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DOD/DODOASHA RIN: 0720-AB62 Publication ID: Spring 2015 
Title: TRICARE; Revision of Nonparticipating Providers Reimbursement Rate; Removal of Cost Share for Dental Sealants; TRICARE Dental Program 
Abstract:

The Department of Defense (DoD) proposed several amendments to the TRICARE Dental Program (TDP) regulation. Specifically, this rule revises the benefit payment provision for nonparticipating providers to more closely mirror industry practices by requiring TDP nonparticipating providers to be reimbursed (minus the appropriate cost-share) at the lesser of (1) billed charges, or (2) the network maximum allowable charge for similar services in that same locality (region) or state. This rule also updates the regulatory provisions regarding dental sealants to categorize them clearly as a preventive service and eliminate the current 20 percent cost-share applicable to sealants to conform the language in the regulation to the statute.

 
Agency: Department of Defense(DOD)  Priority: Substantive, Nonsignificant 
RIN Status: Previously published in the Unified Agenda Agenda Stage of Rulemaking: Final Rule Stage 
Major: No  Unfunded Mandates: No 
CFR Citation: 32 CFR 199   
Legal Authority: 5 U.S.C. 301    10 U.S.C. ch 55   
Legal Deadline:  None
Timetable:
Action Date FR Cite
NPRM  12/30/2014  79 FR 78362   
NPRM Comment Period End  03/02/2015 
Final Action  12/00/2015 
Regulatory Flexibility Analysis Required: No  Government Levels Affected: None 
Small Entities Affected: No  Federalism: No 
Included in the Regulatory Plan: No 
RIN Data Printed in the FR: No 
Agency Contact:
COL James Honey
Department of Defense
Office of Assistant Secretary for Health Affairs
1200 Defense Pentagon,
Washington, DC 20301
Phone:703 681-0039