Federal Register: October 29, 2009 (Volume 74, Number 208)
DOCID: fr29oc09-29 FR Doc E9-26049
DEPARTMENT OF DEFENSE
Defense Department
CFR Citation: 32 CFR Part 199
RIN ID: RIN 0720-AB36
NOTICE: PROPOSED RULES
DOCID: fr29oc09-29
DOCUMENT ACTION: Proposed rule.
SUBJECT CATEGORY:
TRICARE: Non-Physician Referrals for Physical Therapy, Occupational Therapy, and Speech Therapy
DATES: Comments received at the address indicated below by December 28, 2009 will be accepted.
DOCUMENT SUMMARY:
The Department of Defense is publishing this proposed rule to authorize certified physician assistants and certified nurse practitioners (nonphysicians) to engage in referrals of beneficiaries to the managed care support system for physical therapy, occupational therapy, and speech therapy.
SUMMARY:
TRICARE; Non-Physician Referrals for Physical Therapy, Occupational Therapy, and Speech Therapy
SUPPLEMENTAL INFORMATION
This proposed rule will permit services of
an otherwise TRICAREauthorized individual paramedical provider,
Physical Therapists (PT), Occupational Therapists (OT), and Speech
Therapists (ST) to be paid on a feeforservice basis if based on a
referral from a certified physician assistant or certified nurse practitioner. This change will also align
[[Page 55795]]
TRICARE with Medicare's allowance of ``nonphysician providers'' to
provide, certify, or supervise therapy services. The language of 32 CFR
199.4(c)(3)(x) states that PT and OT may be cost shared when services are prescribed and monitored by a physician and 32 CFR
199.6(c)(3)(iii)(K) states that the services of PT, OT, and ST can be
paid on a feeforservice basis if the beneficiary is referred by a
physician for the treatment of a medically diagnosed condition and a
physician provides continuing oversight. In the Military Treatment
Facility (MTF) setting, certified physician assistants work under the
supervision of a physician. Until recently, the mechanical process of
entering referrals into the electronic system allowed the MTF to
reflect which physician was overseeing these referrals. However, with
the implementation of the National Provider Identifier Standard as
required by the Health Insurance Portability and Accountability Act,
and the changes to the electronic system, the responsible physician is
no longer allowed to be annotated on the referral. Additionally, a
review of the processes used by Medicare found that Medicare no longer
restricts the referral for PT, OT, and ST to only physicians, but now
allows nonphysician providers to make these referrals. After
consideration, the Department of Defense has determined that this model
should be proposed within the Military Health System so that a
certified physician assistant or certified nurse practitioner may be allowed to issue such referrals.
Regulatory Procedures
Executive Order 12866, ``Regulatory Planning and Review''
Section 801 of title 5, United States Code, and Executive Order
(E.O.) 12866 require 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 economically significant, and has
been reviewed by the Office of Management and Budget as required under the provisions of E.O. 12866.
Public Law 1044, Section 202, ``Unfunded Mandates Reform Act''
Section 202 of Public Law 1044, ``Unfunded Mandates Reform Act,''
requires that an analysis be performed to determine whether any federal
mandate may result in the expenditure by State, local and tribal
governments, in the aggregate, or by the private sector of $100 million
in any one year. It has been certified that this proposed 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, and thus this proposed rule is not subject to this requirement.
Public Law 96354, ``Regulatory Flexibility Act'' (RFA) (5 U.S.C. 601)
Public Law 96354, ``Regulatory Flexibility Act'' (RFA) (5 U.S.C. 601), requires that each Federal agency prepare 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 is not an economically significant regulatory action, and it has been certified that it will not have a significant impact on a substantial number of small entities. Therefore, this proposed rule is not subject to the requirements of the RFA. Public Law 96511, ``Paperwork Reduction Act'' (44 U.S.C. Chapter 35)
This rule does not contain a ``collection of information'' requirement, and will not impose additional information collection requirements on the public under Public Law 96511, ``Paperwork Reduction Act'' (44 U.S.C. Chapter 35).
Executive Order 13132, ``Federalism''
E.O. 13132, ``Federalism,'' requires that an impact analysis be performed to determine whether the rule has 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. It has been certified that this proposed rule does not have federalism implications, as set forth in E.O. 13132.
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: 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 199.4 is amended by revising paragraph (c)(3)(x)(A) to read as follows:
Sec. 199.4 Basic program benefits.
* * * * *
(c) * * *
(3) * * *
(x) * * *
(A) The services are prescribed and monitored by a physician,
certified physician assistant or certified nurse practitioner. * * * * *
3. Section 199.6 is amended by revising paragraph (c)(3)(iii)(K) to read as follows:
Sec. 199.6 TRICAREauthorized providers.
* * * * *
(c) * * *
(3) * * *
(iii) * * *
(K) Other individual paramedical providers.
(1) The services of the following individual professional providers
of care to be considered for benefits on a feeforservice basis may be
provided only if the beneficiary is referred by a physician for the
treatment of a medically diagnosed condition and a physician must also
provide continuing and ongoing oversight and supervision of the program
or episode of treatment provided by these individual paramedical providers.
(i) Licensed registered nurses.
(ii) Audiologists.
(2) The services of the following individual professional providers
of care to be considered for benefits on a feeforservice basis may be
provided only if the beneficiary is referred by a physician, a
certified physician assistant or certified nurse practitioner and a
physician, a certified physician assistant or certified nurse
practitioner must also provide continuing and ongoing oversight and
supervision of the program or episode of treatment provided by these individual paramedical providers.
(i) Licensed registered physical therapist and occupational therapist.
(ii) Licensed registered speech therapists (speech pathologists). * * * * *
Dated: October 23, 2009.
Patricia L. Toppings,
OSD Federal Register Liaison Officer, Department of Defense. [FR Doc. E926049 Filed 102809; 8:45 am]
BILLING CODE 500106P
FOR FURTHER INFORMATION CONTACT
Glenn Corn, Medical Benefits and Reimbursement Branch, TRICARE Management Activity, telephone (303) 676 3566.