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

Federal Register: July 24, 2009 (Volume 74, Number 141)

Proposed Rules

Page 36638-36639

From the Federal Register Online via GPO Access [wais.access.gpo.gov]

DOCID:fr24jy09-13

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.

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:

Federal eRulemaking 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: Colonel John Kugler, Office of the

Chief Medical Officer, TRICARE Management Activity, telephone (703) 681-0064.

SUPPLEMENTARY INFORMATION:

1. 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.

2. 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:

   1. Revise paragraphs (g)(37)(viii) and (ix).

   2. Redesignate paragraphs (g)(27)(x) through (g)(37)(xii) as

      (g)(37)(xi) through (g)(37)(xiii).

   3. 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

      BILLING CODE 5001-06-P