2290 Federal Register / Vol. 76, No. 9 / Thursday, January 13, 2011 / Proposed Rules 

their eligibility and previous enrollment 

subject to eligibility, enrollment and 

disenrollment provisions described in 

this section and in the TDP contract. 

(iv) Eligible dependents of an active 

duty, Selected Reserve or Individual 

Ready Reserve member serving a 

sentence of confinement in conjunction 

with a sentence of punitive discharge 

are still eligible for the TDP until such 

time as the active duty, Selected Reserve 

or Individual Ready Reserve member’s 

discharge is executed. 

* * * * * 

Dated: January 4, 2011. 

Patricia L. Toppings, 

OSD Federal Register Liaison Officer, 

Department of Defense. 

[FR Doc. 2011–623 Filed 1–12–11; 8:45 am] 

BILLING CODE 5001–06–P 

DEPARTMENT OF DEFENSE 

Office of the Secretary 

32 CFR Part 199 

[DOD–2010–HA–0094; RIN 0720–AB42] 

TRICARE; Reimbursement for Travel 

for Specialty Care Under Exceptional 

Circumstances 

AGENCY: Office of the Secretary, DoD. 

ACTION: Proposed rule. 

SUMMARY: This proposed rule 

implements section 634 of the National 

Defense Authorization Act for Fiscal 

Year 2010 which amends Section 1074i 

of title 10, United States Code, to permit 

reimbursement for reasonable travel 

expenses for active duty members of the 

uniformed Services and their 

dependents, and accompaniment, to a 

specialty care provider under such 

exceptional circumstances as the 

Secretary of Defense may proscribe. The 

Department of Defense through its 

military treatment facilities and its 

robust managed care program, TRICARE 

Prime, is able to fulfill the medical 

needs of the majority of its active duty 

members and their families. However, 

in some locations where active duty 

members and their families live due to 

the duty assignment of the member, the 

medical resources in the military 

treatment facilities and the managed 

care networks may not meet all of the 

specialty care needs of these members 

and their families within normal access 

standards. Reimbursement of reasonable 

travel expenses for required specialty 

care that is more than 100 miles from 

the primary care manager’s office is 

currently a benefit under paragraph (a) 

of section 1074i, title 10, United States 

Code for any covered beneficiary 

enrolled in the TRICARE Prime 

program, including the active duty 

members and their dependents. 

However this proposed rule extends a 

travel reimbursement for active duty 

members of the armed forces and their 

families who, because of an exceptional 

circumstance involving the duty 

assignment of the active duty member of 

the armed forces, are required to travel 

less than 100 miles but more than 60 

minutes in drive time to access needed 

specialty care. This travel 

reimbursement benefit is limited to 

those active duty members and their 

dependents, and accompaniment, 

enrolled in Prime or TRICARE Prime 

Remote. The Director, TRICARE 

Management Activity, shall issue 

procedures and guidelines under which 

authorization for reimbursement of 

travel expenses will be issued after 

verification that the member, family 

member, and/or accompaniment, must 

travel less than 100 miles but more than 

60 minutes drive time from the military 

treatment facility or their primary care 

manager’s office to receive required 

specialty care. 

DATES: Comments must be received on 

or before March 14, 2011. 

ADDRESSES: You may submit comments, 

identified by docket number and/or RIN 

number and title, by any 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 Regulatory 

Information Number (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 viewing on the Internet at http:// 

regulations.gov as they are received 

without change, including any personal 

identifiers or contact information. 

FOR FURTHER INFORMATION CONTACT: 

TRICARE Policy and Operations, 

TRICARE Management Activity, 5111 

Leesburg Pike, Suite 810, Falls Church, 

VA 22041. 

SUPPLEMENTARY INFORMATION: 

I. Introduction and Background 

The TRICARE benefit was directed by 

Congress in section 1097 of the National 

Defense Authorization Act for Fiscal 

Year 1995. For further information on 

TRICARE, the reader may refer to the 

final rule regarding TRICARE published 

in the Federal Register on October 5, 

1995. 

Travel for Specialty Care 

Managed care support contractors are 

required to establish adequate networks 

throughout regions to complement 

military treatment facilities and support 

TRICARE Prime and Extra. However, 

there are many active duty members of 

the uniformed Services and their 

families who are required by the 

member’s duty assignment to live in 

certain more remote areas where there 

are insufficient numbers or types of 

specialty or subspecialty providers to 

provide care within normal drive-time 

access standards notwithstanding the 

due diligence of the contractors in 

developing the network around the 

military treatment facilities or their 

diligence in finding network providers 

for those members or families enrolled 

in TRICARE Prime Remote. Under such 

exceptional circumstances as identified 

under procedures and guidelines issued 

by the Director, TRICARE Management 

Activity, reasonable travel expenses to 

obtained specialty care for which the 

enrollee has been referred may be 

reimbursed. The specific location or 

identity of these military treatment 

facilities and the specific TRICARE 

Prime Remote locations and the types of 

specialists or sub-specialists shall be 

determined in accordance with 

guidelines issued by the Assistant 

Secretary of Defense for Health Affairs. 

The guidelines shall include identity of 

the specific military treatment facility or 

TRICARE Prime Remote area, validation 

by either, or both, the facility 

commander and/or the Director of the 

TRICARE Regional Office that the 

specialty care provider or category of 

specialty care provider required to 

provide care to the active duty member 

and their dependents, are not available 

within a 60 minute drive time, but are 

available within 100 miles of the 

military treatment facility or primary 

care manager’s office. The Director of 

the TRICARE Regional Office shall also 

verify that the Managed Care Support 

Contractor has used due diligence in 

attempting to enroll the needed 

specialists who do meet the drive time 

specialty care access standards, into the 

network. The Director, TRICARE 

Management Activity shall establish 

and make available a list of military 

treatment facilities and category of 

specialty providers for which these 

reasonable travel expenses shall be 

allowed. For members, and families, 

enrolled in TPR the Director shall 

ensure that adequate coordination of 

care and travel benefits is provided to 


srobinson on DSKHWCL6B1PROD with PROPOSALS
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