```

[Federal Register Volume 76, Number 180 (Friday, September 16, 2011)]
[Proposed Rules]
[Page 57690]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-23766]

=======================================================================
-----------------------------------------------------------------------

DEPARTMENT OF DEFENSE

Office of the Secretary

32 CFR Part 199

[Docket ID DOD-2011-HA-0059]
RIN 0720-AB52

TRICARE; Elimination of the Non-Availability Statement (NAS) 
Requirement for Non-Emergency Inpatient Mental Health Care

AGENCY: Office of the Secretary, Department of Defense.

ACTION: Proposed rule.

-----------------------------------------------------------------------

SUMMARY: This proposed rule eliminates the requirement that states a 
NAS is needed for non-emergency inpatient mental health care in order 
for a TRICARE Standard beneficiary's claim to be paid.

DATES: Comments must be received on or before November 15, 2011.

ADDRESSES: You may submit comments, identified by docket number and/or 
RIN number and title, by any of the following methods:
     Federal eRulemaking Portal: http://www.regulations.gov . 
Follow the instructions for submitting comments.
     Mail: Federal Docket Management System Office, 4800 Mark 
Center Drive, 2nd Floor, East Tower, Suite 02G09, Alexandria, VA 22350-
3100.
    Instructions: All submissions received must include the agency name 
and docket number or Regulatory Information Number (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 viewing on the Internet at http://regulations.gov as they 
are received without change, including any personal identifiers or 
contact information.

FOR FURTHER INFORMATION CONTACT: Mr. Richard Hart, TRICARE Policy and 
Operations, TRICARE Management Activity, 5111 Leesburg Pike, Suite 810, 
Falls Church, VA 22041.

SUPPLEMENTARY INFORMATION: 

I. Introduction and Background

    Under TRICARE Prime (as provided in 32 CFR, section 199.17), the 
military medical treatment facility (MTF) has the right of first 
refusal for specialty services requested by a civilian provider, if the 
services are available at the MTF. If a TRICARE Prime beneficiary 
living near a MTF is referred for specialty care by a civilian provider 
and the service is available at the MTF, the MTF may decide to provide 
the care. If services are refused by the MTF, the referral will be 
allowed with a network provider. As a result, the issuance of NAS(s) 
has been eliminated and are only required for non-enrolled 
beneficiaries who live within the MTF catchment area for non-emergency 
inpatient mental health care. Currently, the number of NASs issued is 
negligible as most mental health admissions are emergency admissions. 
Requiring a NAS for a relative few non-emergency inpatient mental 
health admissions is disproportionate to the cost of maintaining the 
systems necessary to process and coordinate the NAS. This proposed rule 
eliminates the requirement for a NAS for non-emergency inpatient mental 
health care in order for the TRICARE Standard beneficiary's claim to be 
paid.

II. Regulatory Procedures

Executive Order 12866, ``Regulatory Planning and Review''; Executive 
Order 13563, ``Improving Regulation and Regulatory Review''; and Public 
Law 96-354, ``Regulatory Flexibility Act'' (5 U.S.C. 601)

    Executive Orders 12866 and 13563 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 proposed 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 proposed rule is not subject to any of these requirements.

Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3511)

    This rule will not impose additional information collection 
requirements on the public.

Executive Order 13132, ``Federalism''

    We have examined the impacts of the 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.

Sec. 202, Public Law 104-4, ``Unfunded Mandates Reform Act''

    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 1 year.

List of Subjects in 32 CFR Part 199

    Claims, Dental health, Health care, Health insurance, Individuals 
with disabilities, Military personnel.

    Accordingly, 32 CFR 199.4 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 199.4 is amended by removing and reserving paragraph 
(a)(9) as follows:

Sec.  199.4  Basic program benefits.

* * * * *
    (a) * * *
    (9) [RESERVED]
* * * * *

    Dated: August 24, 2011.
Patricia L. Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2011-23766 Filed 9-15-11; 8:45 am]
BILLING CODE 5001-06-P
```