[Federal Register Volume 75, Number 159 (Wednesday, August 18, 2010)]
[Rules and Regulations]
[Pages 50883-50884]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-20391]
-----------------------------------------------------------------------
DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 199
[Docket ID: DoD-2008-HA-0123]
RIN 0720-AB29
TRICARE; TRICARE Delivery of Health Care in Alaska
AGENCY: Office of the Secretary, Department of Defense.
ACTION: Final rule.
-----------------------------------------------------------------------
SUMMARY: TRICARE has recognized the unique circumstances existing in
Alaska which make the provision of medical care to TRICARE
beneficiaries through the TRICARE program operated in the other 49
states unrealistic. Recognizing these unique conditions and
circumstances, the Department of Defense has conducted a demonstration
project in the state of Alaska since implementation of the TRICARE
program under which certain exceptions have been made for
administration of the program in Alaska. This rule incorporates the
waiver of the requirement for financial underwriting by a TRICARE
contractor as a permanent change to the administration of the TRICARE
program in Alaska. This rule proposes no change to the TRICARE benefit
or to those who are eligible for it. However, the rule does eliminate
the financial underwriting of health care costs in the state of Alaska
by a TRICARE contractor.
DATES: Effective Date: September 17, 2010.
FOR FURTHER INFORMATION CONTACT: LTC Stephen Oates, TRICARE Policy and
Operations Directorate, TRICARE Management Activity, 5111 Leesburg
Pike, Suite 810, Falls Church, VA 22041, telephone (703) 681-0039.
SUPPLEMENTARY INFORMATION:
I. Introduction and Background
In recognition of the unique geographical and environmental
characteristics of the state of Alaska, the Department of Defense has
conducted a demonstration project which tested the viability of
implementing the TRICARE program differently in Alaska (see Federal
Register, Vol. 69, No. 96/Tuesday, May 18, 2004/Notices). To date that
demonstration has supported the impracticability and lack of cost
effectiveness to impose on a TRICARE contractor the financial
underwriting of the delivery of health care resulting from costs
associated with the TRICARE program over which the contractor has no
control. The demonstration is authorized until March 31, 2011. This
rule will make permanent the waiver of the financial underwriting
requirement by the TRICARE contractor in the delivery of health care in
Alaska.
II. Public Comments
The proposed rule was published in the Federal Register (74 FR
62270-62271) on November 27, 2009, for a 60-day comment period. Two
comments were submitted and are responded to below.
Comment: Alaska TRICARE managers need authorization, as do other
states, to designate civilian primary care managers (PCMs) for care
unavailable or too distant for the members who are in TRICARE Prime.
Response: We agree that allowing TRICARE managers the ability to
designate civilian primary care managers (PCMs) would improve the
access to care for eligible beneficiaries. Policies are currently being
reviewed to assess the feasibility of incorporating such practices
without adversely affecting the local community.
Comment: Certified Nurse Midwives and state-licensed direct-entry
midwives are underutilized alternatives to physician-led care for
pregnant women. Also, TRICARE's authorized providers should be expanded
to include state-licensed midwives.
Response: We understand the limited choices available to
beneficiaries in the state of Alaska; however, the ultimate decision
remains with the beneficiary on provider selection. In order for a
Certified Nurse Midwife to become a TRICARE-authorized provider, he/she
must be licensed, when required, by a local licensing agency and
certified by the American College of Nurse Midwives.
II. Regulatory Procedures
Executive Order 12866, ``Regulatory Planning and Review''
Section 801 of title 5, United States Code (U.S.C.) and Executive
Order (E.O.) 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 an economically significant
rule, however, it is a regulatory action which has been reviewed by the
Office of Management and Budget as required under the provisions of
E.O. 12866.
Section 202, Public Law, 104-4, ``Unfunded Mandates Reform Act''
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.
Public Law 96-354, ``Regulatory Flexibility Act'' (5 U.S.C. 601)
The Regulatory Flexibility Act (RFA) requires 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 rule
is not an economically significant regulatory action and will not have
a significant impact on a substantial number of small entities for
purposes of the RFA. Thus, this
[[Page 50884]]
proposed rule is not subject to any of these requirements.
Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3511)
This rule will not impose additional information collection
requirements on the public.
Executive Order 13132, ``Federalism''
We have examined the impact 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.
0
Accordingly, 32 CFR part 199 is amended as follows:
PART 199--CIVILIAN HEALTH AND MEDICAL PROGRAM OF THE UNIFORMED
SERVICES (CHAMPUS)
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 199.17 is amended by revising the second sentence of
paragraph (a)(3), redesignating paragraph (v) as paragraph (w), and by
adding a new paragraph (v) to read as follows:
Sec. 199.17 TRICARE program
* * * * *
(a) * * *
(3) * * * Its geographical applicability is to all 50 states
(except as modified for the state of Alaska under paragraph (v) of this
section) and the District of Columbia. * * *
* * * * *
(v) Administration of the TRICARE program in the state of Alaska.
In view of the unique geographical and environmental characteristics
impacting the delivery of health care in the state of Alaska,
administration of the TRICARE program in the state of Alaska will not
include financial underwriting of the delivery of health care by a
TRICARE contractor. All other provisions of this section shall apply to
administration of the TRICARE program in the state of Alaska as they
apply to the other 49 states and the District of Columbia.
* * * * *
Dated: August 10, 2010.
Patricia L. Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2010-20391 Filed 8-17-10; 8:45 am]
BILLING CODE 5001-06-P