[Federal Register Volume 75, Number 151 (Friday, August 6, 2010)]
[Rules and Regulations]
[Pages 47460-47461]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-19307]


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DEPARTMENT OF DEFENSE

Office of the Secretary

[DOD-2008-HA-0025; 0720-AB20]

32 CFR Part 199


TRICARE: Changes Included in the National Defense Authorization 
Act for Fiscal Year 2007; Improvements to Descriptions of Cancer 
Screening for Women

AGENCY: Office of the Secretary, DoD.

ACTION: Final rule.

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SUMMARY: The Department is publishing this final rule to implement 
section 703 of the National Defense Authorization Act (NDAA) for Fiscal 
Year 2007 (FY07), Public Law 109-364. Specifically, that legislation 
authorizes breast cancer screening and cervical cancer screening for 
female beneficiaries of the Military Health System, instead of 
constraining such testing to mammograms and Papanicolaou smears. The 
rule allows coverage for ``breast cancer screening'' and ``cervical 
cancer screening'' for female beneficiaries of the Military Health 
System, instead of constraining such testing to mammograms and 
Papanicolaou tests. This rule ensures new breast and cervical cancer 
screening procedures can be added to the TRICARE benefit as such 
procedures are proven to be a safe, effective, and nationally accepted 
medical practice. This amends the cancer specific recommendations for 
breast and cervical cancer screenings to be brought in line with the 
processes for updating other cancer screening recommendations. In 
response to public comment on the proposed rule, this final rule 
includes a clarification that the benefit encompasses screening based 
on Health and Human Services guidelines.

DATES: Effective Date: This rule is effective September 7, 2010.

FOR FURTHER INFORMATION CONTACT: Commander James Ellzy, Office of the 
Chief Medical Officer, TRICARE Management Activity, telephone (703) 
681-0064.

SUPPLEMENTARY INFORMATION:

A. Background

    The Department of Defense updated coverage for screening with the 
use of the breast MRI for women in a designated high risk category as 
advised by the American Cancer Society. In the process of providing 
this additional coverage, it was discovered that because of statutory 
wording, there was a group of high risk women that are standard 
beneficiaries under the age of 35 for whom this coverage could not be 
provided without an amendment in the Code of Federal Regulations (CFR). 
Amending the CFR will provide coverage for breast MRI screening for all 
Department of Defense beneficiaries in the high risk category 
recommended by the American Cancer Society.

B. Public Comments

    The Department of Defense published a proposed rule on July 24, 
2009 (74 FR 36638-36639). A single comment was received asking that the 
language be written more clearly. The final rule includes language in 
section (g)(37)(viii) that is more precise in terms of which cancers 
will be covered and notes that cervical and breast cancer screenings 
will be provided in accordance with the standards based on the 
guidelines from the U.S. Department of Health and Human Services.

C. Regulatory Procedures

Executive Order (EO) 12866 and Regulatory Flexibility Act

    E.O. 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. 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 that 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 final rule is not subject to any of 
these requirements. This rule, although not economically significant, 
is a significant rule under E.O. 12866 and has been reviewed by the 
Office of Management and Budget. Amending the CFR will provide coverage 
for breast MRI screening for all Department of Defense beneficiaries in 
the high risk category, if necessary. It is critically important that 
we eliminate any potential gaps in coverage for high risk individuals 
as quickly as possible.

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).

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 tribunal 
governments, in aggregate, or by the private section, of $100 million 
or more in any one year.

Executive Order (EO) 13132

    We have examined the impact(s) of the final rule under E.O. 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

[[Page 47461]]

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

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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 199.4 is amended by:
0
A. Revising paragraphs (g)(37)(viii) and (ix).
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B. Redesignating paragraphs (g)(37)(x) through (g)(37)(xii) as 
(g)(37)(xi) through (g)(37)(xiii).
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C. Adding a new paragraph (g)(37)(x).
    The revisions and additions read as follows:


Sec.  199.4  Basic program benefits.

* * * * *
    (g) * * *
    (37) * * *
    (viii) Cervical and breast cancer screenings in accordance with 
standards issued by the Director, TRICARE Management Activity, based on 
guidelines from the U.S. Department of Health and Human Services. Such 
standards may establish a specific schedule, including frequency, age 
specifications, and gender of the beneficiary, as appropriate.
    (ix) Health promotion and disease prevention visits may include all 
of the services provided pursuant to Sec.  199.18(b)(2) and may be 
provided in connection with immunizations and cancer screening 
examinations authorized by paragraphs (g)(37)(ii) or (g)(37)(viii) of 
this section.
    (x) Physical examinations for beneficiaries ages 5-11 that are 
required in connection with school enrollment, and that are provided on 
or after October 30, 2000.
* * * * *

    Dated: July 26, 2010.
Patricia L. Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2010-19307 Filed 8-5-10; 8:45 am]
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