[Federal Register Volume 73, Number 130 (Monday, July 7, 2008)]
[Proposed Rules]
[Pages 38348-38350]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E8-15350]
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DEPARTMENT OF DEFENSE
Office of the Secretary
[DOD-2007-HA-0127]
32 CFR Part 199
RIN 0720-AB18
TRICARE: Civilian Health and Medical Program of the Uniformed
Services (CHAMPUS) Changes Included in the John Warner National Defense
Authorization Act for Fiscal Year 2007; Authorization of Forensic
Examinations
AGENCY: Department of Defense.
ACTION: Proposed rule.
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SUMMARY: This proposed rule implements section 701 of the John Warner
National Defense Authorization Act for Fiscal Year 2007, Public Law
109-364. Section 701 amends Chapter 55 of title 10 section 1079(a) of
the U.S.C. by authorizing coverage for forensic examinations following
a sexual assault or domestic violence for eligible beneficiaries. This
authorizes forensic examinations following sexual assault or domestic
violence provided in civilian health care facilities (e.g., civilian
rape crisis facilities), which is consistent with the services that are
authorized in Military Medical Treatment Facilities for all
beneficiaries who were victims of a sexual assault or domestic
violence.
DATES: Written comments will be accepted until September 5, 2008.
ADDRESSES: You may submit comments, identified by docket number or
Regulatory Information Number (RIN) and title, by any of the following
methods:
The Web site: http://www.regulations.gov. Follow the
instructions for submitting comments.
Mail: Federal Docket Management System Office, 1160
Defense Pentagon, Washington, DC 20302-1160.
[[Page 38349]]
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: Margaret A. Brown, Office of Medical
Benefits and Reimbursement Systems, TRICARE Management Activity,
telephone (303) 676-3581.
SUPPLEMENTARY INFORMATION:
I. Background
This proposed rule implements section 701 of the John Warner
National Defense Authorization Act for Fiscal Year 2007, which
establishes coverage of contracted medical care with respect to
forensic examinations following a sexual assault or domestic violence.
TRICARE currently pays for and will continue to pay for all emergency
room services delivered to a victim. TRICARE does not reimburse for the
forensic examination, which presented a problem for beneficiaries in
the past. Although most States have laws that designate payment sources
to cover the costs of forensic examinations for sexual assault victims
(some States even prohibit billing victims), some beneficiaries who
were victims of a sexual assault have received a bill for the forensic
examination.
Currently, forensic examinations are not covered for beneficiaries
in civilian health care facilities through TRICARE medical plan
contracts because TRICARE, under 10 U.S.C. 1079(a)(13), may cost share
only medically or psychologically necessary services or supplies.
Forensic examinations are not conducted for medical treatment purposes,
but for preservation of evidence in any future criminal investigation
and/or prosecution. However, there is a dual purpose of the examination
process. One purpose is to address the needs of the individual
disclosing sexual assault, which include evaluating and treating
injuries; conducting prompt examinations; providing support, crisis
intervention, and advocacy; providing prophylaxis against sexually
transmitted diseases; assessing female patients for pregnancy risk and
discussing treatment options, including reproductive health services;
and providing follow-up care for medical and emotional needs. The other
purpose is to address justice system needs. The needs for justice
system are: obtaining a history of the assault, documenting exam
findings, properly collecting, handling, and preserving evidence, and
interpreting and analyzing findings (post exam) and subsequently,
presenting findings and providing factual and expert opinion related to
the exam and evidence collection.
Forensic Examination (Rape Kits)
A rape kit is used to collect and preserve the evidence. Rape kits
(also known as early evidence kits) typically include forms for
documentation of what is observed, tubes for blood samples, a urine
sample container (for detecting drugs that may have been used to
facilitate a sexual assault), cotton swabs for biological evidence
collection, sterile water, sterile saline, glass slides, unwaxed dental
floss, a wooden stick for fingernail scrapings, envelopes or boxes for
individual evidence samples, labels for each item and paper bags for
clothing collection and a large sheet of paper for patient to undress
over. The victim's clothing is collected for any external evidence and
new clothes are provided. Forensic examinations can take up to 4 hours.
Forensic examinations are currently paid for active duty members
with supplemental care, which under 10 U.S.C. 1074(c)(1), does not have
the same requirement for medical or psychological necessity. All
beneficiaries are covered if they are examined in a military treatment
facility. The forensic examination becomes an issue when services are
provided in a civilian health care facility. Eighteen States have
mechanisms in place that require civilian health care facilities to
bill a State agency directly. Certain other States, to some degree,
have mechanisms to minimize the possibility of invoicing the
beneficiary. This proposed rule puts into place a mechanism that allows
civilian health care facilities to invoice TRICARE for reimbursement of
forensic examinations.
We believe that a large portion of the costs for the examinations
are probably already being paid by TRICARE as most services associated
with a forensic exam are covered benefits under any circumstance; and
if a claim from a health care facility is submitted with the
appropriate procedure code the claim would be paid. What is not being
cost-shared are the examinations to gather information for the justice
system. In a civilian facility, the victim's private insurance should
not be billed for the cost of the examination. This stipulation has
been made pursuant to the Federal Victims of Crime Act (VOCA). A
reimbursement request from a provider under the VOCA should only be
submitted for a victim who is not covered by a Federal or federally
funded program, such as Medicare, Medicaid, TRICARE or the Department
of Veterans Affairs. This proposed rule amends the regulation to ensure
that forensic examinations following sexual assault or domestic
violence are specifically listed as a covered benefit.
II. Regulatory Procedures
Executive Order 12866, ``Regulatory Planning and Review''
It has been certified that 32 CFR 199.4(e)(27) does not:
(1) Have an annual effect on the economy of $100 million or more or
adversely affect in a material way the economy; a section of the
economy; productivity; competition; jobs; the environment; public
health or safety; or State, local, or tribal governments or
communities;
(2) Create a serious inconsistency or otherwise interfere with an
action taken or planned by another Agency;
(3) Materially alter the budgetary impact of entitlements, grants,
user fees, or loan programs, or the rights and obligations of
recipients thereof; or
(4) Raise novel legal or policy issues arising out of legal
mandates, the President's priorities, or the principles set forth in
this Executive Order.
Sec. 202, Pub. L. 104-4, ``Unfunded Mandates Reform Act''
It has been certified that 32 CFR 199.4(e)(27) 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)
It has been certified that 32 CFR 199.4(e)(27) is not subject to
the Regulatory Flexibility Act (5 U.S.C. 601) because it would not, if
promulgated, have a significant economic impact on a substantial number
of small entities.
Public Law 96-511, ``Paperwork Reduction Act'' (44 U.S.C. Chapter 35)
It has been certified that 32 CFR 199.4(e)(27) does not impose
reporting or recordkeeping requirements under the Paperwork Reduction
Act of 1995.
Executive Order 13132, ``Federalism''
It has been certified that 32 CFR 199.4(e)(27) does not have
federalism implications, as set forth in Executive
[[Page 38350]]
Order 13132. This rule does not have substantial direct effects on:
(1) The States;
(2) The relationship between the National Government and the
States; or
(3) The distribution of power and responsibilities among the
various levels of Government.
List of Subjects in 32 CFR Part 199
Claims, Health care, Health insurance, 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 adding paragraph (e)(27) to read as
follows:
Sec. 199.4 Basic program benefit.
* * * * *
(e) * * *
(27) TRICARE will cost share forensic examinations following a
sexual assault or domestic violence. The forensic examination includes
a history of the event and a complete physical and collection of
forensic evidence, and medical and psychological follow-up care. The
examination for sexual assault also includes, but is not limited to, a
test kit to retrieve forensic evidence, testing for pregnancy, testing
for sexual transmitted disease and HIV, and medical services and
supplies for prevention of sexually transmitted diseases, HIV,
pregnancy, and counseling services.
* * * * *
Dated: June 30, 2008.
Patricia L. Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. E8-15350 Filed 7-3-08; 8:45 am]
BILLING CODE 5001-06-P