[Federal Register Volume 74, Number 208 (Thursday, October 29, 2009)]
[Rules and Regulations]
[Pages 55776-55778]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-26038]


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DEPARTMENT OF DEFENSE

Office of the Secretary

RIN 0720-AB28; DoD-2008-HA-0073

32 CFR Part 199


TRICARE; Hospital-Based Psychiatric Partial Hospitalization 
Programs

AGENCY: Office of the Secretary, Department of Defense.

ACTION: Final rule.

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SUMMARY: This final 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: Effective Date: This rule is effective November 30, 2009.

FOR FURTHER INFORMATION CONTACT: Ann N. Fazzini, Medical Benefits and 
Reimbursement Branch, TRICARE Management Activity, telephone, (303) 
676-3803. Questions regarding payment of specific claims should be 
addressed to the appropriate TRICARE contractor.

SUPPLEMENTARY INFORMATION:

I. Background

    In the Federal Register of December 30, 2008, (73 FR 79726), the 
Office of the Secretary of Defense published for public comment a 
proposed rule regarding TRICARE certification standards for psychiatric 
PHPs. The rule proposed that TRICARE no longer impose its unique 
certification standards upon hospital-based psychiatric PHPs. Rather, 
TRICARE approval of a hospital shall be sufficient to establish the 
hospital as an authorized provider of its PHP services to TRICARE 
beneficiaries.

II. Review of Public Comments

    We received two comments on the proposed rule. One commenter 
applauded the agency for its decision to find that TRICARE approval of 
a hospital is sufficient for its psychiatric partial hospitalization 
program to be an authorized provider. We appreciate the comment.
    A second commenter recommended that DoD eliminate TRICARE's unique 
requirements for hospital-based PHPs. We note that the proposed rule 
put forward eliminating the unique requirements for hospital based PHPs 
and recognizing a hospital-based PHP as

[[Page 55777]]

an authorized provider. This final rule adopts the provision.
    This same commenter also urged DoD to revise its PHP reimbursement 
regulations by implementing a temporary military contingency payment 
adjustment (TMCPA) for PHP consistent with its policy for other 
outpatient services as described in 32 CFR 199.14. We refer the 
commenter to the final rule published in the Federal Register on 
December 10, 2008 (73 FR 74954), that discusses the Outpatient 
Prospective Payment System (OPPS). The OPPS allows for a temporary 
transitional payment adjustment (TTPA) and a TMCPA to buffer the 
financial impact of the new prospective payment system. The 
Department's rationale for adopting the TTPA was to ease the transition 
from the prior reimbursement system to the prospective payment-type of 
reimbursement and to give hospitals time to adjust and budget for 
potential revenue reductions. We note that the OPPS, TTPA, and TMCPA 
apply to PHP services.
    Finally, the commenter also urged DoD to critically examine its 
payment structure for hospital-based PHP, with a strong attention to 
payment adequacy for hospital-based PHP. The commenter also stated that 
reviewing our payment structure will assure greater access to quality 
hospital-based PHPs. We respond by noting that we believe access and 
reimbursement will be enhanced by adopting the provision in this rule 
which provides that TRICARE approval of a hospital is sufficient for 
its PHP to be an authorized TRICARE provider. Upon implementation of 
this provision, separate TRICARE certification of hospital-based 
psychiatric PHPs shall no longer be required; consequently, access will 
be enhanced. Additionally, with our adoption of the Medicare full-day 
rate for partial hospitalization and allowing payment of professional 
services outside the per diem rate, with some exceptions, we feel the 
overall PHP payment (i.e., the TRICARE OPPS per diem plus payment for 
certain professional services) is comparable to the per diem rates 
currently in effect under TRICARE policy. In addition, the TMCPAs would 
also apply to ensure adequate access to PHP services. Again, for 
further information on PHP reimbursement and OPPS, we refer the reader 
to the final rule published in the Federal Register on December 10, 
2008 (73 FR 74954). It should be noted, however, that neither the 
proposed rule nor this final rule address the reimbursement provisions 
of section 199.14.

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 a significant regulatory 
action. Nor is it subject to the Congressional Review Act.

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 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.

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.


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2. Section 199.6 is amended by revising paragraphs (b)(4)(xii)(A)(2)(i) 
and (b)(4)(xii)(E)(7) introductory text 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:
* * * * *


[[Page 55778]]


    Dated: October 23, 2009.
Patricia L. Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. E9-26038 Filed 10-28-09; 8:45 am]
BILLING CODE 5001-06-P