PART 1241—TO RESEARCH, EVALUATE, ASSESS, AND TREAT (TREAT) ASTRONAUTS Authority: 51 U.S.C. 20149. Source: 85 FR 15357, Mar. 18, 2020, unless otherwise noted. § 1241.05 Purpose and scope. (a) This part establishes a program and sets out the eligibility requirements and procedures to effectuate section 443 of the “To Research, Evaluate, Assess, and Treat Astronauts Act of 2017.” (b) The purpose of this program is to provide medical monitoring and diagnosis of former U.S. Government astronauts and payload specialists for conditions the Administrator considers potentially associated with spaceflight and to provide treatment of former U.S. Government astronauts and payload specialists for conditions the Administrator considers associated with spaceflight. § 1241.10 Covered medical care. (a) Subject to the limitations in paragraph (b) of this section, an eligible individual, as defined in § 1241.15, is eligible for: (1) Monitoring and diagnosis for potentially spaceflight-associated conditions; and (2) Treatment for spaceflight-associated conditions. (b) Medical monitoring, diagnosis, and treatment authorized and described in paragraph (a) of this section will not be provided for any condition that is found by the NASA Administrator or designee to have resulted from a cause other than the eligible individual's participation in spaceflight-related activities. Should a condition be diagnosed that is not related to spaceflight, the individual will be referred to their primary care physician. (c) Medical monitoring, diagnosis, and treatment authorized and described in paragraph (a) of this section may be provided by a local health care provider if the NASA Administrator or designee determines it is unadvisable for the eligible individual to travel to the NASA Johnson Space Center (JSC) due to the individual's condition or if it is otherwise advantageous to the Government. (d) Medical monitoring, diagnosis, and treatment authorized and described in paragraph (a) of this section will be provided without a cost sharing obligation imposed on the eligible individual. (e) NASA is a secondary payer. § 1241.15 Definitions. Conditional Payment Cost Sharing Diagnosis Eligible Individual (1) Astronauts of other United States Government agencies; (2) Employees of commercial spaceflight companies who were never employed by NASA nor a member of the Uniformed Services assigned to NASA; (3) International partner astronauts; (4) Employees of foreign governments; (5) Private individuals or tourists who have flown in space; and (6) Former astronauts, including members of the Uniformed Services, and former payload specialists who have not flown in space. JSC Monitoring Payload Specialist Primary Payer Program Secondary Payer Spaceflight-Associated Condition Treatment TREAT Astronauts Act TREAT Astronauts Act Board or TAAB U.S. Government Agency § 1241.20 Eligibility. (a) This section sets forth those persons who, by the provisions of the TREAT Astronauts Act, are eligible to participate in this program. A determination by the Administrator or designee that a person is eligible does not automatically entitle such a person to medical monitoring, diagnosis, and treatment under the TREAT Astronauts Act. (b) Only eligible individuals defined in § 1241.15 are entitled to medical monitoring, diagnosis, and treatment under this part. (c) Participation in this program is strictly voluntary. NASA may not require an eligible individual to participate in this program. § 1241.25 Basic program. (a) General Scope. (2) Location of medical monitoring, diagnosis, and treatment. (ii) When travel is inadvisable due to the health of the eligible individual or when otherwise advantageous to the Government, monitoring may be provided at a location other than the JSC. (iii) Diagnosis and treatment will be provided for eligible individuals at locations determined by the medical appropriateness of the facility, patient preferences, cost effectiveness, and other pertinent factors. (3) Right to information. (b) Monitoring and Diagnosis. (1) Standardized monitoring will be offered routinely at the JSC. (2) Individualized monitoring will be provided, as necessary. (3) NASA may pay for and obtain autopsies of eligible individuals, who previously consented in writing or with consent of the next of kin, when such autopsy would contribute substantially to the knowledge of spaceflight physiology or pathology. NASA will coordinate with the Armed Forces Medical Examiner System for such autopsies. (c) Treatment. (1) Treatment will be secondary to any services provided by primary payers. (2) Should urgency dictate, NASA may provide for conditional payments for treatment. (d) Exclusions and limitations. (1) Medical monitoring or diagnosis of an eligible individual for any medical or psychological condition that is not potentially associated with human spaceflight; and (2) Treatment of an eligible individual for any medical or psychological condition that is not associated with human spaceflight. § 1241.30 Program participation and claims submission. (a) General program participation. (b) NASA's occupationally related medical monitoring services. (2) [Reserved] (c) Primary payer coverage of diagnosis and treatment services. Former Civil Servants. (2) Members of the Uniformed Services. (3) Former Civil Servants who were also Members of the Uniformed Services. (4) Eligible individuals with claims denied or partially covered. (d) Diagnosis and Treatment or Other Benefits-Veterans. (e) Submitting claims for medical monitoring, diagnosis, and treatment under this program Claim required. (ii) NASA will provide specific forms appropriate for making a claim for medical monitoring, diagnosis, and treatment. Claim forms may be obtained from the JSC Flight Medicine Clinic. Contact information can be found at: https://www.nasa.gov/hhp/treat-act. (2) Information required. (i) Statement of eligibility describing the employment and spaceflight history that justifies medical monitoring, diagnosis, and treatment under this program; (ii) History and diagnosis of medical or psychological condition; (iii) Medical documentation in support of the claim. Healthcare providers must be licensed and permitted to practice under state law and not be on the Centers for Medicare & Medicaid Services (CMS) List of Excluded Individuals and Entities, found at: https://healthdata.gov/dataset/list-excluded-individuals-and-entities; (iv) Documentation of the decisions and/or payments made by the primary payer ( i.e., (v) Justification for determination that the psychological or medical condition is associated with spaceflight; (vi) Expenses for which they are seeking reimbursement, to include documentation of all out-of-pocket costs; and (vii) The signature of the eligible individual or their authorized representative. (3) Responsibility for perfecting claim. § 1241.35 Claims review and decisions. (a) NASA will establish the TREAT Astronauts Act Board (TAAB) to review claims for medical monitoring, diagnosis, and treatment under this program. This review is independent of any review conducted by primary payers. (b) The TAAB will review each claim submitted by the eligible individual, in consultation with specialists, as appropriate. A typical case will be reviewed within 30 calendar days, but cases that are more complex may take additional time. (c) The TAAB will make a recommendation to the Administrator or designee for each claim stating whether the condition is determined to be spaceflight associated. (d) For those eligible individuals who have had other exposures in addition to those experienced during their career as active U.S. Government astronauts or payload specialists, the TAAB will consider that history when making its recommendation. (e) The NASA Administrator or designee will review each claim and associated TAAB recommendation to determine whether the claim should be approved or denied. A typical case can be reviewed within 30 calendar days, but cases that are more complex may take additional time. (f) The decision will be provided to the eligible individual within seven calendar days of the final decision by the NASA Administrator or designee. Decisions not in favor of the eligible individual will include information on how to request reconsideration. (g) An eligible individual or their authorized representative may request reconsideration of the decision at any time if new information is obtained that enhances the claim. Reconsideration requests can be made to the JSC Flight Medicine Clinic. (h) Requests for reconsideration are reviewed by the TAAB and decisions made by the Administrator or designee, following the same process described in paragraphs (b) through (f) of this section. § 1241.40 Payment of approved claims. (a) The NASA Administrator or designee is responsible for ensuring that medical monitoring, diagnosis, and treatment to eligible individuals under this program is paid only to the extent described in this part. (b) Payment for medical monitoring, diagnosis, and treatment is applied secondarily to primary payers and may include the remaining out-of-pocket costs from primary payer coverage. (c) NASA will pay necessary travel expenses related to this program consistent with the Federal Travel Regulations. (d) NASA may provide conditional payments for medical monitoring, diagnosis, and treatment that is obligated to be paid by the U.S. Government or other primary payers prior to a final decision by NASA in accordance with § 1241.35. Such requests for conditional payments can be made to JSC Flight Medicine Clinic. Such payments are permitted when payment for such medical monitoring, diagnosis, and treatment has either not been made or will not be made promptly. (1) NASA may seek to recover costs associated with conditional payments from the U.S. Government, private health insurance company, or other primary payer as allowable by law. (2) If the claim is denied in accordance with § 1241.35, NASA may seek to recover such conditional payments from the eligible individual in accordance with 31 U.S.C. Chapter 37. § 1241.45 Collaboration with other agencies. Copies of records generated from medical monitoring, diagnosis, and treatment collected by primary payer facilities and/or relevant health care providers will be acquired by NASA. NASA will collaborate with the Department of Defense Military Health System, Department of Veterans Affairs, and Department of Labor Office of Workers' Compensation and other entities for acquisition of copies of these medical records as allowed by law. § 1241.50 Records, confidentiality, privacy, and data use. (a) Records on individuals created or obtained pursuant to this regulation that are subject to the Privacy Act of 1974, as amended, 5 U.S.C. 552a, will be maintained in accordance with the NASA's Privacy Act System of Records. (b) NASA will, as necessary, enter into data sharing agreements with other agencies and/or entities to receive such data and/or seek signed medical releases from the eligible individuals, or their authorized representatives, in accordance with law. (c) NASA's collection, use, and disclosure of this data will be in accordance with the Privacy Act of 1974, NASA's implementing regulations at 14 CFR part 1212, and NASA's privacy policies, where applicable.