findings (post examination), and
subsequently, presenting findings; and providing factual and expert
opinion related to the examination and evidence collection. The other
purpose is to address the medical needs of the individual disclosing
the sexual assault or domestic violence, which include: Evaluating and
treating injuries; conducting prompt examinations; providing support,
crisis intervention, and advocacy; providing prophylaxis against
sexually transmitted diseases; assessing female patients for pregnancy
risk and discussing treatment options, including reproductive health
services; and providing follow-up care for medical and emotional needs.
Forensic examinations are paid for Active Duty members by using
supplemental health care funds, which, under 10 U.S.C. 1074(c)(1), does
not have the same requirement for medical or psychological necessity.
All beneficiaries are covered if they are examined in a military
treatment facility. The forensic examination became an issue when
services were provided in a civilian health care facility. Although
most States have laws that designate payment sources to cover the costs
of forensic examinations for sexual assault victims (some States even
prohibit billing victims), some beneficiaries who were victims of a
sexual assault received a bill for the forensic examination. Many
States have mechanisms in place that require civilian health care
facilities to bill a State agency directly. Certain other States, to
some degree, have mechanisms to minimize the possibility of invoicing
the beneficiary. This final rule puts into place a mechanism that
allows civilian health care facilities to invoice TRICARE for
reimbursement of forensic examinations.
Forensic Examination (Early Evidence Kits)
A forensic examination uses an early evidence kit to collect and
preserve the evidence. Early evidence kits (also known as rape kits)
typically include: Forms for documentation of what is observed; tubes
for blood samples; a urine sample container (for detecting drugs that
may have been used to facilitate a sexual assault); cotton swabs for
biological evidence collection; sterile water; sterile saline; glass
slides; unwaxed dental floss; a wooden stick for fingernail scrapings;
envelopes or boxes for individual evidence samples; labels for each
item and paper bags for clothing collection; and a large sheet of paper
for patient to undress over. The victim's clothing is collected for any
external evidence and new clothes are provided. Forensic examinations
can take up to 4 hours.
We believe that a large portion of the costs for forensic
examinations are probably already being paid by TRICARE, as most
services associated with the examination are covered under any
circumstance; and if a claim from a health care facility is submitted
with the appropriate procedure code, then the claim would then be paid.
What was not being cost-shared were the examinations to gather
information for the justice system. In a civilian facility, the
victim's private insurance should not be billed for the cost of the
examination. Pursuant to the Federal Victims of Crime Act (VOCA), the
primary payer is a Federal or federally funded program (such as
Medicare, Medicaid, TRICARE or the Department of Veterans Affairs). A
reimbursement request from a provider, under the VOCA, should only be
submitted for a victim who is not covered by a Federal or federally
funded program. This final rule amends the regulation to ensure that
forensic examinations following sexual assault or domestic violence are
specifically listed as a covered benefit under TRICARE. This rule
applies to services provided on or after October 17, 2006, the
effective date of the NDAA for FY 2007.
II. Review of Public Comments
We provided a 60-day comment period on the proposed rule which was
published in the Federal Register on July 7, 2008 (73 FR 38348-38350).
No comments were received.
III. Regulatory Procedures
Executive Order 12866, ``Regulatory Planning and Review''
Executive Order 12866 requires 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 an economically significant
regulatory action, and it has been certified that it will not have a
significant impact on the national economy.
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 each Federal agency to 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
final 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 final 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
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additional information collection requirements on the public under
Public Law 96-511, ``Paperwork Reduction Act'' (44 U.S.C. Chapter 35).
Public Law 104-4, Section 202, ``Unfunded Mandates Reform Act''
Section 202 of Public Law 104-4, ``Unfunded Mandates Reform Act,''
requires 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 final 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. Therefore, this final rule is
not subject to this requirement.
Executive Order 13132, ``Federalism''
Executive Order 13132, ``Federalism,'' requires 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 final 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 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 adding paragraph (e)(27) to read as
follows:
Sec. 199.4 Basic program benefit.
* * * * *
(e) * * *
(27) TRICARE will cost share forensic examinations following a
sexual assault or domestic violence. The forensic examination includes
a history of the event and a complete physical and collection of
forensic evidence, and medical and psychological follow-up care. The
examination for sexual assault also includes, but is not limited to, a
test kit to retrieve forensic evidence, testing for pregnancy, testing
for sexually transmitted disease and HIV, and medical services and
supplies for prevention of sexually transmitted diseases, HIV,
pregnancy, and counseling services.
* * * * *
Dated: July 14, 2009.
Patricia L. Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. E9-17060 Filed 7-16-09; 8:45 am]
BILLING CODE 5001-06-P