Federal Register / Vol. 74, No. 141 / Friday, July 24, 2009 / Proposed Rules 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 § 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: 

§ 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 

§ 199.18(b)(2)) may include all of the 

services provided pursuant to 

§ 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] 

BILLING CODE 5001–06–P 

DEPARTMENT OF DEFENSE 

Office of the Secretary 

32 CFR Part 199 

[DOD–2008–HA–0060] 

RIN 0720–AB26 

TRICARE; Rare Diseases Definition 

AGENCY: Office of the Secretary, DoD. 

ACTION: Proposed rule. 

SUMMARY: This proposed rule revises the 

definition of rare diseases to adopt the 

definition of a rare disease as 

promulgated by the National Institutes 

of Health, Office of Rare Diseases. The 

rule modification will result in the 

definition used by the TRICARE 

program for a rare disease to be 

consistent with the definition used by 

the National Institutes of Health and the 

Food and Drug Administration. 

TRICARE has generally been applying 

the broader National Institutes of Health 

and Food and Drug Administration 

definitions when making coverage 

decisions for treatments; therefore, there 

will be no practical changes for 

beneficiaries. 

DATES: Written comments received at 

the address indicated below by 

September 22, 2009 will be accepted. 

ADDRESSES: You may submit comments, 

identified by docket number and/or 

Regulatory Information Number (RIN) 

number and title, by either of the 

following methods: 

• Federal Rulemaking Portal: http:// 

www.regulations.gov. Follow the 

instructions for submitting comments. 

• 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: 

LCDR James Ellzy, TRICARE 

Management Activity, Office of the 

Chief Medical Officer, telephone (703) 

681–0064. 

SUPPLEMENTARY INFORMATION: On 

January 6, 1997, the Office of the 

Secretary of Defense published a final 

rule in the Federal Register (62 FR 627– 

631) clarifying the TRICARE exclusion 

of unproven drugs, devices and medical 

treatments and procedures and adding a 

definition of rare diseases to be used in 

the TRICARE Program. TRICARE 

defined a rare disease as one which 

affects fewer than one in 200,000 

Americans. Upon further review, 

TRICARE proposes to revise the 

definition to be in compliance with the 

definition of other federal agencies. The 

Office of Rare Diseases was initially 

established as part of the National 

Institutes of Health in 1993 to promote 

research and collaboration on rare and 

orphan diseases. The Rare Diseases Act 

of 2002 (Pub. L. 107–280) codified the 

establishment of the Office of Rare 

Diseases by adding a section 404F to the 

Public Health Service Act (42 U.S.C. 

283h). This statute defines a rare disease 

as ‘‘any disease or condition that affects 

less than 200,000 persons in the United 

States.’’ Additionally, Section 526(a)(2) 

of the Federal Food, Drug and Cosmetic 

Act (21 U.S.C. 360bb(a)(2)), provides, in 

part, that the term ‘‘rare disease or 

condition’’ means any disease or 

condition which affects less than 

200,000 persons in the United States. 

The proposed rule modification will 

result in the definition used by the 

TRICARE program for a rare disease to 

be consistent with the definition used 

by the National Institutes of Health and 

the Food and Drug Administration. 

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 requires 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, or a 

significant regulatory action under the 

provisions of E.O. 12866. 

Section 202, Public Law 104–4, 

‘‘Unfunded Mandates Reform Act’’ 

It has been certified that his 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 proposed 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 additional 

information collection requirements on 

the public under the Paperwork 

Reduction Act of 1995 (44 U.S.C. 3501– 

3511). 

Executive Order 13132, ‘‘Federalism’’ 

This proposed 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, 


srobinson on DSKHWCL6B1PROD with PROPOSALS
36640 Federal Register / Vol. 74, No. 141 / Friday, July 24, 2009 / Proposed Rules 

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 199.2(b) is amended by 

revising the definition of Rare Diseases 

as follows: 

§ 199.2 Definitions. 

* * * * * 

(b) * * * 

Rare Diseases. TRICARE/CHAMPUS 

defines a rare disease as any disease or 

condition that has a prevalence of less 

than 200,000 persons in the United 

States. 

* * * * * 

Dated: July 17, 2009. 

Patricia Toppings, 

OSD Federal Register Liaison Officer, 

Department of Defense. 

[FR Doc. E9–17650 Filed 7–23–09; 8:45 am] 

BILLING CODE 5001–06–P 

DEPARTMENT OF THE INTERIOR 

National Park Service 

36 CFR Part 7 

RIN 1024–AD73 

Special Regulations; Areas of the 

National Park System 

AGENCY: National Park Service, Interior. 

ACTION: Proposed rule; reopening of 

comment period. 

SUMMARY: The National Park Service 

(NPS) announces the reopening of the 

comment period on the proposed rules 

to manage winter visitation and 

recreational use in Yellowstone 

National Park, Grand Teton National 

Park, and the John D. Rockefeller, Jr., 

Memorial Parkway. The proposed rule 

was published in the Federal Register 

on November 5, 2008. 

DATES: The comment period for the 

proposed rule published on November 

5, 2008 (73 FR 65784), is reopened. 

Comments must be received by 

September 8, 2009. 

ADDRESSES: You may submit your 

comments, identified by Regulatory 

Information Number 1024–AD73 (RIN), 

by any of the following methods: 

• Federal eRulemaking Portal: http:// 

www.regulations.gov. Follow the 

instructions for submitting comments. 

• Mail: Yellowstone National Park, 

Winter Use Proposed Rule, P.O. Box 

168, Yellowstone NP, WY 82190 

All submissions received must 

include the agency name and RIN. For 

additional information see ‘‘Public 

Comments’’ under SUPPLEMENTARY

INFORMATION below. 

FOR FURTHER INFORMATION CONTACT: John 

Sacklin, Management Assistant’s Office, 

Headquarters Building, Yellowstone 

National Park, 307–344–2019 or at the 

address listed in the ADDRESSES section. 

SUPPLEMENTARY INFORMATION: The 

proposed rule was originally published 

with a 15-day comment period. The 

NPS has now determined that there is 

sufficient time to provide for an 

additional 45-day comment period to 

ensure that the public has had an 

opportunity for review and comment. 

The NPS intends for final rules to be 

published on or before November 15, 

2009, and to be in effect for the winter 

season commencing on December 15, 

2009. Under the proposed rule, up to 

318 snowmobiles would be allowed in 

Yellowstone each day. 

The proposed regulatory provisions 

regarding the duration of this rule 

remain as published last year. The NPS 

intends that this rule would be in effect 

in Yellowstone National Park for the 

winter seasons ending with the 2010– 

2011 winter season. During the period 

this rule is in effect, the NPS will work 

with all interested parties to complete a 

new environmental impact statement 

using the best information available, a 

new long-term plan, and permanent 

regulations governing winter use in 

Yellowstone National Park. The 

proposed rules for Grand Teton National 

Park and the John D. Rockefeller, Jr., 

Memorial Parkway, if adopted, will be 

permanent for these two units. 

If you have already commented on the 

rule, you do not have to resend your 

comment. We will consider it in 

preparing the final rule. We will also 

consider any comments that may have 

been received between the close of the 

comment period on November 20, 2008 

and the re-opening of this comment 

period. 

Before including your address, phone 

number, e-mail address, or other 

personal identifying information in your 

comment, you should be aware that 

your entire comment—including your 

personal identifying information—may 

be made publicly available at any time. 

While you can ask us in your comment 

to withhold your personal identifying 

information from public review, we 

cannot guarantee that we will be able to 

do so. 

Dated: July 21, 2009. 

Will Shafroth, 

Principal Deputy Assistant Secretary of the 

Interior for Fish and Wildlife and Parks. 

[FR Doc. E9–17778 Filed 7–23–09; 8:45 am] 

BILLING CODE 4312–52–P 

DEPARTMENT OF VETERANS 

AFFAIRS 

38 CFR Parts 3, 17, and 21 

RIN 2900–AN27 

Herbicide Exposure and Veterans With 

Covered Service in Korea 

AGENCY: Department of Veterans Affairs. 

ACTION: Proposed rule. 

SUMMARY: The Department of Veterans 

Affairs (VA) proposes to amend its 

adjudication, medical, and vocational 

rehabilitation and employment 

regulations to incorporate relevant 

provisions from the Veterans Benefits 

Act of 2003. Specifically, this document 

proposes to amend VA’s regulations 

regarding herbicide exposure of certain 

veterans who served in or near the 

Korean demilitarized zone and 

regulations regarding spina bifida in 

their children. It also proposes to amend 

VA’s medical regulations by correcting 

the Health Administration Center’s 

hand-delivery address. 

DATES: Comments must be received by 

VA on or before September 22, 2009. 

ADDRESSES: Written comments may be 

submitted through http:// 

www.Regulations.gov; by mail or handdelivery to the Office of General 

Counsel (02REG), Department of 

Veterans Affairs, 810 Vermont Ave., 

NW., Room 1068, Washington, DC 

20420; or by fax to (202) 273–9026. 

Comments should indicate that they are 

submitted in response to ‘‘RIN 2900– 

AN27—Herbicide Exposure and 

Veterans with Covered Service in 

Korea.’’ Copies of comments received 

will be available for public inspection in 

the Office of General Counsel, Room 

1063B, between the hours of 8 a.m. and 

4:30 p.m., Monday through Friday 

(except holidays). Please call (202) 461– 

4902 for an appointment. (This is not a 

toll-free number.) In addition, during 

the comment period, comments may be 

viewed online through the Federal 

Docket Management System (FDMS) at 

http://www.Regulations.gov. 


srobinson on DSKHWCL6B1PROD with PROPOSALS