Federal Register / Vol. 76, No. 9 / Thursday, January 13, 2011 / Proposed Rules 2291 

those qualifying members and their 

families. 

II. Regulatory Procedures 

Executive Order 12866, ‘‘Regulatory 

Planning and Review’’ and Public Law 

96–354, ‘‘Regulatory Flexibility Act’’ (5 

U.S.C. 601) 

Executive Order 12866 requires that 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 that 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 proposed 

rule is not a 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. 

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 impacts 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. 

Sec. 202, Public Law 104–4, ‘‘Unfunded 

Mandates Reform Act’’ 

This rule does not contain unfunded 

mandates. It 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. 

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—[AMENDED] 

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 paragraph (n)(2)(vi) to read as 

follows: 

§ 199.17 TRICARE program 

* * * * * 

(n) * * * 

(2) * * * 

(vi) In accordance with guidelines 

issued by the Assistant Secretary of 

Defense for Health Affairs, reasonable 

travel expenses may be reimbursed for 

a TRICARE Prime enrollee and, when an 

adult non-medical attendant is 

necessary, for a parent or guardian of 

the enrollee or another member of the 

enrollee’s family who is at least 21 years 

of age. Such guidelines shall be 

consistent with appropriate provisions 

of generally applicable Department of 

Defense rules and procedures governing 

travel expenses. Reimbursement of 

reasonable travel expenses shall be 

provided under the following 

conditions: 

(A) When a Prime enrollee is referred 

by the primary care manager for 

medically necessary specialty care more 

than 100 miles away from the primary 

care manager’s office. 

(B) When an exceptional 

circumstance exists involving referral 

for specialty care for an active duty 

member of the uniformed Services or a 

dependent of an active duty member of 

the uniformed Services enrolled in 

Prime or in TRICARE Prime Remote. An 

exceptional circumstance exists when 

the enrollee is referred for medically 

necessary specialty care requiring travel 

beyond a 60-minute drive time but 

within 100 miles of the military 

treatment facility or the TRICARE Prime 

Remote primary care manager’s office. 

The Director, TRICARE shall issue 

guidelines and procedures under which 

authorization of travel expenses will be 

issued based on verification that a 

specialty care provider or specific 

category of specialty care provider is not 

available within 60- minute drive time 

but less than 100 miles from a referring 

military treatment facility or TRICARE 

Prime Remote primary care manager’s 

office. The guidelines and procedures 

shall also include verification that the 

Managed Care Support Contractor has 

used due diligence in attempting to 

enroll into the network needed 

specialists who meet the normal drive 

time specialty care access standards or 

has otherwise identified non-network 

providers within the specialty care 

access standards to whom a Prime 

enrollee may be referred without 

incurring point of service costs. The 

Director, TRICARE may establish and 

make available a list of military 

treatment facilities and specialty 

providers for each for which these 

reasonable travel expenses shall be 

allowed and shall ensure that members 

and their families enrolled in TRICARE 

Prime Remote obtain assistance in 

receiving this benefit when appropriate. 

* * * * * 

Dated: January 4, 2011. 

Patricia L. Toppings, 

OSD Federal Register Liaison Officer, 

Department of Defense. 

[FR Doc. 2011–622 Filed 1–12–11; 8:45 am] 

BILLING CODE 5001–06–P 

DEPARTMENT OF DEFENSE 

Office of the Secretary 

32 CFR Part 199 

[DOD–2011–HA–0007] 

RIN 0720–AB43 

TRICARE Reimbursement Revisions 

AGENCY: Office of the Secretary, DoD. 

ACTION: Proposed rule. 

SUMMARY: The rule proposes several 

revisions to the regulation necessary to 

be consistent with Medicare, to include: 

hospice periods of care; reimbursement 

of physician assistants and assistant-atsurgery claims; and this rule revises the 

regulation by removing references to 

specific numeric Diagnosis Related 

Group (DRG) values, and replacing them 

with their narrative description. 

DATES: Written comments received at 

the address indicated below by March 

14, 2011 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 


srobinson on DSKHWCL6B1PROD with PROPOSALS
2292 Federal Register / Vol. 76, No. 9 / Thursday, January 13, 2011 / Proposed Rules 

received without change, including any 

personal identifiers or contact 

information. 

FOR FURTHER INFORMATION CONTACT: Ms. 

Ann N. Fazzini, TRICARE Management 

Activity, Medical Benefits and 

Reimbursement Systems, telephone 

(303) 676–3803. 

SUPPLEMENTARY INFORMATION: 

I. Hospice 

This proposed rule revises the 

regulation for hospice periods of care. 

The Defense Authorization Act for FY 

1992–1993, Public Law 102–190, 

directed TRICARE to provide hospice 

care in the manner and under the 

conditions provided in section 1861(dd) 

of the Social Security Act (42 U.S.C. 

1395x(dd)). Congress’ intent was for 

TRICARE to establish a benefit in the 

same manner as Medicare. TRICARE 

originally had the same periods of 

hospice care used by Medicare; 

however, over time the Medicare benefit 

changed, but TRICARE’s regulation has 

not. The TRICARE regulation currently 

provides for an initial period of 90 days, 

a subsequent period of 90 days, a 

second subsequent period of 30 days, 

and a final period of unlimited duration. 

Rather than maintaining this level of 

specificity in the regulation and to 

ensure that TRICARE and Medicare’s 

benefit periods are equal, we are 

revising the regulation to state that the 

distinct periods of care available under 

the hospice benefit shall be the same as 

those offered under Medicare’s hospice 

program. Currently under Medicare, 

patients are entitled to two 90-day 

election periods, followed by an 

unlimited number of 60-day periods. 

The level of specific benefits shall be 

included in the TRICARE 

Reimbursement Manual, and may be 

accessed at http://www.tricare.mil. 

II. Physician Assistants and Assistantat-Surgery 

The current regulatory language 

references specific reimbursement 

percentages for assistant-at-surgery 

reimbursement. Rather than including 

these specific percentage amounts, 

which would require a regulatory 

change any time the percentage amounts 

change, we are making a general 

statement referring to the current 

percentages used by Medicare. Our 

authority for this is 10 U.S.C. 1079(h) 

which states: Except as provided in 

paragraphs (2) and (3), payment for a 

charge for services by an individual 

health care professional (or other 

noninstitutional health care provider) 

for which a claim is submitted under a 

plan contracted for under subsection (a) 

shall be equal to an amount determined 

to be appropriate, to the extent 

practicable, in accordance with the 

same reimbursement rules as apply to 

payments for similar services under title 

XVIII of the Social Security Act (42 

U.S.C. 1395 et seq.). The Secretary of 

Defense shall determine the appropriate 

payment amount under this paragraph 

in consultation with the other 

administering Secretaries. The specific 

percentages are more appropriately 

included in the TRICARE 

Reimbursement Manual, and may be 

accessed at http://www.tricare.mil. 

III. DRG 

10 U.S.C. 1079(j)(2) provides that the 

amount to be paid to a provider of 

services for services provided under a 

plan covered by this section shall be 

determined under joint regulations to be 

prescribed by the administering 

Secretaries which provide that the 

amount of such payments shall be 

determined to the extent practicable in 

accordance with the same 

reimbursement rules as apply to 

payments to providers of services of the 

same type under title XVIII of the Social 

Security Act (42 U.S.C. 1395 et seq.). 

In accordance with the above statute, 

the TRICARE/CHAMPUS DRG-based 

payment system transitioned to 

adopting the Medicare Severity-DRG 

based payment system on October 1, 

2008. When TRICARE transitioned to 

the severity-based system, it was 

necessary to renumber the existing 

DRGs, and to assign different narrative 

descriptions to the DRG numbers. As a 

result, the existing regulatory reference 

to specific DRG numbers and 

descriptions became obsolete, so we are 

removing the numeric references in the 

regulation and utilizing only the 

descriptive terminology. 

Regulatory Procedures 

Executive Order 12866, ‘‘Regulatory 

Planning and Review’’ 

Section 801 of title 5, United States 

Code, 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 economically 

significant. It has been reviewed by the 

Office of Management and Budget as 

required under the provisions of E.O. 

12866. 

Public Law 104–4, Section 202, 

‘‘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 proposed 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, 

and thus this proposed rule is not 

subject to this requirement. 

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 that each Federal agency 

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 proposed 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 proposed 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). 

Executive Order 13132, ‘‘Federalism’’ 

E.O. 13132, ‘‘Federalism,’’ requires 

that 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 proposed rule does 

not have federalism implications, as set 

forth in E.O. 13132. 

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: 


srobinson on DSKHWCL6B1PROD with PROPOSALS
Federal Register / Vol. 76, No. 9 / Thursday, January 13, 2011 / Proposed Rules 2293 

PART 199—[AMENDED] 

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 199.4 is amended by 

revising paragraph (e)(19)(v) to read as 

follows: 

§ 199.4 Basic program benefits 

* * * * * 

(e) * * * 

(19) * * * 

(v) Periods of care. Hospice care is 

divided into distinct periods of care. 

The periods of care that may be elected 

by the terminally ill CHAMPUS 

beneficiary shall be as the Director, 

TRICARE determines to be appropriate, 

but shall not be less than those offered 

under Medicare’s Hospice Program. 

* * * * * 

3. Section 199.14 is amended by 

revising paragraphs (a)(1)(ii)(C)(3), 

(a)(1)(iii)(A)(2), and (j)(1)(ix) to read as 

follows: 

§ 199.14 Provider reimbursement methods 

* * * * * 

(a) * * * 

(1) * * * 

(ii) * * * 

(C) * * * 

(3) All services related to heart and 

liver transplantation for admissions 

prior to October 1, 1998, which would 

otherwise be paid under the respective 

DRG. 

* * * * * 

(iii) * * * 

(A) * * * 

(2) Remove DRGs. Those DRGs that 

represent discharges with invalid data 

or diagnoses insufficient for DRG 

assignment purposes are removed from 

the database. 

* * * * * 

(j) * * * 

(1) * * * 

(ix) The allowable charge for 

physician assistant services other than 

assistant-at-surgery shall be at the same 

percentage, used by Medicare, of the 

allowable charge for a comparable 

service rendered by a physician 

performing the service in a similar 

location. For cases in which the 

physician assistant and the physician 

perform component services of a 

procedure other than assistant-atsurgery (e.g., home, office or hospital 

visit), the combined allowable charge 

for the procedure may not exceed the 

allowable charge for the procedure 

rendered by a physician alone. The 

allowable charge for physician assistant 

services performed as an assistant-atsurgery shall be at the same percentage, 

used by Medicare, of the allowable 

charge for a physician serving as an 

assistant surgeon when authorized as 

CHAMPUS benefits in accordance with 

the provisions of § 199.4(c)(3)(iii). 

Physician assistant services must be 

billed through the employing physician 

who must be an authorized CHAMPUS 

provider. 

* * * * * 

Dated: January 5, 2011. 

Patricia L. Toppings, 

OSD Federal Register Liaison Officer, 

Department of Defense. 

[FR Doc. 2011–624 Filed 1–12–11; 8:45 am] 

BILLING CODE 5001–06–P 

ENVIRONMENTAL PROTECTION 

AGENCY 

40 CFR Part 52 

[EPA–R05–OAR–2010–0675; FRL–9250–9] 

Approval and Promulgation of Air 

Quality Implementation Plans; 

Minnesota; Gopher Resource, LLC 

AGENCY: Environmental Protection 

Agency (EPA). 

ACTION: Proposed rule. 

SUMMARY: EPA is proposing to approve 

a request submitted by the Minnesota 

Pollution Control Agency (MPCA) on 

July 29, 2010, to revise the Minnesota 

State Implementation Plan (SIP) for lead 

(Pb) under the Clean Air Act (CAA). The 

State has submitted a joint Title I/Title 

V document (joint document) in the 

form of Air Emission Permit No. 

03700016–003, and has requested that 

the conditions laid out with the citation 

‘‘Title I Condition: SIP for Lead NAAQS’’ 

replace an existing Administrative 

Order (Order) as the enforceable SIP 

conditions for Gopher Resource, LLC. 

EPA approved the existing Order on 

October 18, 1994. MPCA’s July 29, 2010, 

revisions were meant to satisfy the 

maintenance requirements for the 1978 

Pb National Ambient Air Quality 

Standard (NAAQS), promulgated at 1.5 

micrograms per cubic meter, or 

1.5 μg/m 3. 

DATES: Comments must be received on 

or before February 14, 2011. 

ADDRESSES: Submit your comments, 

identified by Docket ID No. EPA–R05– 

OAR–2010–0675, by one of the 

following methods: 

1. http://www.regulations.gov: Follow 

the on-line instructions for submitting 

comments. 

2. E-mail: mooney.john@epa.gov. 

3. Fax: (312) 692–2551. 

4. Mail: John M. Mooney, Chief, 

Attainment Planning and Maintenance 

Section, Air Programs Branch (AR–18J), 

U.S. Environmental Protection Agency, 

77 West Jackson Boulevard, Chicago, 

Illinois 60604. 

5. Hand Delivery: John M. Mooney, 

Chief, Attainment Planning and 

Maintenance Section, Air Programs 

Branch (AR–18J), U.S. Environmental 

Protection Agency, 77 West Jackson 

Boulevard, Chicago, Illinois 60604. 

Such deliveries are only accepted 

during the Regional Office normal hours 

of operation, and special arrangements 

should be made for deliveries of boxed 

information. The Regional Office official 

hours of business are Monday through 

Friday, 8:30 a.m. to 4:30 p.m., excluding 

Federal holidays. 

Please see the direct final rule which 

is located in the Final Rules section of 

this Federal Register for detailed 

instructions on how to submit 

comments. 

FOR FURTHER INFORMATION CONTACT: 

Andy Chang, Environmental Engineer, 

Attainment Planning and Maintenance 

Section, Air Programs Branch (AR–18J), 

Environmental Protection Agency, 

Region 5, 77 West Jackson Boulevard, 

Chicago, Illinois 60604, (312) 886–0258, 

chang.andy@epa.gov. 

SUPPLEMENTARY INFORMATION: In the 

Final Rules section of this Federal 

Register, EPA is approving the State’s 

SIP submittal as a direct final rule 

without prior proposal because the 

Agency views this as a noncontroversial 

submittal and anticipates no adverse 

comments. A detailed rationale for the 

approval is set forth in the direct final 

rule. If we do not receive any adverse 

comments in response to this rule, we 

do not contemplate taking any further 

action. If EPA receives adverse 

comments, we will withdraw the direct 

final rule, and will address all public 

comments in a subsequent final rule 

based on this proposed rule. EPA will 

not institute a second comment period. 

Any parties interested in commenting 

on this action should do so at this time. 

Please note that if EPA receives adverse 

comment on an amendment, paragraph, 

or section of this rule and if that 

provision may be severed from the 

remainder of the rule, EPA may adopt 

as final those provisions of the rule that 

are not the subject of an adverse 

comment. For additional information, 

see the direct final rule, which is 

located in the Final Rules section of this 

Federal Register. 


srobinson on DSKHWCL6B1PROD with PROPOSALS