44800 Federal Register / Vol. 74, No. 167 / Monday, August 31, 2009 / Proposed Rules 

Dated: August 21, 2009. 

Patricia L. Toppings, 

OSD Federal Register Liaison Officer, 

Department of Defense. 

[FR Doc. E9–20684 Filed 8–28–09; 8:45 am] 

BILLING CODE 5001–06–P 

DEPARTMENT OF DEFENSE 

Office of the Secretary 

32 CFR Part 199 

[DoD–2009–HA–0095] 

RIN 0720–AB33 

TRICARE; Extended Care Health 

Option 

AGENCY: Office of the Secretary, 

Department of Defense. 

ACTION: Proposed rule. 

SUMMARY: The Department of Defense is 

publishing this proposed rule to 

implement the requirements enacted by 

Congress in Section 732 of the Duncan 

Hunter National Defense Authorization 

Act for Fiscal Year 2009 which changes 

the limit of the Government’s share of 

providing certain benefits under the 

Extended Care Health Option (ECHO) 

from $2,500 per month to $36,000 per 

year, and for other non-legislated 

changes to the ECHO. 

DATES: Comments received at the 

address indicated below by October 30, 

2009 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 Rulemaking Portal: http:// 

www.regulations.gov. Follow the 

instructions for submitting comments. 

• Mail: Federal Docket Management 

System Office, Room 3C843 Pentagon, 

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 

received without change, including any 

personal identifiers or contact 

information. 

FOR FURTHER INFORMATION CONTACT: 

Michael Kottyan, TRICARE 

Management Activity, Medical Benefits 

and Reimbursement Branch, telephone 

(303) 676–3520. 

SUPPLEMENTARY INFORMATION: 

I. Background 

Section 1079 of title 10, United States 

Code (U.S.C.), as amended by Section 

701(b) of the National Defense 

Authorization Act for Fiscal Year 2002 

[Pub. L. 107–107], required the 

Department of Defense to establish a 

program of extended benefits for eligible 

dependents. That program, known as 

the Extended Care Heath Option 

(ECHO), replaced the Program for 

Persons with Disabilities (PFPWD) and 

was implemented on September 1, 2005. 

The primary purpose of the ECHO is to 

provide eligible beneficiaries with 

benefits that are not available through 

the TRICARE Basic Program. The term 

‘‘eligible beneficiary’’ means an 

individual who is a dependent of an 

Active Duty Service Member (ADSM) or 

is a Transitional Survivor of a deceased 

ADSM and who has a qualifying 

condition. Qualifying conditions 

include moderate or severe mental 

retardation, serious physical disability, 

or an extraordinary physical or 

psychological condition. The benefits 

available through the ECHO are 

intended to assist in the reduction of the 

disabling effects of an ECHO qualifying 

condition. 

Section 1079(e)(3) and (4) authorized 

benefits, including training, 

rehabilitation, special education, 

assistive technology devices, 

institutional care in private, nonprofit, 

public, and State institutions and 

facilities and, if appropriate, 

transportation to and from such 

institutions and facilities in which the 

beneficiary is receiving institutional 

care. 

Section 1079(f)(2) limited the 

Government’s liability for benefits 

authorized by Section 1079(e) and (4) to 

$2,500 per month and required that the 

beneficiary’s sponsor be liable for any 

amount of the monthly total cost for 

those benefits that exceeded the 

Government’s limit. Section 1079(e) also 

authorized the extended benefits 

program to provide additional benefits 

including diagnostic services, inpatient 

and outpatient care, comprehensive 

home health care, respite care, and other 

services and supplies as determined 

appropriate by the Secretary. However, 

Section 1079(f) did not limit the 

Government’s liability for those 

additional benefits. By Final Rule 

published in the Federal Register on 

August 20, 2004, (69 FR 51559) the 

Department established that those 

additional benefits accrued to the 

$2,500 per month limit. 

Section 732 of the Duncan Hunter 

National Defense Authorization Act for 

Fiscal Year 2009 [Public Law 110–417] 

(NDAA 2009) changed the limit of the 

Government’s liability for benefits 

authorized under Section 1079(e)(3) and 

(4) from $2,500 per month to $36,000 

per year, prorated as determined by the 

Secretary. This rule does not prorate the 

annual limit of Government liability. 

Section 732 does not affect other 

benefits authorized under Section 

1079(e). 

This proposed rule changes the 

Government’s share of providing all 

benefits available through the Extended 

Care Health Option from $2,500 per 

month to $36,000 per fiscal year. This 

rule does not change the Government’s 

liability for benefits provided by the 

ECHO Home Health Care (EHHC) 

benefit or the EHHC Respite Care 

benefit. 

Additionally, Section 732 changed the 

sponsor’s liability for costs exceeding 

the limit of the Government’s liability 

from a per-month basis to a per-year 

basis; this rule includes that change. 

The following additional changes 

contained in this rule are further 

discussed below: deletes references to 

the PFPWD, eliminates allocating the 

allowable cost of durable equipment 

authorized for purchase through the 

ECHO, clarifies the monthly 

reimbursement for benefits received 

through the ECHO Home Health Care 

(EHHC), and allows a waiver of the 

requirement to enroll in the sponsor’s 

branch of Service Exceptional Family 

Member Program (EFMP) in order to 

register in the ECHO. 

Active Duty Family Members who 

have a qualifying condition are eligible 

to receive benefits through the ECHO. 

Qualifying conditions include moderate 

or severe mental retardation, a serious 

physical disability, or an extraordinary 

physical or psychological condition 

such that the beneficiary is homebound. 

Serious physical disabilities include 

those conditions that preclude an 

individual from the unaided 

performance of at least one major life 

activity such as breathing, cognition, 

hearing, seeing, and age appropriate 

ability essential to bathing, dressing, 

eating, grooming, speaking, stair use, 

toilet use, transferring, and walking. 

The ECHO, as the replacement for the 

PFPWD, has been fully implemented for 

several years; it is therefore appropriate 

to delete references in the regulations to 

the transition of the PFPWD to the 

ECHO. 

Durable equipment, which is defined 

as a device or apparatus which does not 

qualify as ‘‘Durable Medical 

Equipment’’ under the TRICARE Basic 

Program but which is essential to the 

efficient arrest or reduction of the 

functional loss resulting from, or the 


sroberts on DSKD5P82C1PROD with PROPOSALS
Federal Register / Vol. 74, No. 167 / Monday, August 31, 2009 / Proposed Rules 44801 

disabling effects of an ECHO-qualifying 

condition, is eligible for TRICARE 

coverage through the ECHO. Paragraph 

(g)(2) within § 199.5 provides for 

prorating the allowable amount for 

durable equipment over a calculated 

period of time. The method of proration 

resulted in the monthly benefit limit of 

$2,500 being divided, at the ECHOregistered beneficiary’s sponsor’s 

discretion, at least equally between the 

allowable cost of purchasing ECHOauthorized durable equipment and the 

cost of other authorized ECHO benefits. 

As a result of Section 732 and the 

changes made in this rule, the allowable 

expense for durable equipment accrues 

to the maximum fiscal year Government 

limit of $36,000. Therefore, proration of 

allowable durable equipment expense is 

no longer an appropriate option. As a 

result, the ECHO beneficiary’s sponsor 

will have only one cost share liability 

for each authorized item of durable 

equipment purchased through the 

ECHO. 

The ECHO Home Health Care benefit 

is limited on a fiscal year basis to the 

amount TRICARE would reimburse a 

Skilled Nursing Facility (SNF) if the 

beneficiary were a patient in the SNF. 

Paragraph (g)(4)(iii) of § 199.5 limits the 

maximum monthly Government 

reimbursement for the EHHC, including 

EHHC respite care, to no more than onetwelfth of the annual maximum 

Government cost share. Because the 

actual number of days in the month 

varies, the one-twelfth limit can be over 

or understated for a given month. This 

rule revises that requirement by taking 

into account the actual number of days 

in a month EHHC benefits are received. 

As required by Section 1079(d)(1), 

eligible beneficiaries must register in the 

ECHO in order to receive ECHO 

benefits. Evidence of enrollment in the 

sponsor’s branch of Service’s EFMP is 

required in order to register in the 

ECHO. The Department recognizes there 

are circumstances when that 

requirement is not appropriate. This 

rule specifies when the EFMP 

enrollment requirement can be waived. 

Except as specified herein, all other 

requirements of the ECHO remain as 

currently published. 

Regulatory Procedures 

Executive Order 12866, ‘‘Regulatory 

Planning and Review’’ 

Section 801 of Title 5, U.S.C., and 

Executive Order (E.O.) 12866 requires 

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 proposed 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 proposed rule has been 

examined for its impact under E.O. 

13132 and it 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 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 

Extended benefits for disabled family 

members of Active Duty Service 

members, health care, 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 199.5 is amended by: 

a. Removing paragraphs (b)(4), 

(g)(2)(ii)(A) through (g)(2)(ii)(C)(2), and 

(g)(2)(ii)(E); 

b. Redesignating paragraph 

(g)(2)(ii)(D) as (g)(2)(ii); and 

c. Revising paragraphs (c)(6), 

(c)(7)(iii), (f)(3)(i), (g)(2)(i), newly 

redesignated paragraph (g)(2)(ii), 

(g)(4)(iii), (h)(2), (h)(3)(v)(A), and (j) to 

read as follows: 

§ 199.5 TRICARE Extended Care Health 

Option (ECHO). 

* * * * * 

(c) * * * 

(6) Transportation of an ECHO 

beneficiary receiving benefits under 

paragraph (c)(5), and a medical 

attendant when necessary to assure the 

beneficiary’s safety, to or from a facility 

or institution to receive authorized 

ECHO services or items. 

* * * * * 

(7) * * * 

(iii) The Government’s cost-share 

incurred for these services accrues to 

the fiscal year benefit limit of $36,000. 

* * * * * 

(f) * * * 

(3) * * * 

(i) ECHO. The total Government share 

of the cost of all ECHO benefits, except 

ECHO Home Health Care (EHHC) and 

EHHC respite care, provided in a given 

fiscal year to a beneficiary, may not 

exceed $36,000 after application of the 

allowable payment methodology. 

* * * * * 

(g) * * * 

(2) Equipment. (i) The TRICARE 

allowable amount for durable 

equipment shall be calculated in the 

same manner as durable medical 

equipment allowable through Section 

199.4, and accrues to the fiscal year 

benefit limit specified in paragraph 

(f)(3) of this section. 

(ii) Cost-share. A cost-share, as 

provided by paragraph (f)(2) of this 

section, is required for each item of 

durable equipment that is authorized 

and purchased by the Director, 

TRICARE Management Activity or 

designee. 

* * * * * 

(4) * * * 

(iii) The maximum monthly 

Government reimbursement for EHHC, 

including EHHC respite care, will be 

based on the actual number of hours of 

EHHC services rendered in the month, 

but in no case will it exceed one-twelfth 

of the annual maximum Government 

cost-share as determined in this section 

and adjusted according to the actual 

number of days in the month the 

services were provided. 


sroberts on DSKD5P82C1PROD with PROPOSALS
44802 Federal Register / Vol. 74, No. 167 / Monday, August 31, 2009 / Proposed Rules 

(h) * * * 

(2) Registration. Active Duty sponsors 

must register potential ECHO-eligible 

beneficiaries through the Director, 

TRICARE Management Activity, or 

designee prior to receiving ECHO 

benefits. The Director, TRICARE 

Management Activity, or designee will 

determine ECHO eligibility and update 

the Defense Enrollment Eligibility 

Reporting System (DEERS) accordingly. 

Unless waived by the Director, 

TRICARE Management Activity or 

designee, sponsors must provide 

evidence of enrollment in the 

Exceptional Family Member Program 

provided by their branch of Service at 

the time they register their family 

member(s) for the ECHO. 

(3) * * * 

(v) Public facility use. (A) An ECHO 

beneficiary residing within a state must 

demonstrate that a public facility is not 

available and adequate to meet the 

needs of their qualifying condition. 

Such requirements shall apply to 

beneficiaries who request authorization 

for training, rehabilitation, special 

education, assistive technology, and 

institutional care in private nonprofit, 

public, and state institutions and 

facilities, and if appropriate for 

beneficiaries receiving institutional 

care, transportation to and from such 

institutions and facilities. The 

maximum Government cost-share for 

services that require demonstration of 

public facility non-availability or 

inadequacy is limited to $36,000 per 

fiscal year per beneficiary. Stateadministered plans for medical 

assistance under Title XIX of the Social 

Security Act (Medicaid) are not 

considered available and adequate 

facilities for the purpose of this section. 

* * * * * 

(j) Effective date. All changes to this 

section are effective as of October 14, 

2008, and claims for ECHO benefits 

provided on or after that date will be 

reprocessed retroactively to that date as 

necessary. 

* * * * * 

Dated: August 21, 2009. 

Patricia Toppings, 

OSD Federal Register Liaison Officer, 

Department of Defense. 

[FR Doc. E9–20685 Filed 8–28–09; 8:45 am] 

BILLING CODE 5001–06–P 

ENVIRONMENTAL PROTECTION 

AGENCY 

40 CFR Part 146 

[EPA–HQ–OW–2008–0390; FRL–8951–3] 

RIN 2040–AE98 

Federal Requirements Under the 

Underground Injection Control (UIC) 

Program for Carbon Dioxide (CO2) 

Geologic Sequestration (GS) Wells; 

Notice of Data Availability and Request 

for Comment 

AGENCY: Environmental Protection 

Agency (EPA). 

ACTION: Data availability; request for 

comment. 

SUMMARY: Today’s Notice supplements 

the proposed ‘‘Federal Requirements 

Under the Underground Injection 

Control (UIC) Program for Carbon 

Dioxide (CO2) Geologic Sequestration 

(GS) Wells’’ of July 25, 2008, presents 

new data and information, and requests 

public comment on related issues that 

have evolved in response to comments 

on the original proposal. This Notice 

contains preliminary field data from the 

Department of Energy-sponsored 

Regional Carbon Sequestration 

Partnership projects, the results of GSrelated studies conducted by the 

Lawrence Berkeley National Laboratory, 

and additional GS-related research. 

Today’s Notice also discusses comments 

and presents an alternative the Agency 

is considering related to the proposed 

injection depth requirements for Class 

VI wells. 

DATES: Comments on the contents of 

this NODA must be received on or 

before October 15, 2009. EPA does not 

plan to extend the comment period for 

this Notice. EPA will hold a public 

hearing from 9 a.m. to 12 p.m. and 1 

p.m. to 4 p.m., CDT, September 17, 2009 

in Chicago, IL. 

ADDRESSES: The public hearing will be 

held at the Ralph H. Metcalfe Federal 

Building, 77 W. Jackson Boulevard, 

Chicago, IL 60604. Due to capacity 

limitations, we encourage you to 

indicate your intent to participate 

through pre-registration. To pre-register, 

for directions, and for site specific 

information, please visit the following 

Web site: http:// 

gshearing.cadmusweb.com/. 

Submit your comments, identified by 

Docket ID No. EPA–HQ–OW–2008– 

0390, by one of the following methods: 

• http://www.regulations.gov: Follow 

the on-line instructions for submitting 

comments. 

• Mail: Water Docket, Environmental 

Protection Agency, Mailcode: 4101T, 

1200 Pennsylvania Ave., NW., 

Washington, DC 20460. 

• Hand Delivery: Water Docket, EPA 

Docket Center (EPA/DC), Public Reading 

Room, Room 3334, EPA West, 1301 

Constitution Ave., NW., Washington, 

DC. Such deliveries are only accepted 

during the Docket’s normal hours of 

operation which are 8:30 a.m. to 4:30 

p.m., and special arrangements should 

be made for deliveries of boxed 

information. 

Instructions: Direct your comments to 

Docket ID No. EPA–HQ–OW–2008– 

0390. EPA’s policy is that all comments 

received will be included in the public 

docket without change and may be 

made available online at http:// 

www.regulations.gov, including any 

personal information provided, unless 

the comment includes information 

claimed to be Confidential Business 

Information (CBI) or other information 

whose disclosure is restricted by statute. 

Do not submit information that you 

consider to be CBI or otherwise 

protected through http:// 

www.regulations.gov or e-mail. Contact 

EPA directly (see the FOR FURTHER

INFORMATION CONTACT section) prior to 

submitting CBI. The http:// 

www.regulations.gov Web site is an 

‘‘anonymous access’’ system, which 

means EPA will not know your identity 

or contact information unless you 

provide it in the body of your comment. 

If you send an e-mail comment directly 

to EPA without going through http:// 

www.regulations.gov your e-mail 

address will be automatically captured 

and included as part of the comment 

that is placed in the public docket and 

made available on the Internet. If you 

submit an electronic comment, EPA 

recommends that you include your 

name and other contact information in 

the body of your comment and with any 

disk or CD–ROM you submit. If EPA 

cannot read your comment due to 

technical difficulties and cannot contact 

you for clarification, EPA may not be 

able to consider your comment. 

Electronic files should avoid the use of 

special characters, any form of 

encryption, and be free of any defects or 

viruses. 

Docket: All documents in the docket 

are listed in the http:// 

www.regulations.gov index. Although 

listed in the index, some information is 

not publicly available, e.g., CBI or other 

information whose disclosure is 

restricted by statute. Certain other 

material, such as copyrighted material, 

will be publicly available only in hard 

copy. Publicly available docket 

materials are available either 

electronically in http:// 

www.regulations.gov or in hard copy at 


sroberts on DSKD5P82C1PROD with PROPOSALS