[Federal Register Volume 74, Number 141 (Friday, July 24, 2009)]
[Proposed Rules]
[Pages 36638-36639]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-17651]


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DEPARTMENT OF DEFENSE

Office of the Secretary

32 CFR Part 199

[DOD-2008-HA-0025; 0720-AB20]


TRICARE; Changes Included in the National Defense Authorization 
Act for Fiscal Year 2007; Improvements to Descriptions of Cancer 
Screening for Women

AGENCY: TRICARE Management Activity, Department of Defense.

ACTION: Proposed rule.

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SUMMARY: The Department is publishing this proposed 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.

DATES: Written comments will be accepted at the address indicated below 
until September 22, 2009.

ADDRESSES: You may submit comments, identified by docket number and/or 
RIN, by any of the following methods:
    <bullet> Federal eRulemaking Portal: http://www.regulations.gov. 
Follow the instructions for submitting comments.
    <bullet> Mail: Federal Docket Management System Office, 1160 
Defense Pentagon, Washington, DC 20301-1160.
    Instructions: All submissions received must include the agency name 
and docket number or 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 public viewing on the 
Internet at http://www.regulations.gov, as they are received without 
change, including any personal identifiers or contact information.

FOR FURTHER INFORMATION CONTACT: Colonel John Kugler, Office of the 
Chief Medical Officer, TRICARE Management Activity, telephone (703) 
681-0064.

SUPPLEMENTARY INFORMATION:

I. 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.

II. 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 proposed 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 proposed 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 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 proposed to be amended as follows:

[[Page 36639]]

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. In Sec.  199.4:
    A. Revise paragraphs (g)(37)(viii) and (ix).
    B. Redesignate paragraphs (g)(27)(x) through (g)(37)(xii) as 
(g)(37)(xi) through (g)(37)(xiii).
    C. Add a new paragraph (g)(37)(x).
    The revisions and additions read as follows:


Sec.  199.4   Basic program benefits.

* * * * *
    (g) * * *
    (37) * * *
    (viii) Cancer screenings authorized by 10 U.S.C. 1079.
    (ix) Health promotion and disease preventions visits (which may 
include all of the services provided pursuant to Sec.  199.18(b)(2)) 
may include all of the services provided pursuant to Sec.  
199.18(b)(2)) 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.
* * * * *

    Dated: July 17, 2009.
Patricia L. Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. E9-17651 Filed 7-23-09; 8:45 am]
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