50882 Federal Register / Vol. 75, No. 159 / Wednesday, August 18, 2010 / Rules and Regulations 

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 (c)(3)(x)(A) to read as 

follows: 

§ 199.4 Basic program benefits. 

* * * * * 

(c) * * * 

(3) * * * 

(x) * * * 

(A) The services are prescribed and 

monitored by a physician, certified 

physician assistant or certified nurse 

practitioner. 

* * * * * 

■ 3. Section 199.6 is amended by 

revising paragraph (c)(3)(iii)(K) to read 

as follows: 

§ 199.6 TRICARE-authorized providers. 

* * * * * 

(c) * * * 

(3) * * * 

(iii) * * * 

(K) Other individual paramedical 

providers. (1) The services of the 

following individual professional 

providers of care to be considered for 

benefits on a fee-for-service basis may 

be provided only if the beneficiary is 

referred by a physician for the treatment 

of a medically diagnosed condition and 

a physician must also provide 

continuing and ongoing oversight and 

supervision of the program or episode of 

treatment provided by these individual 

paramedical providers. 

(i) Licensed registered nurses. 

(ii) Audiologists. 

(2) The services of the following 

individual professional providers of 

care to be considered for benefits on a 

fee-for-service basis may be provided 

only if the beneficiary is referred by a 

physician, a certified physician assistant 

or certified nurse practitioner and a 

physician, a certified physician 

assistant, or certified nurse practitioner 

must also provide continuing and 

ongoing oversight and supervision of 

the program or episode of treatment 

provided by these individual 

paramedical providers. 

(i) Licensed registered physical 

therapist and occupational therapist. 

(ii) Licensed registered speech 

therapists (speech pathologists). 

* * * * * 

Dated: August 10, 2010. 

Patricia L. Toppings, 

OSD Federal Register Liaison Officer, 

Department of Defense. 

[FR Doc. 2010–20390 Filed 8–17–10; 8:45 am] 

BILLING CODE 5001–06–P 

DEPARTMENT OF DEFENSE 

Office of the Secretary 

32 CFR Part 199 

[Docket ID: DOD–2009–HA–0096] 

RIN 0720–AB34 

TRICARE: Transitional Assistance 

Management Program (TAMP) 

AGENCY: Office of the Secretary, 

Department of Defense. 

ACTION: Final rule. 

SUMMARY: The Department of Defense is 

publishing this final rule to implement 

section 4 of the Hubbard Actand section 

734 of the Duncan Hunter National 

Defense Authorization Act for Fiscal 

Year 2009. These Acts provide two new 

categories of beneficiaries for the 

Transitional Assistance Management 

Program (TAMP). Specifically, a 

member who receives a sole 

survivorship discharge and a member 

who is separated from Active Duty who 

agrees to become a member of the 

Selected Reserve of the Ready Reserve 

of a reserve component are eligible for 

TAMP. 

DATES: Effective Date: This rule is 

effective September 17, 2010. 

FOR FURTHER INFORMATION CONTACT: Mr. 

Glenn J. Corn, TRICARE Management 

Activity, Medical Benefits and 

Reimbursement Branch, telephone (303) 

676–3566. Questions regarding payment 

of specific claims should be addressed 

to the appropriate TRICARE contractor. 

SUPPLEMENTARY INFORMATION: 

I. Background 

In the Federal Register of November 

27, 2009, (74 FR 62269), the Office of 

the Secretary of Defense published for 

public comment a proposed rule 

establishing two new eligibility 

categories under TAMP. The TAMP 

benefit provides continued TRICARE 

coverage for a period of 180 days. For 

those who qualify, the 180 day time 

frame begins upon the Active Duty 

member’s separation. 

II. Explanation of Provisions 

Public Law 110–317 amended section 

1145(a)(2) of title 10, U.S.C. by adding 

‘‘a member who receives a sole 

survivorship discharge (as defined in 

section 1174(i) of this title)’’ as an 

additional category of TAMP eligible. 

The provision is effective August 29, 

2008. 

Public Law 110–471 amended section 

1145(a)(2) of title 10, U.S.C. by adding 

‘‘A member who is separated from 

Active Duty who agrees to become a 

member of the Selected Reserve of the 

Ready Reserve of a reserve component.’’ 

This provision is effective October 14, 

2008. 

This final rule establishes these two 

new eligibility categories under TAMP. 

III. Public Comments 

We provided a 60-day public 

comment period following publication 

of the Proposed Rule in the Federal 

Register (74 FR 62269) on November 27, 

2009. No comments were received. 

IV. 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 will not significantly affect 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). Existing information 

collection requirements of the TRICARE 

and Medicare programs will be utilized. 

Executive Order 13132, ‘‘Federalism’’ 

This rule has been examined for its 

impact under E.O. 13132 and does not 

contain policies that have federalism 


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Federal Register / Vol. 75, No. 159 / Wednesday, August 18, 2010 / Rules and Regulations 50883 

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. 

■ Accordingly, 32 CFR part 199 is 

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 199.3 is amended by adding 

paragraphs (e)(1)(v) and (e)(1)(vi) to read 

as follows: 

§ 199.3 Eligibility. 

* * * * * 

(e) * * * 

(1) * * * 

(v) A member who receives a sole 

survivorship discharge (as defined in 

section 1174(i) of this title). 

(vi) A member who is separated from 

Active Duty who agrees to become a 

member of the Selected Reserve of the 

Ready Reserve of a reserve component. 

* * * * * 

Dated: August 10, 2010. 

Patricia L. Toppings, 

OSD Federal Register Liaison Officer, 

Department of Defense. 

[FR Doc. 2010–20393 Filed 8–17–10; 8:45 am] 

BILLING CODE 5001–06–P 

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. 

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 


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