50880 Federal Register / Vol. 75, No. 159 / Wednesday, August 18, 2010 / Rules and Regulations 

Effective Date 

(a) This airworthiness directive (AD) is 

effective September 22, 2010. 

Affected ADs 

(b) None. 

Applicability 

(c) This AD applies to McDonnell Douglas 

Corporation Model MD–90–30 airplanes, 

certificated in any category, as identified in 

Boeing Service Bulletin MD90–57–016, 

Revision 2, dated April 28, 2006. 

Subject 

(d) Air Transport Association (ATA) of 

America Code 57: Wings. 

Unsafe Condition 

(e) This AD results from reports of the 

retract cylinder support fitting for the main 

landing gear (MLG) failing during gear 

extension, and subsequently damaging the 

hydraulic system. The Federal Aviation 

Administration is issuing this AD to prevent 

corrosion and damage that could compromise 

the integrity of the retract cylinder support 

fitting for the MLG, which could adversely 

affect the airplane’s safe landing. 

Compliance 

(f) You are responsible for having the 

actions required by this AD performed within 

the compliance times specified, unless the 

actions have already been done. 

Inspection and Corrective Actions 

(g) Before the accumulation of 30,000 total 

flight hours, or within 15,000 flight hours 

after the effective date of this AD, whichever 

occurs later, do a general visual inspection of 

the retract cylinder support fitting for the 

MLG and the mating bore in the MLG 

trunnion fitting for corrosion, install 

bushings and bearings without cadmium 

plating in the bore, and do all applicable 

corrective actions, in accordance with 

Configuration 1 of the Accomplishment 

Instructions of Boeing Service Bulletin 

MD90–57–016, Revision 2, dated April 28, 

2006. Do all applicable corrective actions 

before further flight. 

Note 1: For the purposes of this AD, a 

general visual inspection is: ‘‘A visual 

examination of an interior or exterior area, 

installation, or assembly to detect obvious 

damage, failure, or irregularity. This level of 

inspection is made from within touching 

distance unless otherwise specified. A mirror 

may be necessary to ensure visual access to 

all surfaces in the inspection area. This level 

of inspection is made under normally 

available lighting conditions such as 

daylight, hangar lighting, flashlight, or 

droplight and may require removal or 

opening of access panels or doors. Stands, 

ladders, or platforms may be required to gain 

proximity to the area being checked.’’ 

(h) Doing a general visual inspection, 

installing bushings and bearings, and doing 

all applicable corrective actions is also 

acceptable for compliance with the 

requirements of paragraph (g) of this AD if 

done before the effective date of this AD in 

accordance with the Accomplishment 

Instructions of Boeing Service Bulletin 

MD90–57–016, Revision 1, dated October 26, 

2005. 

(i) Doing a general visual inspection, 

installing bushings and bearings, and doing 

all applicable corrective actions is also 

acceptable for compliance with the 

requirements of paragraph (g) of this AD if 

done before the effective date of this AD in 

accordance with the Accomplishment 

Instructions of Boeing Service Bulletin 

MD90–57–016, dated September 18, 2002, 

provided that before the accumulation of 

30,000 total flight hours, or within 15,000 

flight hours after the effective date of this AD, 

whichever occurs later, electroless nickel 

fittings are installed, and bushings and 

bearings without cadmium plating in the 

bore are installed in accordance with the 

Accomplishment Instructions of any of the 

service bulletins listed in Table 1 of this AD. 

TABLE 1—SERVICE INFORMATION

Document Revision Date Incorporated by 

reference 

Boeing Service Bulletin MD90–57–016 ....................................................................... 1 October 26, 2005 .... No. 

Boeing Service Bulletin MD90–57–016 ....................................................................... 2 April 28, 2006 .......... Yes. 

Alternative Methods of Compliance 

(AMOCs) 

(j)(1) The Manager, Los Angeles Aircraft 

Certification Office (ACO), FAA, has the 

authority to approve AMOCs for this AD, if 

requested using the procedures found in 14 

CFR 39.19. Send information to ATTN: Roger 

Durbin, Aerospace Engineer, Airframe 

Branch, ANM–120L, FAA, Los Angeles 

Aircraft Certification Office, 3960 Paramount 

Boulevard, Lakewood, California 90712– 

4137; telephone (562) 627–5233; fax (562) 

627–5210. 

(2) To request a different method of 

compliance or a different compliance time 

for this AD, follow the procedures in 14 CFR 

39.19. Before using any approved AMOC on 

any airplane to which the AMOC applies, 

notify your principal maintenance inspector 

(PMI) or principal avionics inspector (PAI), 

as appropriate, or lacking a principal 

inspector, your local Flight Standards District 

Office. The AMOC approval letter must 

specifically reference this AD. 

(3) An AMOC that provides an acceptable 

level of safety may be used for any repair 

required by this AD, if it is approved by 

Boeing Commercial Airplanes Organization 

Designation Authorization (ODA) who has 

been authorized by the Manager, Los Angeles 

ACO, to make those findings. For a repair 

method to be approved, the repair must meet 

the certification basis of the airplane and 14 

CFR 25.571, Amendment 45, and the 

approval must specifically refer to this AD. 

Material Incorporated by Reference 

(k) You must use Boeing Service Bulletin 

MD90–57–016, Revision 2, dated April 28, 

2006, to do the actions required by this AD, 

unless the AD specifies otherwise. 

(1) The Director of the Federal Register 

approved the incorporation by reference of 

this service information under 5 U.S.C. 

552(a) and 1 CFR part 51. 

(2) For service information identified in 

this AD, contact Boeing Commercial 

Airplanes, Attention: Data & Services 

Management, 3855 Lakewood Boulevard, MC 

D800–0019, Long Beach, California 90846– 

0001; telephone 206–544–5000, extension 2; 

fax 206–766–5683; e-mail 

dse.boecom@boeing.com; Internet https:// 

www.myboeingfleet.com. 

(3) You may review copies of the service 

information at the FAA, Transport Airplane 

Directorate, 1601 Lind Avenue, SW., Renton, 

Washington. For information on the 

availability of this material at the FAA, call 

425–227–1221. 

(4) You may also review copies of the 

service information that is incorporated by 

reference at the National Archives and 

Records Administration (NARA). For 

information on the availability of this 

material at NARA, call 202–741–6030, or go 

to: http://www.archives.gov/federal_register/ 

code_of_federal_regulations/ibr_locations

.html. 

Issued in Renton, Washington, on July 28, 

2010. 

Ali Bahrami, 

Manager, Transport Airplane Directorate, 

Aircraft Certification Service. 

[FR Doc. 2010–19328 Filed 8–17–10; 8:45 am] 

BILLING CODE 4910–13–P 

DEPARTMENT OF DEFENSE 

Office of the Secretary 

32 CFR Part 199 

[Docket ID: DoD–2009–HA–0098] 

RIN 0720–AB36 

TRICARE: Non-Physician Referrals for 

Physical Therapy, Occupational 

Therapy, and Speech Therapy 

AGENCY: Office of the Secretary, 

Department of Defense. 

ACTION: Final rule. 

SUMMARY: The Department of Defense is 

publishing this final rule to provide 


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Federal Register / Vol. 75, No. 159 / Wednesday, August 18, 2010 / Rules and Regulations 50881 

TRICARE approval for authorizing 

certified physician assistants and 

certified nurse practitioners (nonphysicians) to engage in referrals of 

beneficiaries to the Military Health 

System for physical therapy, 

occupational therapy, and speech 

therapy. Upon implementation of this 

provision, certified physician assistants, 

or certified nurse practitioners will be 

allowed to issue referrals to patients for 

physical therapy, occupational therapy, 

and speech therapy without having the 

patient see a physician. This rule will 

align TRICARE with Medicare’s 

allowance of ‘‘non-physician providers’’ 

to provide, certify, or supervise therapy 

services. 

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 October 29, 

2009, (74 FR 55794), the Office of the 

Secretary of Defense published for 

public comment a proposed rule that 

will permit services of an otherwise 

TRICARE-authorized individual 

paramedical provider, physical therapist 

(PT), occupational therapist (OT), and 

speech therapist (ST) to be paid on a 

fee-for-service basis if based on a 

referral from a certified physician 

assistant or certified nurse practitioner. 

II. Public Comments 

We provided a 60-day public 

comment period following publication 

of the Proposed Rule in the Federal 

Register (74 FR 55794) on October 29, 

2009. We received three comments on 

the proposed rule. 

One commenter expressed concern 

that allowing referrals directly from 

nurse practitioners or physician 

assistants will keep patients—or at least 

their records—from being seen by a 

physician, and by doing so, it could 

result in the misdiagnosis of an injury 

or illness resulting in the wrong 

treatment action being taken. We 

appreciate the comment. This rule 

allows referral from TRICAREauthorized certified nurse practitioners 

and certified physician assistants to 

TRICARE-authorized physical 

therapists, occupational therapists, and 

speech therapists. All providers are 

required to practice within the scope of 

their licensure and, should treatment 

require referral to a higher level of 

professional medical provider, such 

referrals or consultations are expected. 

A second commenter wanted to speak 

against the provision that a Doctor of 

Medicine and especially a Nurse 

Practitioner or Physician Assistant are 

qualified to provide oversight to a 

Doctor of Physical Therapy. The 

commenter further stated that physical 

therapists are certified under their 

respective states and their educational 

qualifications are equivalent to a 

graduate of a professional medicine 

degree program and exceed the 

education of both the nurse practitioner 

and physician assistant, who are health 

professionals and are qualified to 

provide referral, but not oversight of a 

physical therapy plan of care. We 

appreciate the comment and recognize 

the education and training of those who 

obtain a Doctor of Physical Therapy 

degree. However, at this time the 

Department is only expanding the 

categories of persons who can make 

referral to a physical therapist and is not 

contemplating a revocation of the 

requirement for oversight of these 

providers. The Department of Defense’s 

position on this issue is consistent with 

Medicare’s and its allowance of ‘‘nonphysician providers’’ to provide, certify, 

or supervise therapy services. 

The third commenter requests that 

TRICARE policy also allow for the 

referral of beneficiaries for licensed 

registered nurse services and audiology 

services by non-physician practitioners. 

We appreciate the comment. The 

proposed rule only proposed expanding 

referrals by certified nurse practitioners 

or certified physician assistants to 

TRICARE-authorized physical 

therapists, occupational therapists, and 

speech therapists. Under current 

TRICARE rules, referrals for licensed 

registered nurse services and audiologist 

services can only be made by a 

physician. At this time the Department 

of Defense is limiting the certified nurse 

practitioner and certified physician 

assistant referral services to physical 

therapy, occupational therapy, and 

speech therapy as outlined in the 

proposed rule. At this time the 

Department does not intend to expand 

this rule to include a referral for 

registered nurse services or audiology. 

At this time the Department feels the 

need for these services are best assessed 

by a physician. 

III. 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 1 year. 

Public Law 96–354, ‘‘Regulatory 

Flexibility Act’’ (5 U.S.C. 601) 

The Regulatory Flexibility Act (RFA) 

requires each Federal agency to 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 

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: 


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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 


erowe on DSK5CLS3C1PROD with RULES