[Federal Register Volume 75, Number 159 (Wednesday, August 18, 2010)]
[Rules and Regulations]
[Pages 50883-50884]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-20391]


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DEPARTMENT OF DEFENSE

Office of the Secretary

32 CFR Part 199

[Docket ID: DoD-2008-HA-0123]
RIN 0720-AB29


TRICARE; TRICARE Delivery of Health Care in Alaska

AGENCY: Office of the Secretary, Department of Defense.

ACTION: Final rule.

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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 incorporates the 
waiver of the requirement for financial underwriting by a TRICARE 
contractor as a permanent change 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.

DATES: Effective Date: September 17, 2010.

FOR FURTHER INFORMATION CONTACT: LTC Stephen Oates, TRICARE Policy and 
Operations Directorate, TRICARE Management Activity, 5111 Leesburg 
Pike, Suite 810, Falls Church, VA 22041, 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, Vol. 69, No. 96/Tuesday, May 18, 2004/Notices). 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. The demonstration is authorized until March 31, 2011. This 
rule will make permanent the waiver of the financial underwriting 
requirement by the TRICARE contractor in the delivery of health care in 
Alaska.

II. Public Comments

    The proposed rule was published in the Federal Register (74 FR 
62270-62271) on November 27, 2009, for a 60-day comment period. Two 
comments were submitted and are responded to below.
    Comment: Alaska TRICARE managers need authorization, as do other 
states, to designate civilian primary care managers (PCMs) for care 
unavailable or too distant for the members who are in TRICARE Prime.
    Response: We agree that allowing TRICARE managers the ability to 
designate civilian primary care managers (PCMs) would improve the 
access to care for eligible beneficiaries. Policies are currently being 
reviewed to assess the feasibility of incorporating such practices 
without adversely affecting the local community.
    Comment: Certified Nurse Midwives and state-licensed direct-entry 
midwives are underutilized alternatives to physician-led care for 
pregnant women. Also, TRICARE's authorized providers should be expanded 
to include state-licensed midwives.
    Response: We understand the limited choices available to 
beneficiaries in the state of Alaska; however, the ultimate decision 
remains with the beneficiary on provider selection. In order for a 
Certified Nurse Midwife to become a TRICARE-authorized provider, he/she 
must be licensed, when required, by a local licensing agency and 
certified by the American College of Nurse Midwives.

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.

Section 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

[[Page 50884]]

proposed rule is not subject to any of these requirements.

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

    This rule will not impose additional information collection 
requirements on the public.

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.

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.


0
2. Section 199.17 is amended by revising the second sentence of 
paragraph (a)(3), redesignating paragraph (v) as paragraph (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. 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: August 10, 2010.
Patricia L. Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2010-20391 Filed 8-17-10; 8:45 am]
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