46808 Federal Register / Vol. 73, No. 156 / Tuesday, August 12, 2008 / Rules and Regulations 

DEPARTMENT OF DEFENSE 

Office of the Secretary 

[DoD–2006–OS–0091; RIN 0720–AB00] 

32 CFR Part 199 

TRICARE; Reserve and Guard Family 

Member Benefits 

AGENCY: Office of the Secretary, DoD. 

ACTION: Final rule. 

SUMMARY: This final rule implements 

sections 704 and 705 of the Ronald W. 

Reagan National Defense Authorization 

Act for Fiscal Year 2005. These 

provisions apply to eligible family 

members who become eligible for 

TRICARE as a result of their Reserve 

Component (RC) sponsor (including 

those with delayed effective date orders 

up to 90 days) being called or ordered 

to active duty for more than 30 days in 

support of a federal/contingency 

operation and choose to participate in 

TRICARE Standard or Extra, rather than 

enroll in TRICARE Prime. The first 

provision gives the Secretary the 

authority to waive the annual TRICARE 

Standard (or Extra) deductible, which is 

set by law (10 U.S.C. 1079(b)) at $150 

per individual and $300 per family 

($50/$100 for families of members in 

pay grades E–4 and below). The second 

provision gives the Secretary the 

authority to increase TRICARE 

payments up to 115 percent of the 

TRICARE maximum allowable charge, 

less the applicable patient cost share if 

not previously waived under the first 

provision, for covered inpatient and 

outpatient health services received from 

a provider that does not participate 

(accept assignment) with TRICARE. 

These provisions help ensure timely 

access to health care and maintain 

clinically appropriate continuity of 

health care to family members of 

Reservists and Guardsmen activated in 

support of a federal/contingency 

operation; limit the out-of-pocket health 

care expenses for those family members; 

and remove potential barriers to health 

care access by Guard and Reserve 

families. 

DATES: Effective Date: August 12, 2008. 

FOR FURTHER INFORMATION CONTACT: Jody 

W. Donehoo, TRICARE Policy and 

Operations, TRICARE Management 

Activity, telephone (703) 681–0039. 

SUPPLEMENTARY INFORMATION: 

I. Introduction and Background 

A. On November 5, 2001, the 

Department of Defense (DoD) published 

notice of a nationwide TRICARE 

Demonstration Project (66 FR 55928–

55930). This demonstration was 

conducted under the authority of 10 

U.S.C. 1092. In this demonstration 

project, DoD addressed unreasonable 

impediments to the continuity of health 

care encountered by certain family 

members of Reservists and National 

Guard called to active duty in support 

of a federal contingency operation for 

more than 30 days. 

On November 12, 2003, DoD 

published a notice (68 FR 64087) to 

extend through October 31, 2004, the 

demonstration project which was 

scheduled to end on November 1, 2003. 

On October 1, 2004, the DoD 

published another notice (69 FR 58895) 

extending the demonstration project, 

previously scheduled to end on October 

31, 2004, to October 31, 2005. 

On October 12, 2005, DoD published 

a notice (70 FR 59320) to extend the 

demonstration project, previously 

scheduled to end on October 31, 2005, 

to October 31, 2007. 

On June 19, 2007, the Department 

published a notice (72 FR 33742) to 

extend the demonstration through 

October 31, 2008. 

On April 18, 2008, the Department 

published a notice (73 FR 21120) to 

extend the demonstration through 

October 31, 2009. 

The continued deployment of RC 

members in support of Operation Noble 

Eagle/Operation Enduring Freedom and 

Operation Iraqi Freedom warrants 

making permanent the Secretary’s 

authority to exercise certain 

components of this demonstration 

project. Sections 704 and 705 of the 

Ronald W. Reagan National Defense 

Authorization Act for Fiscal Year 2005 

provide DoD authority to make two 

components of the demonstration 

project permanent and amend section 

1095d(a) and section 1079(h) of Title 10, 

United States Code, as appropriate. In 

accordance with these two statutory 

provisions, DoD is implementing this 

discretionary authority. 

B. Public Comments. The proposed 

rule was published in the Federal 

Register on August 22, 2006 (71 FR 

48864). We received no public 

comments. The final rule is consistent 

with the proposed rule, with the 

exception of two technical corrections. 

In the proposed rule, the family 

deductible for E–4s and below was 

stated as $150. That amount is incorrect. 

Under 10 U.S.C. 1079(b)(3), the family 

deductible for dependents of E–4s and 

below is $100. The correct amount is 

reflected in this final rule. 

Also, in the proposed rule, the 

allowable charge authorized for nonparticipating providers was described 

incorrectly. The proposed rule used the 

phrase ‘‘the lower of the billed amount 

or the applicable balance billing limit 

under paragraph (j)(l)(i)(C) of this 

section, less the applicable beneficiary 

cost share.’’ The correct phrase to 

describe the allowable charge 

authorized for non-participating 

providers is ‘‘the CMAC level as 

established in paragraph (j)(l)(i)(B) of 

this section plus any balance billing 

amount up to the balance billing limit 

as referred to in paragraph (j)(l)(i)(C) of 

this section.’’ This phrase, which is 

more consistent with the statutory 

language, is used in this final rule. 

II. Permanent Benefits Offered To 

Reserve Component Families 

A. Waiver of deductible (paragraph 

199.4(f)(2)(i)(H)). Eligible family 

members of RC sponsors called or 

ordered to active duty for more than 30 

days in support of a federal contingency 

operation, who choose to participate in 

TRICARE Standard, may not be 

responsible for paying the annual 

TRICARE Standard deductible. By law, 

the TRICARE Standard deductible for 

active duty family members is $150 per 

individual, $300 per family ($50/$100 

for E–4s and below) each fiscal year. 

Exercise of the authority to waive this 

annual deductible appropriately limits 

out-of-pocket expenses for many 

Reserve and Guard family members, in 

consideration of the fact that many may 

have already paid annual deductibles 

under their civilian health plan. 

B. Increased payment to providers 

(paragraph 199.14(j)). Executive 

authority contained in this program 

allows an increase in TRICARE 

payments up to 115 percent of the 

TRICARE maximum allowable charge, 

less the applicable patient cost share if 

not previously waived under the first 

provision, for inpatient and outpatient 

care received from a provider that does 

not participate (accept assignment) 

under TRICARE. This helps Reserve and 

Guard family members to be able to 

continue to see civilian providers with 

whom they have established relations 

and promotes access and clinically 

appropriate continuity of care. 

III. Regulatory Procedures 

Executive Order 12866 requires 

certain regulatory assessments for any 

significant regulatory action that results 

in an annual effect on the economy of 

$100 million or more. The 

Congressional Review Act establishes 

certain procedures for major rules, 

defined as those with similar major 

impacts. The Regulatory Flexibility Act 

(RFA) requires that each Federal agency 

prepare, and make available for public 

comment, a regulatory flexibility 


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Federal Register / Vol. 73, No. 156 / Tuesday, August 12, 2008 / Rules and Regulations 46809 

analysis when the agency issues a 

regulation that has significant impact on 

a substantial number of small entities. 

This final rule does not have an annual 

effect on the economy of $100 million 

or more. According to an independent 

government cost estimate, the annual 

cost for both of these provisions will be 

less than $30 million. 

This rule, however, does address a 

novel policy issue relating to waiving 

the deductibles for one category of 

family member beneficiaries and not 

others, as well as allowing providers 

who treat this same group of 

beneficiaries to receive reimbursement 

at a higher rate than providers who treat 

similar beneficiaries. Thus this rule has 

been reviewed by the Office of 

Management and Budget under E.O. 

12866. 

This rule will not have a significant 

impact on a substantial number of small 

entities for purposes of the RFA. 

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 sector, of $100 million or more 

in any one year. 

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). 

We have examined the impact(s) of 

the final rule under Executive Order 

13132 and it does not have policies that 

have federalism implications that 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: 

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 (f)(2)(i)(H) to read as 

follows: 

§ 199.4 Basic program benefits. 

* * * * * 

(f) * * * 

(2) * * * 

(i) * * * 

(H) The Director, TRICARE 

Management Activity, may waive the 

annual individual or family fiscal year 

deductible for dependents of a Reserve 

Component member who is called or 

ordered to active duty for a period of 

more than 30 days or a National Guard 

member who is called or ordered to 

fulltime federal National Guard duty for 

a period of more than 30 days in 

support of a contingency operation (as 

defined in 10 U.S.C. 101(a)(13)). For 

purposes of this paragraph, a dependent 

is a lawful husband or wife of the 

member and a child is defined in 

paragraphs (b)(2)(ii)(A) through (F) and 

(b)(2)(ii)(H)(1), (2), and (4) of § 199.3. 

* * * * * 

■ 3. Section 199.14 is amended by 

adding paragraph (j)(1)(i)(E) to read as 

follows: 

§ 199.14 Provider reimbursement 

methods. 

* * * * * 

(j) * * * 

(1) * * * 

(i) * * * 

(E) Special rule for certain TRICARE 

Standard Beneficiaries. In the case of 

dependent spouse or child, as defined 

in paragraphs (b)(2)(ii)(A) through (F) 

and (b)(2)(ii)(H)(1), (2), and (4) of 

§ 199.3, of a Reserve Component 

member serving on active duty pursuant 

to a call or order to active duty for a 

period of more than 30 days in support 

of a contingency operation under a 

provision of law referred to in section 

101(a)(13)(B) of title 10, United States 

Code, the Director, TRICARE 

Management Activity, may authorize 

non-participating providers the 

allowable charge to be the CMAC level 

as established in paragraph (j)(l)(i)(B) of 

this section plus any balance billing 

amount up to the balance billing limit 

as referred to in paragraph (j)(l)(i)(C) of 

this section. 

* * * * * 

Dated: August 6, 2008. 

Patricia L. Toppings, 

OSD Federal Register Liaison Officer, 

Department of Defense. 

[FR Doc. E8–18597 Filed 8–11–08; 8:45 am] 

BILLING CODE 5001–06–P 

DEPARTMENT OF HOMELAND 

SECURITY 

Federal Emergency Management 

Agency 

44 CFR Part 65 

[Docket No. FEMA–B–7797] 

Changes in Flood Elevation 

Determinations 

AGENCY: Federal Emergency 

Management Agency, DHS. 

ACTION: Interim rule. 

SUMMARY: This interim rule lists 

communities where modification of the 

Base (1% annual-chance) Flood 

Elevations (BFEs) is appropriate because 

of new scientific or technical data. New 

flood insurance premium rates will be 

calculated from the modified BFEs for 

new buildings and their contents. 

DATES: These modified BFEs are 

currently in effect on the dates listed in 

the table below and revise the Flood 

Insurance Rate Maps (FIRMs) in effect 

prior to this determination for the listed 

communities. 

From the date of the second 

publication of these changes in a 

newspaper of local circulation, any 

person has ninety (90) days in which to 

request through the community that the 

Mitigation Assistant Administrator of 

FEMA reconsider the changes. The 

modified BFEs may be changed during 

the 90-day period. 

ADDRESSES: The modified BFEs for each 

community are available for inspection 

at the office of the Chief Executive 

Officer of each community. The 

respective addresses are listed in the 

table below. 

FOR FURTHER INFORMATION CONTACT: 

William R. Blanton, Jr., Engineering 

Management Branch, Mitigation 

Directorate, Federal Emergency 

Management Agency, 500 C Street SW., 

Washington, DC 20472, (202) 646–3151. 

SUPPLEMENTARY INFORMATION: The 

modified BFEs are not listed for each 

community in this interim rule. 

However, the address of the Chief 

Executive Officer of the community 

where the modified BFE determinations 

are available for inspection is provided. 

Any request for reconsideration must 

be based on knowledge of changed 

conditions or new scientific or technical 

data. 

The modifications are made pursuant 

to section 201 of the Flood Disaster 

Protection Act of 1973, 42 U.S.C. 4105, 

and are in accordance with the National 

Flood Insurance Act of 1968, 42 U.S.C. 

4001 et seq., and with 44 CFR part 65. 


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