[Federal Register Volume 70, Number 182 (Wednesday, September 21, 2005)]
[Rules and Regulations]
[Pages 55251-55252]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-18753]



[[Page 55251]]

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DEPARTMENT OF DEFENSE

Office of the Secretary

32 CFR Part 199

RIN 0720-AA93


TRICARE; Changes Included in the National Defense Authorization 
Act for Fiscal Year 2005; TRICARE Dental Program

AGENCY: Office of the Secretary. DoD.

ACTION: Interim final rule.

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SUMMARY: The Department is publishing this interim final rule to 
implement sections 711 and 715 of the Ronald W. Reagan National Defense 
Authorization Act for Fiscal Year 2005 (NDAA-05), Public Law 108-375. 
Specifically, that legislation makes young dependents of deceased 
Service members eligible for enrollment in the TRICARE Dental Program 
when the child was not previously enrolled because of age, and 
authorizes post-graduate dental residents in a dental treatment 
facility of the uniformed services under a graduate dental education 
program accredited by the American Dental Association to provide dental 
treatment to dependents who are 12 years of age or younger and who are 
covered by a dental plan established under 10 U.S.C. 1076a. This rule 
also corrects certain references in 32 CFR 199.13. The rule is being 
published as an interim final rule with comment period in order to 
comply with statutory effective dates. Public comments are invited and 
will be considered for possible revisions to the final rule.

DATES: This rule is effective November 21, 2005.
    Comments: Written comments received at the address indicated below 
by November 21, 2005 will be accepted. Because of staff and resource 
limitations, we can only accept comments by mail or electronic mail (e-
mail). We are unable to accept comments by facsimile (FAX) 
transmission. Send e-mail comments to [email protected] Mail written 
comments to the following address only: TRICARE Management Activity, 
TRICARE Operation/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 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. Questions regarding payment of 
specific claims should be addressed to the appropriate TRICARE 
contractor.

SUPPLEMENTARY INFORMATION: 

I. Background

Opportunity for Young Child Dependent of Decease Member To Become 
Eligible for Enrollment in a TRICARE Dental Plan

    Currently, military members may enroll dependent children of any 
age in the TRICARE Dental Progam (TDP), but many members choose not to 
enroll young children until they are automatically enrolled at four 
years of age. Unfortunately, when a member on active duty for a period 
of more than thirty days or a member of the Ready Reserve (i.e., 
Selected Reserve and Individual Ready Reserve) dies, dependent children 
less than four years of age who are not enrolled in the TDP at the time 
of the member's death are ineligible for enrollment for the three-year 
TDP survivor's benefit. The NDAA for FY05 corrects this inequity by 
giving young dependent children of deceased Service members the 
opportunity to become eligible for enrollment in the TDP although they 
were not previously enrolled due to their age.

Professional Accreditation of Military Dentists

    Currently, section 199.13(a)(2)(iii) of this Part excludes 
dependents of active duty, Selected Reserve and individual Ready 
Reserve members enrolled in the TRICARE Dental Program (TDP) from 
obtaining benefit services provided by the TDP in military dental care 
facilities except for emergency treatment, dental care provided outside 
the United States, and services incidental to non-covered services. Due 
to insufficient numbers of pediatric patients available for treatment 
in DoD's training facilities, the uniformed services faced significant 
problems with program accreditation and pediatric dental training. The 
Services had difficulty maintaining accreditation of post-graduate 
training programs because of a lack of pediatric dental patients with 
the proper dental case mix required for training. in addition, without 
adequate case numbers and case complexity, residents who at completion 
of their training were assigned overseas were not always fully trained 
to manage and treat pediatric dental patients.
    Therefore, section 715 of the NDAA FY 05 provides the uniformed 
services with authority to maintain American Dental Association 
accreditation standards for certain military dental specialty training 
programs that require treatment of pediatric patients and to provide 
pediatric training to meet requirements for the delivery of authorized 
dental care to children accompanying sponsors at OCONUS locations. The 
statute authorizes the Services to treat in their facilities a limited 
number of pediatric dental patients enrolled in the TDP. The Services 
have estimated their pediatric patient load requirements to sustain 
training facilities at 500-600 patients annually per Service. only 
those patients age 12 years or younger meeting training needs and 
accepted for care in DoD's training programs will be treated in those 
programs to the maximum of 2,000 patients annually across DoD. To 
ensure strict compliance with the amended statute, Health Affairs will 
allocate specific numbers of patient training cases to each Service 
POC. Service POCs will implement registries to track the number of 
patients served on a daily basis to ensure that the respective patient 
case caps are not exceeded. Each Service will forward a semi-annual 
report to the Dental Care Division, TRICARE Management Activity. An 
annual report will be submitted at the end of each fiscal year to the 
Assistant Secretary of Defense for Health Affairs.

II. Regulatory Procedures

Executive Order (EO) 12866

    Executive Order 12866 requires that 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. 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 
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 interim final rule 
is not subject to any of these requirements. This rule, although not 
economically significant under Executive Order 12866, is a significant 
rule under Executive Order 12866 and has been reviewed by the Office of 
Management and Budget. This rule is being issued as an interim final 
rule, with comment period, as an exception to our standard practice of 
soliciting public comments

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prior to issuance. This is because the effective date of the changes to 
these statutes was October 28, 2004. The rule changes the regulation to 
conform to the new statutory entitlement. Based on these statutory 
requirements, the Assistant Secretary of Defense (Health Affairs) has 
determined that following the standard practice in this case would be 
unnecessary, impractical and contrary to the public interest. Public 
comments are invited. All comments will be carefully considered. A 
discussion of the major issues received by public comments will be 
included with the issuance of the final rule.

Paperwork Reduction Act

    This rule will not impose additional information collection 
requirements on the public under the Paperwork Reduction Act of 1995 
(44 U.S.C. 3501-3511).

List of Subjects in 32 CFR Part 199

    Claims, Dental Program, Dental Health, Health care, Health 
insurance, Military personnel.

0
For the reasons set out in the preamble, the Department of Defense 
amends 32 CFR part 199 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 199.13 is amended by revising paragraphs (a)(2)(iii), 
(c)(2)(i)(a)(2) and (c)(3)(ii)(E)(2), and adding paragraphs (a)(2)(iv) 
and (i) to read as follows:


Sec.  199.13  TRICARE Dental Program.

    (a) * * *
    (2) * * *
    (iii) Exclusion of benefit services performed in military dental 
care facilities. Except for emergency treatment, dental care provided 
outside the United States, services incidental to noncovered services, 
and services provided under paragraph (a)(2)(iv), dependents of active 
duty, Selected Reserve and Individual Ready Reserve members enrolled in 
the TDP may not obtain those services that are benefits of the TDP in 
military dental care facilities, as long as those covered benefits are 
available for cost-sharing under the TDP. Enrolled dependents of active 
duty, Selected Reserve and Individual Ready Reserve members may 
continue to obtain noncovered services from military dental care 
facilities subject to the provisions for space available care.
    (iv) Exception to the exclusion of services performed in military 
dental care facilities.
    (A) Dependents who are 12 years of age or younger and are covered 
by a dental plan established under this section may be treated by 
postgraduate dental residents in a dental treatment facility of the 
uniformed services under a graduate dental education program accredited 
by the American Dental Association if
    (1) Treatment of pediatric dental patients is necessary in order to 
satisfy an accreditation standard of the American Dental Association 
that is applicable to such program, or training in pediatric dental 
care is necessary for the residents to be professionally qualified to 
provide dental care for dependent children accompanying members of the 
uniformed services outside the United States; and
    (2) The number of pediatric patients at such facility is 
insufficient to support satisfaction of the accreditation or 
professional requirements in pediatric dental care that apply to such 
programs or students.
    (B) The total number of dependents treated in all facilities of the 
uniformed services under paragraph (a)(2)(iv) in a fiscal year may not 
exceed 2,000.
* * * * *
    (c) * * *
    (2) * * *
    (i) * * *
    (A) * * *
    (2) Child. To be eligible, the child must be unmarried and meet one 
of the requirements set forth in section 199.3(b)(2)(ii)(A)-(F) or 
199.3(b)(2)(ii)(H).
* * * * *
    (c) * * *
    (3) * * *
    (ii) * * *
    (E) * * *
    (2) Continuation of eligibility. Eligible dependents of active duty 
members while on active duty for a period of more than 30 days and 
eligible dependents of members of the Ready Reserve (i.e., Selected 
Reserve or Individual Ready Reserve, as specified in 10 U.S.C. 10143 
and 10144(b) respectively), shall be eligible for continued enrollment 
in the TDP for up to three (3) years from the date of the member's 
death, if, on the date of the death of the member, the dependent is 
enrolled in the TDP, or is not enrolled by reason of discontinuance of 
a former enrollment under paragraphs (e)(3)(ii)(E)(4)(ii) and 
(c)(3)(ii)(E)(4)(iii) of this section, or is not enrolled because the 
dependent was under the minimum age for enrollment at the time of the 
member's death. This continued enrollment is not contingent on the 
Selected Reserve or Individual Ready Reserve member's own enrollment in 
the TDP. During the three-year period of continuous enrollment, the 
government will pay both the Government and the beneficiary's portion 
of the premium share.
* * * * *
    (i) Implementing Instructions. The Director, TRICARE Management 
Activity or designee may issue TRICARE Dental Program policies, 
standards, and criteria as may be necessary to implement the intent of 
this section.
* * * * *

    Dated: September 14, 2005.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 05-18753 Filed 9-20-05; 8:45 am]
BILLING CODE 5001-06-M