47710 Federal Register / Vol. 75, No. 152 / Monday, August 9, 2010 / Rules and Regulations 

§ 71.1 [Amended] 

■ 2. The incorporation by reference in 

14 CFR 71.1 of the Federal Aviation 

Administration Order 7400.9T, Airspace 

Designations and Reporting Points, 

signed August 27, 2009, and effective 

September 15, 2009, is amended as 

follows: 

Paragraph 6010(a) Domestic VOR Federal 

Airways. 

* * * * * 

V–8 [Amended] 

From INT Seal Beach, CA, 266° and 

Ventura, CA, 144° radials; Seal Beach; 

Paradise, CA; 35 miles, 7 miles wide (3 miles 

SE and 4 miles NW of centerline) Hector, CA; 

Goffs, CA; INT Goffs 033° and Morman Mesa, 

NV, 196° radials; Morman Mesa; Bryce 

Canyon, UT; Hanksville, UT; Grand Junction, 

CO; Kremmling, CO; Mile High, CO; Akron, 

CO; Hayes Center, NE; Grand Island, NE; 

Omaha, NE; Des Moines, IA; Iowa City, IA; 

Moline, IL; Joliet, IL; Chicago Heights, IL; 

Goshen, IN; Flag City, OH; Mansfield, OH; 

Briggs, OH; Bellaire, OH; INT Bellaire 107° 

and Grantsville, MD, 285° radials; 

Grantsville; Martinsburg, WV; to Washington, 

DC. The portion outside the United States 

has no upper limit. 

* * * * * 

V–14 [Amended] 

From Chisum, NM; Lubbock, TX; 

Childress, TX; Hobart, OK; Will Rogers, OK; 

INT Will Rogers 052° and Tulsa, OK 246° 

radials; Tulsa; Neosho, MO; Springfield, MO; 

Vichy, MO; INT Vichy 067° and St. Louis, 

MO, 225° radials; Vandalia, IL; Terre Haute, 

IN; Brickyard, IN; Muncie, IN; Flag City, OH; 

INT Flag City 079° and Dryer, OH, 240° 

radials; Dryer; Jefferson, OH; Erie, PA; 

Dunkirk, NY; Buffalo, NY; Geneseo, NY; 

Georgetown, NY; INT Georgetown 093° and 

Albany, NY, 270° radials; Albany; INT 

Albany 084° and Gardner, MA, 284° radials; 

Gardner; to Norwich, CT. 

* * * * * 

V–38 [Amended] 

From Moline, IL; INT Moline 082° and 

Peotone, IL, 281° radials; Peotone; Fort 

Wayne, IN; Flag City, OH; INT Flag City 131° 

and Appleton, OH, 312° radials; Appleton; 

Zanesville, OH; Parkersburg, WV; Elkins, 

WV; Gordonsville, VA; Richmond, VA; 

Harcum, VA; Cape Charles, VA. 

* * * * * 

V–47 [Amended] 

From Pine Bluff, AR; Gilmore, AR; 

Dyersburg, TN; Cunningham, KY; Pocket 

City, IN; Nabb, IN; Cincinnati, OH; 

Rosewood, OH; Flag City, OH; to Waterville, 

OH. 

* * * * * 

V–279 [Amended] 

From INT Flag City, OH, 146° and 

Rosewood, OH, 083° radials; to Flag City; 7 

miles wide (4 miles northeast and 3 miles 

southwest of the centerline) to Flag City. 

* * * * * 

V–422 [Amended] 

From INT Chicago O’Hare, IL, 127° and 

Chicago Heights, IL, 358° radials; Chicago 

Heights; INT Chicago Heights 117° and Knox, 

IN, 276° radials; Knox; Webster Lake, IN; INT 

Webster Lake 097° and Flag City, OH, 289° 

radials; to Flag City. 

* * * * * 

Issued in Washington, DC, on July 27, 

2010. 

Edith V. Parish, 

Manager, Airspace and Rules Group. 

[FR Doc. 2010–19271 Filed 8–6–10; 8:45 am] 

BILLING CODE 4910–13–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: Final rule. 

SUMMARY: The Department of Defense is 

publishing this final 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: Effective Date: This rule is 

effective August 9, 2010 and applicable 

October 14, 2008. and all claims for 

ECHO benefits provided on or after that 

date will be reprocessed retroactively to 

that date as necessary. 

FOR FURTHER INFORMATION CONTACT: Mr. 

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 (NDAA) for Fiscal 

Year (FY) 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) authorizes 

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)(3) 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 (FR) 

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 

NDAA for FY 2009 [Pub. L. 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 rule changes the Government’s 

share of providing all benefits available 

through the Extended Care Health 


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Federal Register / Vol. 75, No. 152 / Monday, August 9, 2010 / Rules and Regulations 47711 

Option from $2,500 per month to 

$36,000 per FY. 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 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 disabling effects of 

an ECHO-qualifying condition, is 

eligible for TRICARE coverage through 

the ECHO. Paragraph (g)(2) within Sec. 

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 ECHO-registered 

beneficiary’s sponsor’s discretion, at 

least equally between the allowable cost 

of purchasing ECHO-authorized 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 FY 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 FY 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 Sec. 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. 

II. Public Comments 

We provided a 60-day public 

comment period following publication 

of the proposed rule in the Federal 

Register (74 FR 44800) on August 30, 

2009. No comments were received. 

However, following additional 

Department review, Section 

199.5(g)(2)(ii) was revised further to 

clarify the sponsor’s cost-share liability 

for benefits received under this section. 

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 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 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 

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) introductory text through 

(g)(2)(ii)(C)(2), and (g)(2)(ii)(E); 


sroberts on DSKD5P82C1PROD with RULES
47712 Federal Register / Vol. 75, No. 152 / Monday, August 9, 2010 / Rules and Regulations 

■ 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 month in 

which equipment is purchased under 

this section. However, in no month shall 

a sponsor be required to pay more than 

one cost-share regardless of the number 

of benefits the sponsor’s dependents 

received under this section. 

* * * * * 

(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. 

(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 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: July 26, 2010. 

Patricia L. Toppings, 

OSD Federal Register Liaison Officer, 

Department of Defense. 

[FR Doc. 2010–19312 Filed 8–6–10; 8:45 am] 

BILLING CODE 5001–06–P 

DEPARTMENT OF DEFENSE 

Office of the Secretary 

32 CFR Part 199 

[Docket ID: DOD–2009–HA–0097] 

RIN 0720–AB35 

TRICARE; Elimination of Voluntary 

Disenrollment Lock-Out 

AGENCY: Office of the Secretary, 

Department of Defense. 

ACTION: Final rule. 

SUMMARY: This final rule eliminates the 

1 year lock out for non-Active Duty 

members who disenroll from TRICARE 

Prime before their annual enrollment 

renewal date. 

DATES: Effective Date: September 8, 

2010. 

FOR FURTHER INFORMATION CONTACT: Ms. 

Kathleen Larkin, TRICARE Policy and 

Operations, TRICARE Management 

Activity, 5111 Leesburg Pike, Suite 810, 

Falls Church, VA 22041, telephone 

(703) 681–0039. 

SUPPLEMENTARY INFORMATION: 

I. Introduction and Background 

The TRICARE benefit was directed by 

Congress in section 1097 of the National 

Defense Authorization Act for Fiscal 

Year 1995. For further information on 

TRICARE, the reader may refer to the 

final rule regarding TRICARE published 

in the Federal Register on October 5, 

1995. 

Administrative Change 

When TRICARE Prime was 

implemented, it was envisioned that 

TRICARE Prime enrollees would 

transfer their enrollment when they 

moved to a new location. The reality is 

that some enrollees, such as college 

students, move several times a year. 

When TRICARE Prime is available at 

their new location, they transfer 

enrollment. However, TRICARE Prime 

might not be available at the gaining 

location, so they voluntarily disenroll in 

advance of their annual enrollment date. 

This automatically triggers a one year 

lock-out. This final rule eliminates the 

lock-out for active duty family members 

and allows TRICARE Prime enrollment 

when they relocate in an area that offers 

TRICARE Prime. 

II. Public Comments 

The proposed rule was published in 

the Federal Register on October 29, 

2009, for a 60-day comment period. We 

received one comment and we thank the 

person for commenting. 


sroberts on DSKD5P82C1PROD with RULES