81366 Federal Register / Vol. 76, No. 249 / Wednesday, December 28, 2011 / Rules and Regulations 

DEPARTMENT OF DEFENSE 

Office of the Secretary 

32 CFR Part 199 

[Docket ID: DOD–2010–HA–0113] 

RIN 0720–AB46 

TRICARE: Changes Included in the 

National Defense Authorization Act for 

Fiscal Year 2010; Enhancement of 

Transitional Dental Care for Members 

of the Reserve Component on Active 

Duty for More Than 30 Days in Support 

of a Contingency Operation 

AGENCY: Office of the Secretary, DoD. 

ACTION: Final rule. 

SUMMARY: The Department is publishing 

this final rule to implement section 703 

of the National Defense Authorization 

Act for Fiscal Year 2010 (NDAA for 

FY10). Specifically, that legislation 

amends the transitional health care 

dental benefits for Reserve Component 

members on active duty for more than 

30 days in support of a contingency 

operation. The legislation entitles these 

Reserve Component members to dental 

care in the same manner as a member 

of the uniformed services on active duty 

for more than 30 days, thus providing 

care to the Reserve member in both 

military dental treatment facilities and 

authorized private sector dental care. 

This final rule does not eliminate any 

medical or dental care that is currently 

covered as transitional health care for 

the member. 

DATES: Effective January 27, 2012. 

FOR FURTHER INFORMATION CONTACT: COL 

Jeffrey Chaffin, TRICARE Management 

Activity, telephone (703) 681–0039. 

SUPPLEMENTARY INFORMATION: Section 

703 of the National Defense 

Authorization Act for Fiscal Year 2010 

(NDAA for FY10), Public Law 111–84, 

amends the transitional health care 

dental benefits for Reserve Component 

members on active duty for more than 

30 days in support of a contingency 

operation. The legislation entitles these 

Reserve Component members to dental 

care in the same manner as a member 

of the uniformed services on active duty 

for more than 30 days, thus providing 

care to the Reserve member in both 

military dental treatment facilities and 

authorized private sector dental care. 

This final rule does not eliminate any 

medical or dental care that is currently 

covered as transitional health care for 

the member. However the member’s 

dependents are not entitled to this 

enhanced benefit. 

At present, the transitional health care 

dental benefits for Reserve Component 

members include space available care in 

military dental treatment facilities and 

eligibility for the TRICARE Dental 

Program (TDP). The implementation of 

section 703 of NDAA for FY10 will 

enhance the dental benefit to include 

space required care in military dental 

treatment facilities; military dental 

treatment facility referred care to the 

private sector; and authorized remote 

dental care in the private sector during 

the 180 day transitional health care 

period. Both dental treatment facility 

referred care and remote care will be 

administered by TRICARE’s Active Duty 

Dental Program (ADDP). TDP eligibility 

will begin after the transitional health 

care period ends. 

Reserve Component family members 

are also eligible for the TRICARE Dental 

Program (TDP). These family members 

pay 100% of the premiums while their 

sponsor is in Reserve status. If their 

sponsor is activated for more than 30 

days, the TDP enrolled Reserve 

Component family members obtain the 

same benefits as any other TDP enrolled 

active duty family members with the 

Government subsidizing 60 percent of 

the premium cost for enrolled active 

duty family members. This change in 

status and subsidy occurs automatically. 

Upon the sponsor’s deactivation, the 

family members automatically revert to 

Reserve Component family member TDP 

status and pay 100% of the TDP 

premium cost. With the final rule, there 

is no change to status or eligibility for 

family members. 

I. Background 

Currently, Reserve Component 

members who separate from active duty 

after serving for more than 30 days in 

support of a contingency operation are 

entitled to dental care under the 

transitional assistance medical program 

in the same manner as a dependent. 

This consists of only space-available 

dental care in a military dental 

treatment facility and is very limited. 

This final rule amends the transitional 

health care dental benefit for Reserve 

Component members who were on 

active duty for more than 30 days in 

support of a contingency operation by 

providing those members’ dental care is 

the same as that for a member of the 

uniformed services on active duty for 

more than 30 days. This enhanced 

benefit does not apply to member’s 

dependents. 

As mentioned, the transitional health 

care dental benefits for Reserve 

Component members include space 

available care in military dental 

treatment facilities. Additionally, 

Reserve Component members are 

eligible for the TRICARE Dental 

Program (TDP). The TDP provides 

comprehensive dental care insurance 

and requires premium and cost-share 

payments but includes an annual 

maximum per enrollee per contract year 

for non-orthodontic services. This 

means that the total payments for 

covered dental services (except 

orthodontic services) for each enrolled 

member will not exceed the annual 

maximum amount in any contract year. 

The Government subsidizes 60 percent 

of the premium cost for enrolled 

Reserve Component members. If 

activated for more than 30 days in 

support of a contingency operation, a 

TDP enrolled Reserve Component 

member is automatically disenrolled 

from the TDP and automatically reenrolled upon deactivation. 

Under the final rule, a TDP enrolled 

Reserve Component member activated 

for more than 30 days is still 

automatically disenrolled from the TDP; 

however, the Reserve Component 

member will not be automatically reenrolled upon deactivation because the 

member will be entitled to the same 

dental benefits as an active duty 

member. The Reserve Component 

member will be TDP eligible and 

automatically re-enrolled in the TDP 

after the Transitional Health Care period 

is completed. 

Reserve Component family members 

are also eligible for the TRICARE Dental 

Program (TDP). These family members 

pay 100% of the premiums while their 

sponsor is in Reserve status. If their 

sponsor is activated for more than 30 

days, the TDP enrolled Reserve 

Component family members obtain the 

same benefits as any other TDP enrolled 

active duty family members with the 

Government subsidizing 60 percent of 

the premium cost for enrolled active 

duty family members. This change in 

status and subsidy occurs automatically. 

Upon the sponsor’s deactivation, the 

family members automatically revert to 

Reserve Component family member TDP 

status and pay 100% of the TDP 

premium cost. With the final rule, there 

is no change to status or eligibility for 

family members. 

II. Public Comments 

The proposed rule was published in 

the Federal Register on January 13, 

2011 (76 FR 2288) for a 60-day comment 

period. We received only two comments 

on the proposed rule. Both comments 

were supportive of the rule and the 

enhanced dental benefits offered. No 

changes have been made to the final 

rule as a result of these comments. 

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Federal Register / Vol. 76, No. 249 / Wednesday, December 28, 2011 / Rules and Regulations 81367 

III. Regulatory Procedures 

Executive Order 12866, ‘‘Regulatory 

Planning and Review’’; Executive Order 

13563, ‘‘Improving Regulation and 

Regulatory Review’’; and Regulatory 

Flexibility Act 

Executive Orders 12866 and 12563 

require 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 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 final rule 

is not subject to any of these 

requirements. 

Paperwork Reduction Act 

This rule will not impose additional 

information collection requirements on 

the public under the Paperwork 

Reduction Act of 1995 (44 U.S.C. 3501– 

3511). 

Unfunded Mandates 

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. 

Federalism 

We have examined the impact(s) of 

the final 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. 

Accordingly, 32 CFR part 199 is 

amended as follows: 

PART 199—CIVILIAN HEALTH AND 

MEDICAL PROGRAM OF THE 

UNIFORMED SERVICES (CHAMPUS) 

■ 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. § 199.3 is amended by revising 

paragraph (e)(3) to read as follows: 

§ 199.3 Eligibility. 

* * * * * 

(e) * * * 

(3) TAMP benefits under TRICARE 

begin on the day after the member is 

separated from active duty, and, if such 

separation occurred on or after 

November 6, 2003, end 180 days after 

such date. TRICARE benefits available 

to both the member and eligible family 

members are generally those available to 

family members of members of the 

uniformed services under this Part. 

However, during TAMP eligibility, a 

member of a Reserve Component as 

described in paragraph (e)(1)(ii) of this 

section, is entitled to dental care to 

which a member of the uniformed 

services on active duty for more than 30 

days is entitled. Each branch of service 

will determine eligibility for its 

members and eligible family members 

and provide data to DEERS. 

* * * * * 

■ 3. § 199.13 is amended by revising 

paragraph (c)(3)(ii)(E)(1) to read as 

follows: 

§ 199.13 TRICARE Dental Program. 

* * * * * 

(c) * * * 

(3) * * * 

(ii) * * * 

(E) Changes in and termination of 

enrollment. 

(1) Changes in status of active duty, 

Selected Reserve or Individual Ready 

Reserve member. When the active duty, 

Selected Reserve or Individual Ready 

Reserve member is separated, 

discharged, retired, transferred to the 

Standby or Retired Reserve, his or her 

enrolled dependents and/or the enrolled 

Selected Reserve or Individual Ready 

Reserve member loses eligibility and 

enrollment as of 11:59 p.m. on the last 

day of the month in which the change 

in status takes place. When the Selected 

Reserve or Individual Ready Reserve 

member is ordered to active duty for a 

period of more than 30 days without a 

break in service, the member loses 

eligibility and is disenrolled, if 

previously enrolled; however, their 

enrolled dependents maintain their 

eligibility and previous enrollment 

subject to eligibility, enrollment and 

disenrollment provisions described in 

this section and in the TDP contract. 

(i) Reserve component members 

separated from active duty in support of 

a contingency operation. When a 

member of a reserve component who is 

separated from active duty to which 

called or ordered in support of a 

contingency operation if the active duty 

is for more than 30 days, the member 

becomes eligible for Transitional Health 

Care pursuant to 10 U.S.C. 1145(a) and 

the member is entitled to dental care to 

which a member of the uniformed 

services on active duty for more than 30 

days is entitled. Thus the member has 

no requirement for the TDP and is not 

eligible to purchase the TDP. Upon the 

termination of Transitional Health Care 

eligibility, the member regains TDP 

eligibility and is reenrolled, if 

previously enrolled. 

(ii) Dependents of members separated 

from active duty in support of a 

contingency operation. Dependents of a 

member of a reserve component who is 

separated from active duty to which 

called or ordered in support of a 

contingency operation if the active duty 

is active for more than 30 days maintain 

their eligibility and previous 

enrollment, subject to eligibility, 

enrollment and disenrollment 

provisions described in this section and 

in the TDP contract. During the 

member’s Transitional Health Care 

eligibility, the dependents are 

considered family members of Reserve 

Component members. 

(iii) Members separated from active 

duty and not covered by 10 U.S.C. 

1145(a)(2)(B). When the previously 

enrolled active duty member is 

transferred back to the Selected Reserve 

or Individual Ready Reserve, and is not 

covered by 10 U.S.C. 1145(a)(2)(B), 

without a break in service, the member 

regains TDP eligibility and is reenrolled; 

however, enrolled dependents maintain 

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. 

* * * * * 

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81368 Federal Register / Vol. 76, No. 249 / Wednesday, December 28, 2011 / Rules and Regulations 

Dated: December 21, 2011. 

Aaron Siegel, 

Alternate OSD Federal Register Liaison 

Officer, Department of Defense. 

[FR Doc. 2011–33175 Filed 12–27–11; 8:45 am] 

BILLING CODE 5001–06–P 

DEPARTMENT OF DEFENSE 

Office of the Secretary 

32 CFR Part 199 

[DOD–2009–HA–0175] 

RIN 0720–AB38 

TRICARE; Elimination of Co-payments 

for Authorized Preventive Services for 

Certain TRICARE Standard 

Beneficiaries 

AGENCY: Office of the Secretary, 

Department of Defense. 

ACTION: Final rule. 

SUMMARY: The Department of Defense is 

publishing this final rule to implement 

section 711 of the National Defense 

Authorization Act (NDAA) for Fiscal 

Year 2009 (FY 2009), Public Law 110– 

417. Section 711 eliminates copayments 

for authorized preventive services for 

TRICARE Standard beneficiaries other 

than Medicare-eligible beneficiaries. 

This rule also realigns the covered 

preventive services listed in the 

Exclusions section of the regulation to 

the Special Benefits section in the 

regulation. 

DATES: Effective Date: This final rule is 

effective January 27, 2012. Applicability 

Date: 32 CFR 199.4(f)(12) applies for 

dates of service on or after October 14, 

2008, for preventive services listed in 

paragraph (e) (28) of this section. 

FOR FURTHER INFORMATION CONTACT: Ann 

Fazzini, Medical Benefits and 

Reimbursement Branch, TRICARE 

Management Activity, telephone (303) 

676–3803. Questions regarding payment 

of specific claims should be addressed 

to the appropriate TRICARE contractor. 

SUPPLEMENTARY INFORMATION: 

I. Background 

Sections 1079(b) and 1086(b) of Title 

10, United States Code (U.S.C.), as 

amended by Section 711 of the National 

Defense Authorization Act (NDAA) for 

Fiscal Year (FY) 2009 (Pub. L. 110–417), 

required the Department of Defense to 

eliminate copayments for those 

authorized preventive services named in 

the law for TRICARE Standard 

beneficiaries other than Medicareeligible beneficiaries. 

This language requires all copayments 

to be eliminated for authorized 

preventive services for certain TRICARE 

Standard beneficiaries who would 

otherwise pay copayments and that 

certain TRICARE Standard beneficiaries 

pay nothing for the preventive services 

during a year even if the beneficiary has 

not paid the amount necessary to cover 

the beneficiary’s deductible for the year. 

The language does not expand coverage 

of preventive services not otherwise 

authorized by law under the TRICARE 

preventive care benefit. 

The proposed rule published in the 

Federal Register on September 27, 2010, 

(75 FR 59173) clarified and realigned 

the preventive services currently listed 

in the Exclusions section of the 

TRICARE regulation to the Special 

Benefits section in the regulation. This 

realignment does not remove from 

coverage any preventive services 

currently covered under the program 

nor does it create a new entitlement to 

preventive or other services not 

otherwise authorized in title 10, Chapter 

55, United States Code. We performed 

this realignment because Title 32 Code 

of Federal Regulations (CFR) § 199.4(g), 

‘‘Exclusions and limitations,’’ states in 

subparagraph (37) that preventive care 

is excluded, and then lists those 

services that are not excluded. We 

believe including covered preventive 

services in the Exclusions section 

created confusion for those seeking 

information about preventive services 

under the TRICARE program. A person 

seeking information about what 

preventive services are covered would 

most likely not look for that information 

in a section labeled ‘‘Exclusions.’’ We 

remedied this confusion by removing 

the list of covered preventive services 

from this section and placing the list in 

the ‘‘Special Benefit Information’’ 

section of 32 CFR 199.4(e). We also 

realigned those services currently in the 

‘‘Exclusions’’ section that are not truly 

preventive but are more evaluative in 

nature in the ‘‘Special Benefit 

Information’’ section of 32 CFR 199.4(e) 

and added a definition of ‘‘evaluative’’ 

services in 32 CFR 199.2. However, 

based upon public comments received, 

we have removed the evaluative 

services definition and label from the 

Final Rule language, instead opting to 

simply list separately those covered 

benefits that while preventive in nature 

are authorized independently from the 

statutory lists of specifically authorized 

preventive services contained in 

Chapter 55 of title 10, United States 

Code. See Section III. Public Comments 

below. 

II. Section 711 of the Duncan Hunter 

NDAA for FY 2009 

Section 711 of the NDAA 2009 waives 

certain copayments for authorized 

preventive services for TRICARE 

Standard beneficiaries by amending 

subparagraphs 1079(b) and 1086(b) of 

Title 10, United States Code. 

It is important to note that the 

language in Section 711 includes in the 

list of preventive services for which a 

cost share is not applicable an ‘‘annual 

physical exam.’’ By law, only well-child 

visits for beneficiaries under 6 years of 

age are covered, as are physical 

examinations for beneficiaries 6 years of 

age or older if conducted as part of 

health promotion and disease 

prevention visits when provided in 

connection with otherwise authorized 

immunizations and or cancer 

screenings, resulting in elimination of 

copayments for these specific physical 

examinations for TRICARE Standard 

beneficiaries. See Title 10, U.S.C. 

1079(a)(2). Routine annual 

examinations, other than as described 

above, are not covered by the TRICARE 

program. 

III. Public Comments 

The proposed rule was published in 

the Federal Register (75 FR 59173) on 

September 27, 2010 for a 60-day public 

comment period. We received seven 

comments from six respondents on the 

proposed rule. 

Five respondents expressed support 

of this rule change because it will 

provide better overall coverage for 

beneficiaries, will increase awareness of 

disease states and prevention, is a step 

toward healthier lifestyles and better 

health choices, and in the long run will 

save the government money. We agree, 

and are pleased to promulgate this rule. 

One respondent stated agreement that 

a military beneficiary seeking 

information about what preventive 

services are covered would most likely 

not look for that information in a section 

labeled ‘‘Exclusions.’’ We agree and are 

pleased we are able to remedy this 

confusion. 

Two respondents requested minimal 

changes to make the regulation better 

understood and to eliminate confusing 

verbiage. We appreciate the comments 

and believe that the new evaluative 

services category may have been 

misleading. Adding the new evaluative 

services language in 32 CFR 199.4, the 

‘‘Special Benefit Information’’ section, 

may have had the unintended result of 

implying that we were expanding 

benefit coverage of preventive services 

beyond what was otherwise authorized 

by law or otherwise creating a new type 

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