79348 Federal Register / Vol. 75, No. 243 / Monday, December 20, 2010 / Notices 

ROUTINE USES OF RECORDS MAINTAINED IN THE

SYSTEM, INCLUDING CATEGORIES OF USERS AND

THE PURPOSES OF SUCH USES: 

In addition to those disclosures 

generally permitted under 5 U.S.C. 

552a(b) of the Privacy Act, as amended, 

these records may specifically be 

disclosed outside the Department of 

Defense as a routine use pursuant to 5 

U.S.C. 552a(b)(3) as follows: 

To interface with all commercial 

insurance carriers and parties against 

whom recovery has been sought by the 

Department of Defense Military Health 

System, as well as all parties involved 

in support of the collection activities for 

health care approved by the Department 

of Defense. 

To the National Data Clearinghouse, 

an electronic healthcare clearinghouse, 

for purposes of converting the data to an 

industry-wide format prior to 

forwarding the billing information to the 

insurance companies for payment. 

The DoD ‘Blanket Routine Uses’ set 

forth at the beginning of Office of the 

Secretary of Defense’s compilation of 

systems of records notices apply to this 

system. 

Note 1: This system of records contains 

individually identifiable health information. 

The Department of Defense Health 

Information Privacy Regulation (DoD 

6025.18–R) issued pursuant to the Health 

Insurance Portability and Accountability Act 

of 1996, applies to most such health 

information. DoD 6025.18–R may place 

additional procedural requirements on the 

uses and disclosures of such information 

beyond what is found in the Privacy Act of 

1974 or mentioned in this system of records 

notice. 

Note 2: Personal identity, diagnosis, 

prognosis or treatment information of any 

patient maintained in connection with the 

performance of any program or activity 

relating to substance abuse education, 

prevention, training, treatment, 

rehabilitation, or research, which is 

conducted, regulated, or directly or indirectly 

assisted by any department or agency of the 

United States is, except as per 42 U.S.C. 

290dd–2, treated as confidential and 

disclosed only for the purposes and under 

the circumstances expressly authorized 

under 42 U.S.C. 290dd–2. 

POLICIES AND PRACTICES FOR STORING, 

RETRIEVING, ACCESSING, RETAINING, AND

DISPOSING OF RECORDS IN THE SYSTEM: 

STORAGE: 

Paper file folders and electronic 

storage media. 

RETRIEVABILITY: 

Records are retrieved by the sponsor 

or patient name, Social Security 

Number, Department of Defense 

Benefits Number, third party payer 

identification number assigned to 

individual, family member prefix (a 

two-digit code identifying the person’s 

relationship to the Military Sponsor), 

and/or Patient Control Number. 

SAFEGUARDS: 

Physical access to system location 

restricted by cipher locks, visitor escort, 

access rosters, and photo identification. 

Adequate locks on doors and server 

components secured in a locked 

computer room with limited access. 

Each system end user device protected 

within a locked storage container, room, 

or building outside of normal business 

hours. All visitors and other persons 

that require access to facilities that 

house servers and other network devices 

supporting the system that do not have 

authorization for access escorted by 

appropriately screened/cleared 

personnel at all times. 

Access to the system is role-based and 

a valid user account is required. The 

system provides two-factor 

authentication, using either a Common 

Access Card and Personal Identification 

Number or a unique logon identification 

and password. Where a unique logon 

identification and password is used, 

passwords must be renewed every sixty 

(60) days. Authorized personnel must 

have appropriate Information Assurance 

training, Health Insurance Portability 

and Accountability Act training, and 

Privacy Act of 1974 training. 

RETENTION AND DISPOSAL: 

Records are destroyed five years after 

the end of the year in which the record 

was closed. 

SYSTEM MANAGER(S) AND ADDRESS: 

Program Manager, Defense Health 

Services Systems, Suite 1500, 5203 

Leesburg Pike, Falls Church, VA 22041– 

3891. 

NOTIFICATION PROCEDURE: 

Individuals seeking to determine 

whether this system contains 

information about themselves should 

address written inquires to the 

TRICARE Management Activity, 

Department of Defense, ATTN: TMA 

Privacy Officer, Suite 810, 5111 

Leesburg Pike, Falls Church, VA 22041– 

3206. 

Request should contain participant’s 

and/or sponsor’s full name, their Social 

Security Number (SSN), and current 

address and telephone number and the 

names of the military treatment facility 

or facilities in which they have received 

medical treatment. 

If requesting health information of a 

minor (or legally incompetent person), 

the request must be made by a custodial 

parent, legal guardian, or party acting in 

loco parentis of such individual(s). 

Written proof of the capacity of the 

requestor may be required. 

RECORD ACCESS PROCEDURES: 

Individuals seeking access to records 

about themselves contained in this 

system should address written inquiries 

to TRICARE Management Activity, 

Attention: Freedom of Information Act 

Requester Service Center, 16401 East 

Centretech Parkway, Aurora, CO 80011– 

9066. 

Requests should contain participant’s 

and/or sponsor’s full name, their Social 

Security Number (SSN), and current 

address and telephone number and the 

names of the military treatment facility 

or facilities in which they have received 

medical treatment. 

If requesting health information of a 

minor (or legally incompetent person), 

the request must be made by a custodial 

parent, legal guardian, or party acting in 

loco parentis of such individual(s). 

Written proof of the capacity of the 

requestor may be required. 

CONTESTING RECORD PROCEDURES: 

The Office of the Secretary of Defense 

rules for accessing records, for 

contesting contents and appealing 

initial agency determinations are 

published in Office of the Secretary of 

Defense Administrative Instruction 81 

(32 CFR part 311) or may be obtained 

from the system manager. 

RECORD SOURCE CATEGORIES: 

Information is obtained from an 

automated medical records system, the 

Composite Health Care System 

(specifically, the Ambulatory Data 

Module), which is automatically sent to 

the Third Party Collection System. 

Other information may be obtained from 

the AHLTA System and the Theater 

Data Medical Stores System. 

EXEMPTIONS CLAIMED FOR THE SYSTEM: 

None. 

[FR Doc. 2010–31789 Filed 12–17–10; 8:45 am] 

BILLING CODE 5001–06–P 

DEPARTMENT OF DEFENSE 

Office of the Secretary 

TRICARE; Formerly Known as the 

Civilian Health and Medical Program of 

the Uniformed Services (CHAMPUS); 

Fiscal Year 2011 Diagnosis-Related 

Group (DRG) Updates 

AGENCY: Office of the Secretary, DoD. 

ACTION: Notice of DRG revised rates. 

SUMMARY: This notice describes the 

changes made to the TRICARE DRGVerDate Mar<15>2010 17:18 Dec 17, 2010 Jkt 223001 PO 00000 Frm 00015 Fmt 4703 Sfmt 4703 E:\FR\FM\20DEN1.SGM 20DEN1

jlentini on DSKJ8SOYB1PROD with NOTICES
Federal Register / Vol. 75, No. 243 / Monday, December 20, 2010 / Notices 79349 

based payment system in order to 

conform to changes made to the 

Medicare Prospective Payment System 

(PPS). It also provides the updated fixed 

loss cost outlier threshold, cost-tocharge ratios and the data necessary to 

update the Fiscal Year 2011 rates. 

DATES: The rates, weights, and Medicare 

PPS changes which affect the TRICARE 

DRG-based payment system contained 

in this notice are effective for 

admissions occurring on or after 

October 1, 2010. 

ADDRESSES: TRICARE Management 

Activity (TMA), Medical Benefits and 

Reimbursement Branch, 16401 East 

Centretech Parkway, Aurora, CO 80011– 

9066. 

FOR FURTHER INFORMATION CONTACT: Ann 

N. Fazzini, Medical Benefits and 

Reimbursement Branch, TMA, 

telephone (303) 676–3803. 

Questions regarding payment of 

specific claims under the TRICARE 

DRG-based payment system should be 

addressed to the appropriate contractor. 

SUPPLEMENTARY INFORMATION: The final 

rule published on September 1, 1987 (52 

FR 32992) set forth the basic procedures 

used under the CHAMPUS DRG-based 

payment system. This was subsequently 

amended by final rules published 

August 31, 1988 (53 FR 33461), October 

21, 1988 (53 FR 41331), December 16, 

1988 (53 FR 50515), May 30, 1990 (55 

FR 21863), October 22, 1990 (55 FR 

42560), and September 10, 1998 (63 FR 

48439). 

An explicit tenet of these final rules, 

and one based on the statute authorizing 

the use of DRGs by TRICARE, is that the 

TRICARE DRG-based payment system is 

modeled on the Medicare PPS, and that, 

whenever practicable, the TRICARE 

system will follow the same rules that 

apply to the Medicare PPS. The Centers 

for Medicare and Medicaid Services 

(CMS) publishes these changes annually 

in the Federal Register and discusses in 

detail the impact of the changes. 

In addition, this notice updates the 

rates and weights in accordance with 

our previous final rules. The actual 

changes we are making, along with a 

description of their relationship to the 

Medicare PPS, are detailed below. 

I. Medicare PPS Changes Which Affect 

the TRICARE DRG-Based Payment 

System 

Following is a discussion of the 

changes CMS has made to the Medicare 

PPS that affect the TRICARE DRG-based 

payment system. 

A. DRG Classifications 

Under both the Medicare PPS and the 

TRICARE DRG-based payment system, 

cases are classified into the appropriate 

DRG by a Grouper program. The 

Grouper classifies each case into a DRG 

on the basis of the diagnosis and 

procedure codes and demographic 

information (that is, sex, age, and 

discharge status). The Grouper used for 

the TRICARE DRG-based payment 

system is the same as the current 

Medicare Grouper with two 

modifications. The TRICARE system has 

replaced Medicare DRG 435 with two 

age-based DRGs (900 and 901), and has 

implemented thirty-four (34) neonatal 

DRGs in place of Medicare DRGs 385 

through 390. For admissions occurring 

on or after October 1, 2001, DRG 435 has 

been replaced by DRG 523. The 

TRICARE system has replaced DRG 523 

with the two age-based DRGs (900 and 

901). For admissions occurring on or 

after October 1, 1995, the CHAMPUS 

grouper hierarchy logic was changed so 

the age split (age < 29 days) and 

assignments to Major Diagnostic 

Category (MDC) 15 occur before 

assignment of the PreMDC DRGs. This 

resulted in all neonate tracheostomies 

and organ transplants to be grouped to 

MDC 15 and not to DRGs 480–483 or 

495. For admissions occurring on or 

after October 1, 1998, the CHAMPUS 

grouper hierarchy logic was changed to 

move DRG 103 to the PreMDC DRGs and 

to assign patients to PreMDC DRGs 480, 

103, and 495 before assignment to MDC 

15 DRGs and the neonatal DRGs. For 

admissions occurring on or after 

October 1, 2001, DRGs 512 and 513 

were added to the PreMDC DRGs, 

between DRGs 480 and 103 in the 

TRICARE grouper hierarchy logic. For 

admissions occurring on or after 

October 1, 2004, DRG 483 was deleted 

and replaced with DRGs 541 and 542, 

splitting the assignment of cases on the 

basis of the performance of a major 

operating room procedure. The 

description for DRG 480 was changed to 

‘‘Liver Transplant and/or Intestinal 

Transplant’’, and the description for 

DRG 103 was changed to ‘‘Heart/Heart 

Lung Transplant or Implant of Heart 

Assist System’’. For Fiscal Year 2007, 

CMS implemented classification 

changes, including surgical hierarchy 

changes. The TRICARE Grouper 

incorporated all changes made to the 

Medicare Grouper, with the exception of 

the pre-surgical hierarchy changes, 

which will remain the same as Fiscal 

Year 2006. For Fiscal Year 2008, 

Medicare implemented their MedicareSeverity DRG (MS–DRG) based payment 

system. TRICARE, however, continued 

with the Centers for Medicare and 

Medicaid Services DRG-based (CMS 

DRG) payment system for Fiscal Year 

2008. For Fiscal Year 2009, the 

TRICARE/CHAMPUS DRG-based 

payment system shall be modeled on 

the MS–DRG system, with the following 

modifications. 

The MS–DRG system consolidated the 

43 pediatric CMS DRGs that were 

defined based on age less than or equal 

to 17 into the most clinically similar 

MS–DRGs. In their Inpatient Prospective 

Payment System final rule for MS– 

DRGs, Medicare stated for their 

population these pediatric CMS DRGs 

contained a very low volume of 

Medicare patients. At the same time, 

Medicare encouraged private insurers 

and other non-Medicare payers to make 

refinements to MS–DRGs to better suit 

the needs of the patients they serve. 

Consequently, TRICARE finds it 

appropriate to retain the pediatric CMS 

DRGs for our population. TRICARE is 

also retaining the TRICARE-specific 

DRGs for neonates and substance use. 

TRICARE has retained the MS–DRG 

numbering system for Fiscal Year 2009 

and those TRICARE-specific DRGs have 

been assigned available, blank DRG 

numbers unused in the MS–DRG 

system. We refer the reader to http:// 

www.tricare.mil/drgrates for a complete 

crosswalk containing the TRICARE DRG 

numbers for Fiscal Year 2009. 

For Fiscal Year 2009, TRICARE will 

use the MS–DRG v26.0 pre-MDC 

hierarchy, with the exception that MDC 

15 is applied after DRG 011–012 and 

before MDC 24. 

For Fiscal Year 2010, there are no 

additional or deleted DRGs. 

For Fiscal Year 2011, the added DRGs 

and deleted DRGs are the same as those 

included in CMS’ final rule published 

on August 16, 2010. That is, DRG 009 

is deleted; DRGs 014 and 015 are being 

added. 

B. Wage Index and Medicare 

Geographic Classification Review Board 

Guidelines 

TRICARE will continue to use the 

same wage index amounts used for the 

Medicare PPS. TRICARE will also 

duplicate all changes with regard to the 

wage index for specific hospitals that 

are redesignated by the Medicare 

Geographic Classification Review Board. 

In addition, TRICARE will continue to 

utilize the out commuting wage index 

adjustment. 

C. Revision of the Labor-Related Share 

of the Wage Index 

TRICARE is adopting CMS’ 

percentage of labor related share of the 

standardized amount. For wage index 

values greater than 1.0, the labor related 

portion of the Adjusted Standardized 

Amount (ASA) shall equal 68.8 percent. 


jlentini on DSKJ8SOYB1PROD with NOTICES
79350 Federal Register / Vol. 75, No. 243 / Monday, December 20, 2010 / Notices 

For wage index values less than or equal 

to 1.0 the labor related portion of the 

ASA shall continue to equal 62 percent. 

D. Hospital Market Basket 

TRICARE will update the adjusted 

standardized amounts according to the 

final updated hospital market basket 

used for the Medicare PPS for all 

hospitals subject to the TRICARE DRGbased payment system according to 

CMS’s August 16, 2010, final rule. For 

Fiscal Year 2011, the market basket is 

2.6 percent. This year, Medicare applied 

two reductions to their market basket 

amount: (1) A 0.25 percent reduction 

due to provisions found in the Patient 

Protection and Affordable Care Act, and 

(2) a 2.9 percent reduction for 

documentation and coding adjustments 

found in Public Law 110–90. These two 

reductions do not apply to TRICARE. 

E. Outlier Payments 

Since TRICARE does not include 

capital payments in our DRG-based 

payments (TRICARE reimburses 

hospitals for their capital costs as 

reported annually to the contractor on a 

pass-through basis), we will use the 

fixed loss cost outlier threshold 

calculated by CMS for paying cost 

outliers in the absence of capital 

prospective payments. For Fiscal Year 

2011, the TRICARE fixed loss cost 

outlier threshold is based on the sum of 

the applicable DRG-based payment rate 

plus any amounts payable for Indirect 

Medical Education (IDME) plus a fixed 

dollar amount. Thus, for Fiscal Year 

2011, in order for a case to qualify for 

cost outlier payments, the costs must 

exceed the TRICARE DRG-based 

payment rate (wage adjusted) for the 

DRG plus the IDME payment plus 

$21,229 (wage adjusted). The marginal 

cost factor for cost outliers continues to 

be 80 percent. 

F. National Operating Standard Cost as 

a Share of Total Costs 

The Fiscal Year 2011 TRICARE 

National Operating Standard Cost as a 

Share of Total Costs (NOSCASTC) used 

in calculating the cost outlier threshold 

is 0.92. TRICARE uses the same 

methodology as CMS for calculating the 

NOSCASTC; however, the variables are 

different because TRICARE uses 

national cost-to-charge ratios while CMS 

uses hospital-specific cost-to-charge 

ratios. 

G. Indirect Medical Education (IDME) 

Adjustment 

Passage of the Medicare 

Modernization Act of 2003 modified the 

formula multipliers to be used in the 

calculation of the indirect medical 

education (IDME) adjustment factor. 

Since the IDME formula used by 

TRICARE does not include 

disproportionate share hospitals (DSHs), 

the variables in the formula are different 

than Medicare’s; however, the 

percentage reductions that will be 

applied to Medicare’s formula will also 

be applied to the TRICARE IDME 

formula. The new multiplier for the 

IDME adjustment factor for TRICARE for 

Fiscal Year 2011 is 1.02. 

H. Expansion of the Post Acute Care 

Transfer Policy 

For Fiscal Year 2011 TRICARE is 

adopting CMS’ expanded post acute 

care transfer policy according to CMS’ 

final rule published August 16, 2010. 

I. Cost-to-Charge Ratio 

While CMS uses hospital-specific 

cost-to-charge ratios, TRICARE uses a 

national cost-to-charge ratio. For Fiscal 

Year 2011, the cost-to-charge ratio used 

for the TRICARE DRG-based payment 

system for acute care hospitals and 

neonates will be 0.3664. This shall be 

used to calculate the adjusted 

standardized amounts and to calculate 

cost outlier payments, except for 

children’s hospitals. For children’s 

hospital cost outliers, the cost-to-charge 

ratio used is 0.3974. 

J. Updated Rates and Weights 

The updated rates and weights are 

accessible through the Internet at 

http://www.tricare.osd.mil under the 

sequential headings TRICARE Provider 

Information, Rates and Reimbursements, 

and DRG Information. Table 1 provides 

the ASA rates and Table 2 provides the 

DRG weights to be used under the 

TRICARE DRG-based payment system 

during Fiscal Year 2011. The 

implementing regulations for the 

TRICARE/CHAMPUS DRG-based 

payment system are in 32 CFR Part 199. 

Dated: December 14, 2010. 

Morgan F. Park, 

Alternate OSD Federal Register Liaison 

Officer, Department of Defense. 

[FR Doc. 2010–31792 Filed 12–17–10; 8:45 am] 

BILLING CODE 5001–06–P 

DEPARTMENT OF EDUCATION 

Notice of Submission for OMB Review 

AGENCY: Department of Education. 

ACTION: Comment request. 

SUMMARY: The Director, Information 

Collection Clearance Division, 

Regulatory Information Management 

Services, Office of Management invites 

comments on the submission for OMB 

review as required by the Paperwork 

Reduction Act of 1995 (Pub. L. 104–13). 

DATES: Interested persons are invited to 

submit comments on or before January 

19, 2011. 

ADDRESSES: Written comments should 

be addressed to the Office of 

Information and Regulatory Affairs, 

Attention: Education Desk Officer, 

Office of Management and Budget, 725 

17th Street, NW., Room 10222, New 

Executive Office Building, Washington, 

DC 20503, be faxed to (202) 395–5806 or 

e-mailed to oira_submission@omb.eop.

gov with a cc: to ICDocketMgr@ed.gov. 

Please note that written comments 

received in response to this notice will 

be considered public records. 

SUPPLEMENTARY INFORMATION: Section 

3506 of the Paperwork Reduction Act of 

1995 (44 U.S.C. Chapter 35) requires 

that the Office of Management and 

Budget (OMB) provide interested 

Federal agencies and the public an early 

opportunity to comment on information 

collection requests. The OMB is 

particularly interested in comments 

which: (1) Evaluate whether the 

proposed collection of information is 

necessary for the proper performance of 

the functions of the agency, including 

whether the information will have 

practical utility; (2) Evaluate the 

accuracy of the agency’s estimate of the 

burden of the proposed collection of 

information, including the validity of 

the methodology and assumptions used; 

(3) Enhance the quality, utility, and 

clarity of the information to be 

collected; and (4) Minimize the burden 

of the collection of information on those 

who are to respond, including through 

the use of appropriate automated, 

electronic, mechanical, or other 

technological collection techniques or 

other forms of information technology. 

Dated: December 14, 2010. 

Darrin A. King, 

Director, Information Collection Clearance 

Division, Regulatory Information 

Management Services, Office of Management. 

Institute of Education Sciences 

Type of Review: Revision. 

Title of Collection: High School 

Longitudinal Study of 2009 (HSLS:09) 

First Follow-up Field Test 2011. 

OMB Control Number: 1850–0852. 

Agency Form Number(s): N/A. 

Frequency of Responses: Annually. 

Affected Public: Individuals or 

household. 

Total Estimated Number of Annual 

Responses: 6,873. 

Total Estimated Annual Burden 

Hours: 1,161. 

Abstract: The High School 

Longitudinal Study of 2009 (HSLS:09) is 


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