[Federal Register Volume 74, Number 227 (Friday, November 27, 2009)]
[Proposed Rules]
[Pages 62270-62271]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-28357]


-----------------------------------------------------------------------

DEPARTMENT OF DEFENSE

Office of the Secretary

[DoD-2008-HA-0123; RIN 0720-AB29]

32 CFR Part 199


TRICARE; TRICARE Delivery of Health Care in Alaska

AGENCY: Office of the Secretary, Department of Defense.

ACTION: Proposed 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 proposes to 
incorporate those demonstration exceptions as permanent changes 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. In addition, 
TRICARE Prime may be limited to those eligible beneficiaries enrolled 
to a military treatment facility and those eligible for TRICARE Prime 
Remote.

DATES: Written comments received at the address indicated below by 
January 26, 2010 will be accepted.

ADDRESSES: You may submit comments, identified by docket number and/or 
Regulatory Information Number (RIN) number and title, by either 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. Michael O'Bar, TRICARE Management 
Activity, TRICARE Policy and Operations Directorate, 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, Tuesday, May 18, 2004, 69 FR 28124-28125). 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. In addition, implementation of the TRICARE program in Alaska 
has limited TRICARE Prime to those eligible beneficiaries enrolled at a 
military treatment facility (MTF) and those eligible for TRICARE Prime 
Remote. The demonstration is scheduled to end on March 31, 2009. This 
rule will make permanent those aspects of the demonstration which the 
Department of Defense found to be best in the delivery of health care 
in Alaska. However, in order to ensure continuity of health care 
services in Alaska during the transition to the competitively awarded 
follow-on TRICARE contract, the demonstration may be extended until the 
later of the start of health care delivery under the new contract or 
until this rule becomes final.

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.

Sec. 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 proposed rule is not subject to any of 
these requirements.

[[Page 62271]]

Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3511)

    This rule will not impose additional reporting or recordkeeping 
requirements under the Paperwork Reduction Act of 1995.

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.
    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 199.17 is amended by revising the second sentence of 
paragraph (a)(3), redesignating the current paragraph (v) as (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. In addition, the Assistant Secretary of Defense 
(Health Affairs) may limit the availability of TRICARE Prime in the 
State of Alaska to those eligible beneficiaries enrolled to a military 
treatment facility (MTF) and to those eligible beneficiaries under 
TRICARE Prime Remote. 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: November 19, 2009.
Patricia L. Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. E9-28357 Filed 11-25-09; 8:45 am]
BILLING CODE 5001-06-P