[Federal Register Volume 73, Number 250 (Tuesday, December 30, 2008)]
[Proposed Rules]
[Pages 79726-79727]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E8-31054]


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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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