47460 Federal Register / Vol. 75, No. 151 / Friday, August 6, 2010 / Rules and Regulations 

condition: For example, educational 

counseling, vocational counseling, 

nutritional counseling, and counseling 

for socioeconomic purposes, stress 

management, lifestyle modification. 

Services provided by a certified 

marriage and family therapist, pastoral, 

or mental health counselor in the 

treatment of a mental disorder are 

covered only as specifically provided in 

Section 199.6. Services provided by 

alcoholism rehabilitation counselors are 

covered only when rendered in a 

CHAMPUS-authorized treatment setting 

and only when the cost of those services 

is included in the facility’s CHAMPUSdetermined allowable cost rate. 

* * * * * 

■ 3. Section 199.6 is amended by adding 

paragraphs (c)(3)(iii)(L) and (M) to read 

as follows: 

§ 199.6 TRICARE-authorized providers. 

* * * * * 

(c) * * * 

(3) * * * 

(iii) * * * 

(L) Nutritionist. A nutritionist may 

provide DSMT via an accredited DSMT 

program. The nutritionist must be 

licensed by the State in which the care 

is provided, and must be under the 

supervision of a physician who is 

overseeing the DSMT program. 

(M) Registered Dietitian. A dietitian 

may provide DSMT via an accredited 

DSMT program. The dietitian must be 

licensed by the State in which the care 

is provided, and must be under the 

supervision of a physician who is 

overseeing the DSMT program. 

* * * * * 

Dated: July 26, 2010. 

Patricia L. Toppings, 

OSD Federal Register Liaison Officer, 

Department of Defense. 

[FR Doc. 2010–19311 Filed 8–5–10; 8:45 am] 

BILLING CODE 5001–06–P 

DEPARTMENT OF DEFENSE 

Office of the Secretary 

[DOD–2008–HA–0025; 0720–AB20] 

32 CFR Part 199 

TRICARE: Changes Included in the 

National Defense Authorization Act for 

Fiscal Year 2007; Improvements to 

Descriptions of Cancer Screening for 

Women 

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 (NDAA) for Fiscal Year 2007 

(FY07), Public Law 109–364. 

Specifically, that legislation authorizes 

breast cancer screening and cervical 

cancer screening for female beneficiaries 

of the Military Health System, instead of 

constraining such testing to 

mammograms and Papanicolaou smears. 

The rule allows coverage for ‘‘breast 

cancer screening’’ and ‘‘cervical cancer 

screening’’ for female beneficiaries of the 

Military Health System, instead of 

constraining such testing to 

mammograms and Papanicolaou tests. 

This rule ensures new breast and 

cervical cancer screening procedures 

can be added to the TRICARE benefit as 

such procedures are proven to be a safe, 

effective, and nationally accepted 

medical practice. This amends the 

cancer specific recommendations for 

breast and cervical cancer screenings to 

be brought in line with the processes for 

updating other cancer screening 

recommendations. In response to public 

comment on the proposed rule, this 

final rule includes a clarification that 

the benefit encompasses screening 

based on Health and Human Services 

guidelines. 

DATES: Effective Date: This rule is 

effective September 7, 2010. 

FOR FURTHER INFORMATION CONTACT: 

Commander James Ellzy, Office of the 

Chief Medical Officer, TRICARE 

Management Activity, telephone (703) 

681–0064. 

SUPPLEMENTARY INFORMATION: 

A. Background 

The Department of Defense updated 

coverage for screening with the use of 

the breast MRI for women in a 

designated high risk category as advised 

by the American Cancer Society. In the 

process of providing this additional 

coverage, it was discovered that because 

of statutory wording, there was a group 

of high risk women that are standard 

beneficiaries under the age of 35 for 

whom this coverage could not be 

provided without an amendment in the 

Code of Federal Regulations (CFR). 

Amending the CFR will provide 

coverage for breast MRI screening for all 

Department of Defense beneficiaries in 

the high risk category recommended by 

the American Cancer Society. 

B. Public Comments 

The Department of Defense published 

a proposed rule on July 24, 2009 (74 FR 

36638–36639). A single comment was 

received asking that the language be 

written more clearly. The final rule 

includes language in section (g)(37)(viii) 

that is more precise in terms of which 

cancers will be covered and notes that 

cervical and breast cancer screenings 

will be provided in accordance with the 

standards based on the guidelines from 

the U.S. Department of Health and 

Human Services. 

C. Regulatory Procedures 

Executive Order (EO) 12866 and 

Regulatory Flexibility Act 

E.O. 12866 requires 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 each 

Federal agency prepare, and make 

available for public comment, a 

regulatory flexibility analysis when the 

agency issues a regulation that 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 final rule 

is not subject to any of these 

requirements. This rule, although not 

economically significant, is a significant 

rule under E.O. 12866 and has been 

reviewed by the Office of Management 

and Budget. Amending the CFR will 

provide coverage for breast MRI 

screening for all Department of Defense 

beneficiaries in the high risk category, if 

necessary. It is critically important that 

we eliminate any potential gaps in 

coverage for high risk individuals as 

quickly as possible. 

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 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 tribunal governments, in aggregate, 

or by the private section, of $100 

million or more in any one year. 

Executive Order (EO) 13132 

We have examined the impact(s) of 

the final rule under E.O. 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 


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Federal Register / Vol. 75, No. 151 / Friday, August 6, 2010 / Rules and Regulations 47461 

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 

■ 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: 

■ A. Revising paragraphs (g)(37)(viii) 

and (ix). 

■ B. Redesignating paragraphs (g)(37)(x) 

through (g)(37)(xii) as (g)(37)(xi) through 

(g)(37)(xiii). 

■ C. Adding a new paragraph (g)(37)(x). 

The revisions and additions read as 

follows: 

§ 199.4 Basic program benefits. 

* * * * * 

(g) * * * 

(37) * * * 

(viii) Cervical and breast cancer 

screenings in accordance with standards 

issued by the Director, TRICARE 

Management Activity, based on 

guidelines from the U.S. Department of 

Health and Human Services. Such 

standards may establish a specific 

schedule, including frequency, age 

specifications, and gender of the 

beneficiary, as appropriate. 

(ix) Health promotion and disease 

prevention visits may include all of the 

services provided pursuant to 

§ 199.18(b)(2) and may be provided in 

connection with immunizations and 

cancer screening examinations 

authorized by paragraphs (g)(37)(ii) or 

(g)(37)(viii) of this section. 

(x) Physical examinations for 

beneficiaries ages 5–11 that are required 

in connection with school enrollment, 

and that are provided on or after 

October 30, 2000. 

* * * * * 

Dated: July 26, 2010. 

Patricia L. Toppings, 

OSD Federal Register Liaison Officer, 

Department of Defense. 

[FR Doc. 2010–19307 Filed 8–5–10; 8:45 am] 

BILLING CODE 5001–06–P 

DEPARTMENT OF HOMELAND 

SECURITY 

Coast Guard 

33 CFR Part 117 

[USCG–2009–0754] 

RIN 1625–AA09 

Drawbridge Operation Regulation; 

Elizabeth River, Eastern Branch, 

Norfolk, VA 

AGENCY: Coast Guard, DHS. 

ACTION: Final rule. 

SUMMARY: The Coast Guard is 

temporarily changing the drawbridge 

operation regulations of the Berkley 

(I–264) Bridge, at mile 0.4, across the 

Eastern Branch of the Elizabeth River, 

Norfolk, VA. This change will allow the 

drawbridge to operate with four opening 

periods between the rush hours until 

October 5, 2012, relieving increased 

vehicular traffic congestion while still 

providing for the reasonable needs of 

navigation. 

DATES: This rule is effective from 9 a.m. 

on September 4, 2010, until 2:30 p.m. 

on October 5, 2012. 

ADDRESSES: Comments and related 

materials received from the public, as 

well as documents mentioned in this 

preamble as being available in the 

docket, are part of docket USCG–2009– 

0754 and are available online by going 

to http://www.regulations.gov, inserting 

USCG–2009–0754 in the ‘‘Keyword’’ 

box, and clicking ‘‘Search.’’ This 

material is also available for inspection 

or copying at the Docket Management 

Facility (M–30), U.S. Department of 

Transportation, West Building Ground 

Floor, Room W12–140, 1200 New Jersey 

Avenue, SE., Washington, DC 20590, 

between 9 a.m. and 5 p.m., Monday 

through Friday, except Federal holidays. 

FOR FURTHER INFORMATION CONTACT: If 

you have questions on this rule, call 

Terrance Knowles, Environmental 

Protection Specialist, Fifth Coast Guard 

District, at 757–398–6587. If you have 

questions on viewing the docket, call 

Renee V. Wright, Program Manager, 

Docket Operations, telephone 202–366– 

9826. 

SUPPLEMENTARY INFORMATION: 

Regulatory Information 

On October 9, 2009, we published a 

notice of temporary deviation request 

for comments entitled ‘‘Drawbridge 

Operation Regulations; Elizabeth River, 

Eastern Branch, Norfolk, VA’’ in the 

Federal Register (74 FR 52143) and a 

notice of proposed rulemaking (NPRM) 

entitled ‘‘Drawbridge Operation 

Regulations; Elizabeth River, Eastern 

Branch, Norfolk, VA’’ in the Federal 

Register (74 FR 52158). We received 861 

comments on the published deviation 

and NPRM. 

On March 3, 2010, we published 

another notice of temporary deviation 

request for comments entitled 

‘‘Drawbridge Operation Regulations; 

Elizabeth River, Eastern Branch, 

Norfolk, VA’’ in the Federal Register (75 

FR 9521) and a supplemental notice of 

proposed rulemaking (SNPRM) entitled 

‘‘Drawbridge Operation Regulations; 

Elizabeth River, Eastern Branch, 

Norfolk, VA’’ in the Federal Register (75 

FR 9557). We received four comments 

on the published deviation and SNPRM. 

No public meeting was requested, and 

none was held. 

Background and Purpose 

On behalf of the Cities of Chesapeake 

and Norfolk Virginia, the Virginia 

Department of Transportation (VDOT) 

who owns and operates the lift-type 

Berkley Bridge requested a temporary 

change to the existing bridge 

regulations. In the closed to navigation 

position, the Berkley Bridge has a 

vertical clearance of 48 feet above mean 

high water. The current regulation set 

out in Title 33 CFR Part 117.1007(b) and 

(c) allows the Berkley Bridge, mile 0.4, 

in Norfolk, Virginia to remain closed 

one hour prior to the published start of 

a scheduled marine event regulated 

under § 100.501, and remain closed 

until one hour following the completion 

of the event unless the Patrol 

Commander designated under § 100.501 

allows the bridge to open for 

commercial vessel traffic. In addition, 

the bridge shall open on signal any time 

except from 5 a.m. to 9 a.m. and from 

3 p.m. to 7 p.m., Monday through 

Friday, except Federal holidays, and 

shall open at any time for vessels with 

a draft of 18 feet or more, provided that 

at least 6 hours advance notice has been 

given to the Berkley Bridge Traffic 

Control Room at (757) 494–2490, as 

required by 33 CFR 117.1007(b) and (c). 

Vessel traffic on this waterway consists 

of pleasure craft, tug and barge traffic, 

and ships with assist tugs seeking 

repairs. There is no alternate waterway 

route. 

Due to a temporary closure of two 

area bridges, there has been a significant 

increase in vehicular traffic on the 

Berkley Bridge causing back-ups, 

delays, and congestion on the bridge 

and its approaches. The NPRM 

proposed opening the draw of the 

Berkley Bridge on signal at 9 a.m., 

11 a.m., 1 p.m., and 2:30 p.m. from 

October 9, 2009 to October 5, 2012, and 


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