[Federal Register Volume 76, Number 180 (Friday, September 16, 2011)]
[Rules and Regulations]
[Pages 57642-57643]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-23762]



[[Page 57642]]

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DEPARTMENT OF DEFENSE

Office of the Secretary

32 CFR Part 199

[DOD-2010-HA-0033]
RIN 0720-AB44


TRICARE: Unfortunate Sequelae From Noncovered Services in a 
Military Treatment Facility

AGENCY: Office of the Secretary, Department of Defense.

ACTION: Final rule.

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SUMMARY: The Department of Defense is publishing this final rule to 
allow coverage for otherwise covered services and supplies required in 
the treatment of complications (unfortunate sequelae) resulting from a 
noncovered incident of treatment provided in a Military Treatment 
Facility (MTF), when the initial noncovered service has been authorized 
by the MTF Commander and the MTF is unable to provide the necessary 
treatment of the complications. This final rule is necessary to protect 
TRICARE beneficiaries from incurring financial hardships due to the 
current regulatory restrictions that prohibit TRICARE coverage of 
treatment of the complications resulting from noncovered procedures, 
even when those procedures were conducted in a Department of Defense 
facility.

DATES: Effective Date: This rule is effective October 17, 2011.

FOR FURTHER INFORMATION CONTACT: Ms. Ren[eacute] Morrell, TRICARE 
Management Activity, Medical Benefits and Reimbursement Branch, 
telephone (303) 676-3618.

SUPPLEMENTARY INFORMATION:

I. Background

    In the Federal Register of August 6, 2010, (75 FR 47519-47520), the 
Office of the Secretary of Defense published for public comment a 
proposed rule to allow coverage for otherwise covered services and 
supplies required in the treatment of complications (unfortunate 
sequelae) resulting from a noncovered incident of treatment provided in 
a Military Treatment Facility (MTF), when the initial noncovered 
service has been authorized by the MTF Commander and the MTF is unable 
to provide the necessary treatment of the complications.
    In order to support Graduate Medical Education and maintain 
provider skill levels, MTF providers are frequently required to perform 
medical procedures that may be excluded from coverage under TRICARE. 
Unexpected complications (unfortunate sequelae) from these procedures 
may result and, in those instances where the MTFs are unable to provide 
the appropriate level of care necessary for the proper treatment of 
these complications, the MTF Commander must refer beneficiaries for 
treatment outside the MTF. Under current regulatory provisions, TRICARE 
is unable to cover treatment of the complications resulting from 
noncovered procedures. When beneficiaries require treatment outside the 
MTF for these complications, arising from noncovered procedures, they 
are responsible for payment for this necessary treatment resulting in 
significant financial hardship. This final rule will address that 
unfortunate situation by allowing coverage of treatment for the 
complications resulting from noncovered treatment provided in an MTF 
when the original procedure was authorized by the MTF Commander. The 
specific procedures for approval of this treatment will be addressed in 
the TRICARE Policy Manual rather than in the regulation to ensure that 
this information is current and easily accessible. TRICARE manuals may 
be accessed at http://www.tricare.mil.

II. Public Comments

    We provided a 60-day public comment period following publication of 
the Proposed Rule in the Federal Register (75 FR 47519-47520) on August 
6, 2010. One comment was received in full support of the rule.

III. Regulatory Procedures

Executive Order 12866, ``Regulatory Planning and Review'' and Executive 
Order 13563, ``Improving Regulation and Regulatory Review''

    Section 801 of title 5, United States Code, and Executive Order 
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''

    Section 202 of Public Law 104-4, ``Unfunded Mandates Reform Act,'' 
requires that 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 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 to 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 will not significantly impact a substantial number of small 
entities for purposes of the RFA.

Public Law 96-511, ``Paperwork Reduction Act'' (44 U.S.C. Chapter 35)

    This rule will not impose significant additional information 
collection requirements on the public under the Paperwork Reduction Act 
of 1995 (44 U.S.C. 3501-3511).

Executive Order 13132, ``Federalism''

    This rule has been examined for its impact under E.O. 13132 and 
does not contain 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 in the distribution 
of power and responsibilities among the various levels of government; 
therefore, consultation with the 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 amended as follows:

PART 199--[AMENDED]

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 199.4 is amended by:
0
a. Redesignating paragraph (e)(9) as paragraph (e)(9)(i)
0
b. Adding new paragraph (e)(9)(ii)


Sec.  199.4  Basic program benefits.

* * * * *
    (e) * * *

[[Page 57643]]

    (9) * * *
    (ii) Benefits are available for otherwise covered services and 
supplies required in the treatment of complications (unfortunate 
sequelae) resulting from a noncovered incident of treatment provided in 
an MTF, when the initial noncovered service has been authorized by the 
MTF Commander and the MTF is unable to provide the necessary treatment 
of the complications, according to the guidelines adopted by the 
Director, TMA, or a designee.
* * * * *

    Dated: August 24, 2011.
Patricia L. Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2011-23762 Filed 9-15-11; 8:45 am]
BILLING CODE 5001-06-P