[Federal Register: January 11, 2006 (Volume 71, Number 7)]
[Rules and Regulations]
[Page 1695-1696]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr11ja06-7]
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DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 199
[DOD-2006-OS-002]
RIN 0720-AA92
TRICARE; Revision of Participating Providers Reimbursement Rate;
TRICARE Dental Program (TDP)
AGENCY: Department of Defense.
ACTION: Final rule.
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SUMMARY: The Department is publishing this final rule to revise the
requirements and procedures for the reimbursement of TRICARE Dental
program participating providers. Participating providers will no longer
be reimbursed at the equivalent of a percentile of prevailing charges
sufficiently above the 50th percentile of prevailing charges made for
similar services in the same locality (region) or state, or the
provider's actual charge, whichever is lower, less any cost-share
amount due for authorized services. Specifically, the revision will
require TRICARE Dental Program participating providers to be reimbursed
in accordance with the contractor's network agreements, less any cost-
share amount due for authorized services.
EFFECTIVE DATE: January 11, 2006.
FOR FURTHER INFORMATION CONTACT: Col. Gary C. Martin, Office of the
Assistant Secretary of Defense (Health Affairs)/TRICARE Management
Activity, telephone (703) 681-0039.
SUPPLEMENTARY INFORMATION:
I. Overview of the Rule
This final rule revises the provision found in 32 CFR 199.13 that
requires the TRICARE Dental Program contractor to reimburse
participating providers at the equivalent of a percentile of prevailing
charges sufficiently above the 50th percentile of prevailing charges
made for similar services in the same locality (region) or state, or
the provider's actual charge, whichever is lower, less any cost-share
amount due for authorized services. This provision was included in the
regulation to constitute a significant financial incentive for
participation of providers in the contractor's network and to ensure a
network of quality providers through use of a higher reimbursement
rate. This provision, however, places an unnecessary restriction on
contractors that already have established, high quality provider
networks with reimbursement rates below the 50th percentile that are of
sufficient size to meet the access requirements of the TRICARE Dental
Program. The reimbursement rates that have been negotiated over the
life of the dental contract represent the general market rates for
dental insurance reimbursement, and the final rule brings DoD
reimbursement rates into line with the broader insurance market.
Elimination of the 50th percentile requirement affords the Government
and enrollees significant cost savings through lower provider
reimbursement costs by the contractor. Additionally, contractors have
other methods available to ensure the TDP members receive high quality
dental services. These quality assurance methods include, but are not
limited to, licensing and credentialing standards, patient satisfaction
assessments, and provider trend analyses.
II. Review of Comments
The proposed rule was published in the Federal Register on August
31, 2005
[[Page 1696]]
(70 FR 51692). We received no public comments.
III. Regulatory Procedures
Executive Order 12866 directs agencies to assess costs and benefits
of available regulatory alternatives and, when regulation is necessary,
to select regulatory approaches that maximize net benefits (including
potential economic, environmental, public health and safety, and other
advantages; distributive impacts; and equity). Executive Order 12866
classifies a rule as significant if it meets any one of a number of
specified conditions, including: Having an annual effect on the economy
$100 million or more, adversely affecting a sector of the economy in a
material way, adversely affecting competition, or adversely affecting
jobs. A regulation is also considered a significant action if it raises
novel legal or policy issues.
DoD concludes that this final rule is a significant regulatory
action under the Executive Order since it raises novel policy issues
under section 3(f)(4). DoD concludes, however, that this final rule
does not meet the significance threshold of $100 million effect on the
economy in any one year under section 3(f)(1).
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 analysis when the agency issues a regulation that would
have significant impact on a substantial number of small entities.
This is a not a major rule under 5 U.S.C. 801. It is a significant
regulatory action but not economically significant. This rule has been
designated as significant and has been reviewed by the Office of
Management and Budget as required under the provisions of E.O. 12866.
Paperwork Reduction Act
This final rule contains a new information collection requirement
that has been submitted to and approved by the Office of Management and
Budget. This information collection has been assigned OMB Control
0720-0035.
List of Subjects in 32 CFR Part 199
Claims, Dental health, Health care, Health insurance, Individuals
with disabilities, Military personnel.
0
For the reasons set out in the preamble, 32 CFR part 199 is amended as
follows.
PART 199--[AMENDED]
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1. The authority citation for part 199 continues to read as follows:
Authority: 5 U.S.C. 301; 10 U.S.C. chapter 55.
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2. Section 199.13(g)(2)(ii) is revised to read as follows:
Sec. 199.13 TRICARE Dental Program.
* * * * *
(g) * * *
(2) * * *
(ii) Participating providers shall be reimbursed in accordance with
the contractor's network agreements, less any cost-share amount due for
authorized services.
* * * * *
Dated: January 5, 2006.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 06-219 Filed 1-10-06; 8:45 am]
BILLING CODE 5001-06-M