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SUMMARY: This final aphorism eliminates the affirmation that states a NAS is bare for non-emergency inpatient brainy bloom affliction in adjustment for a TRICARE Standard beneficiary’s affirmation to be paid. Currently, NAS are appropriate for non-emergency inpatient brainy bloom affliction for TRICARE Standard beneficiaries who alive aural a aggressive assay ability catchment area. At this time, the cardinal of NASs issued is negligible as best brainy bloom admissions are emergency admissions. Requiring a NAS for a almost few non-emergency inpatient brainy bloom admissions is asymmetric to the amount of advancement the systems all-important to activity and alike the NAS.



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EFFECTIVE DATE: Effective March 28, 2013.

FOR FURTHER INFORMATION CONTACT: Mr. Richard Hart, TRICARE Policy and Operations, TRICARE Management Activity, 5111 Leesburg Pike, Suite 810, Falls Church, VA 22041, 703-681-0047.

SUPPLEMENTARY INFORMATION:



Executive Summary

I. Purpose of This Authoritative Action

a. Currently, NAS are appropriate for non-emergency inpatient brainy bloom affliction for TRICARE Standard beneficiaries who alive aural a aggressive assay ability catchment area. Pursuant to breadth 1080(c)(2) of appellation 10, United States Code, the Secretary can abandon the affirmation to access NASs afterward an appraisal of the capability of such statements in optimizing the use of accessories of the uniformed services. At this time, the cardinal of NASs issued is negligible as best brainy bloom admissions are emergency admissions. Requiring a NAS for a almost few non-emergency inpatient brainy bloom admissions is asymmetric to the amount of advancement the systems all-important to activity and alike the NAS. This final aphorism eliminates the affirmation for a NAS for non-emergency inpatient brainy bloom affliction in adjustment for the TRICARE Standard beneficiary’s affirmation to be paid.

b. Authority: 5 U.S.C. 301; 10 U.S.C. affiliate 55.

II. Arbitrary of the Major Provisions of This Authoritative Action

This final aphorism eliminates the affirmation for a NAS for non-emergency inpatient brainy bloom affliction in adjustment for the TRICARE Standard beneficiary’s affirmation to be paid.

The abolishment of the affirmation for a NAS for non-emergency inpatient brainy bloom affliction for TRICARE Standard beneficiaries is abstracted and audible from the advancing appropriate of aboriginal abnegation for specialty casework requested by a noncombatant provider beneath TRICARE Prime, if the casework are accessible at the MTF, or the advancing approved affirmation for preadmission allotment afore inpatient brainy bloom casework may be provided. This final aphorism does not annihilate the appropriate of aboriginal abnegation or affirmation for preadmission authorization.

In reviewing the proposed rule, we apparent that we had aback deleted not alone the affirmation to access a NAS for non-emergency inpatient brainy bloom casework for TRICARE Standard beneficiaries active aural the 40-mile catchment breadth of a aggressive assay facility, but additionally the Department’s accepted accomplishing of breadth 721 of Accessible Law 106-398, as adapted by breadth 735 of Accessible Law 107-107, apropos the Secretary’s approved ascendancy to crave a NAS. We accept remedied that blank in this final rule, thereby attention the advantage to appoint the affirmation to access NASs in the future, constant with absolute approved authority, should affairs change and a affirmation be fabricated that, by assuming specific procedures at afflicted aggressive medical assay facilities, use of such accessories would be optimized and cogent costs avoided. Breadth 199.4(a)(9) is thereby adapted to absorb this accepted ascendancy while still eliminating the accepted affirmation to access a NAS for non-emergency inpatient brainy bloom services.

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III. Costs and Allowances of This Authoritative Action

There are no advancing bread-and-butter bloom affliction amount increases. Requiring a NAS for a almost few non-emergency inpatient brainy bloom admissions is asymmetric to the amount of advancement the systems all-important to activity and alike the NAS.

Public Comments

The proposed aphorism was appear in the Federal Register on September 16, 2011 (76 FR 57690). No accessible comments were received.

Regulatory Procedures

Executive Adjustment 12866, “Regulatory Planning and Review” and Executive Adjustment 13563, “Improving Adjustment and Authoritative Review”

Executive Adjustment 12866 requires that a absolute authoritative appulse assay be performed on any economically cogent authoritative action, authentic as one that would aftereffect in an anniversary aftereffect of $100 actor or added on the civic abridgement or which would accept added abundant impacts. This final aphorism is not economically cogent nor a cogent authoritative activity as authentic beneath these admiral orders.

Sec. 202, Accessible Law 104-4, “Unfunded Mandates Reform Act”

This aphorism does not accommodate unfunded mandates. It does not accommodate a Federal authorization that may aftereffect in the amount by State, bounded and affiliated governments, in aggregate, or by the clandestine sector, of $100 actor or added in any 1 year.

Public Law 96-354, “Regulatory Adaptability Act” (5 U.S.C. 601)

The Authoritative Adaptability Act (RFA) requires that anniversary Federal Bureau prepare, and accomplish accessible for accessible comment, a authoritative adaptability assay back the bureau issues a adjustment which would accept a cogent appulse on a abundant cardinal of baby entities. This final aphorism will not accept a cogent appulse on a abundant cardinal of baby entities for purposes of the RFA. Thus this final aphorism is not accountable to this requirement.

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Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3511)

This final aphorism will not appoint added advertisement or recordkeeping requirements beneath the Paperwork Reduction Act of 1995.

Executive Adjustment 13132, “Federalism”

We accept advised the impacts of the aphorism beneath Executive Adjustment 13132 and it does not accept behavior that accept federalism implications that would accept abundant absolute furnishings on the States, on the accord amid the Civic Government and the States, or on the administration of ability and responsibilities amid the assorted levels of government, therefore, appointment with State and bounded admiral is not required.

List of Subjects in 32 CFR Allotment 199

Claims, Dental health, Bloom care, Bloom insurance, Individuals with disabilities, Aggressive personnel.

Accordingly, 32 CFR allotment 199 is adapted as follows:

PART 199–[AMENDED]

1. The ascendancy commendation for allotment 199 continues to apprehend as follows:

Authority: 5 U.S.C. 301; 10 U.S.C. affiliate 55.

2. Breadth 199.4 is adapted by alteration branch (a)(9) to apprehend as follows:

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SEC 199.4 Basic affairs benefits.

* * * * *

(a) * * *

(9) Nonavailability Statements aural a 40-mile catchment area. Unless appropriate by activity of the Assistant Secretary of Defense for Bloom Affairs (ASD(HA)) beneath this branch (a)(9), nonavailability statements are not required. If they are appropriate by ASD(HA) action, in some geographic locations, CHAMPUS beneficiaries not enrolled in TRICARE Prime may be appropriate to access a nonavailability account from a aggressive medical assay ability in adjustment to accept accurately articular bloom affliction casework from a noncombatant provider. If the appropriate affliction cannot be provided through the Uniformed Service facility, the hospital commander, or a designee, will affair a Nonavailability Account (NAS) (DD Form 1251). Failure to defended such a account may abandon the beneficiary’s rights to allowances beneath CHAMPUS/TRICARE.

(i) With the barring of maternology services, the ASD(HA) may crave an NAS above-mentioned to TRICARE cost-sharing for added casework from noncombatant sources if such casework are to be provided to a almsman who lives aural a 40-mile catchment breadth of an MTF area such casework are accessible and the ASD(HA):

(A) Demonstrates that cogent costs would be abhorred by assuming specific procedures at the afflicted MTF or MTFs; or

(B) Determines that a specific action charge be provided at the afflicted MTF or MTFs to ensure the accomplishment levels of the practitioners at the MTF or MTFs; or

(C) Determines that the abridgement of NAS abstracts would decidedly baffle with TRICARE arrangement administration; and

(D) Provides notification of the ASD(HA)’s absorbed to crave an NAS beneath this ascendancy to covered beneficiaries who accept affliction at the MTF or MTFs that will be afflicted by the accommodation to crave an NAS beneath this authority; and

(E) Provides at atomic 60-day notification to the Committees on Armed Casework of the House of Representatives and the Senate of the ASD(HA)’s absorbed to crave an NAS beneath this authority, the acumen for the NAS requirement, and the date that an NAS will be required.

(ii) Rules in aftereffect at the time noncombatant medical affliction is provided apply. The applicative rules and regulations apropos Nonavailability Statements in aftereffect at the time the noncombatant affliction is rendered administer in free whether a NAS is required.

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(iii) The Director, TMA is amenable for arising the procedural rules and regulations apropos Nonavailability Statements. Such rules and regulations should address:

(A) Back and for what casework a NAS is required. However, a NAS may not be appropriate for casework contrarily accessible at an MTF amid aural a 40-mile ambit of the beneficiary’s abode back addition allowance plan or affairs provides the beneficiary’s primary advantage for the services. This affirmation for an NAS does not administer to beneficiaries enrolled in TRICARE Prime, alike back those beneficiaries use the point-of-service advantage beneath SEC 199.17(n)(3) of this part; and

–This is a arbitrary of a Federal Register commodity originally appear on the folio cardinal listed below–

Final rule.

CFR Part: “32 CFR Allotment 199”

RIN Number: “RIN 0720-AB52”

Citation: “78 FR 12951”

Document Number: “Docket ID: DOD-2011-HA-0059”

Federal Register Folio Number: “12951”

“Rules and Regulations”

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