Federal Register / Vol. 74, No. 189 / Thursday, October 1, 2009 / Notices 50785 

service area sites will use a self-reported 

Health Risk Assessment (HRA) designed 

to screen and identify the participants’ 

health risk factors and provide targeted 

interventions that help prevent, manage, 

and improve chronic conditions. They 

will perform all of the study 

participants’ physiological and 

biometric measures, including at least 

blood pressure, glucose levels, lipids, 

nicotine use, and weight. The service 

area sites will schedule follow-up visits, 

encourage participants to take advantage 

of available online educational Web 

sites, and enroll in established wellness 

programs. They will also direct 

participants to retake the HRA/ 

biometrics annually to reassess health 

behaviors and outcomes. A toll-free 

phone line will be available to answer 

questions regarding enrollment and 

monetary incentives from 

demonstration participants. 

Dated: September 25, 2009. 

Patricia L. Toppings, 

OSD Federal Register Liaison Officer, 

Department of Defense. 

[FR Doc. E9–23741 Filed 9–30–09; 8:45 am] 

BILLING CODE 5001–06–P 

DEPARTMENT OF DEFENSE 

Office of the Secretary 

Renewal of Department of Defense 

Federal Advisory Committees 

AGENCY: Department of Defense (DoD). 

ACTION: Renewal of Federal advisory 

committee. 

SUMMARY: Under the provisions of the 

Federal Advisory Committee Act of 

1972, (5 U.S.C. Appendix, as amended), 

the Government in the Sunshine Act of 

1976 (5 U.S.C. 552b, as amended), and 

41 CFR 102–3.50, the Department of 

Defense gives notice that it is renewing 

the charter for the Defense Task Force 

on Sexual Assault in the Military 

Services (hereafter referred to as the 

Task Force). 

FOR FURTHER INFORMATION CONTACT: Jim 

Freeman, Deputy Committee 

Management Officer for the Department 

of Defense, 703–601–6128. 

SUPPLEMENTARY INFORMATION: The Task 

Force, pursuant to Section 576 of Public 

Law 108–375, is a non-discretionary 

Federal advisory committee established 

to conduct an examination of matters 

relating to sexual assault by members or 

against members of the Armed Forces of 

the United States. 

Pursuant to Section 576(e) of public 

Law 108–375, the Task Force, no later 

than one year after the initiation of its 

examination, shall submit to the 

Secretary of Defense and the Secretaries 

of the Army, Navy and Air Force on the 

activities of the Department of Defense 

and the Armed Forces to respond to 

sexual assault. 

The Task Force shall be comprised of 

no more than ten members and the 

membership shall be comprised of an 

equal number of DoD and civilian 

members. 

The Secretary of Defense shall select 

the DoD Co-Chairperson, and the 

civilian members shall select a civilian 

Co-Chairperson. 

Task Force members who are 

appointed by the Secretary of Defense, 

who are not full-time or permanent parttime Federal employees, shall be 

appointed as experts and consultants 

under the authority of 5 U.S.C. 3109 and 

serve as Special Government 

Employees. All members shall be 

appointed on an annual basis for the 

duration of the Task Force. 

Task Force members who are Federal 

officers or employees shall serve 

without compensation (other than 

compensation to which they are entitled 

to as Federal officers or employees). 

Other Task Force members shall be 

appointed under the authority of 5 

U.S.C 3161 and will receive 

compensation for their service. All Task 

Force members shall receive 

compensation for travel and per diem 

for official Task Force travel. 

With DoD approval, the Task Force is 

authorized to establish subcommittees, 

as necessary and consistent with its 

mission. These subcommittees or 

working groups shall operate under the 

provisions of the Federal Advisory 

Committee Act of 1972, the Government 

in the Sunshine Act of 1976 (5 U.S.C 

552B, as amended), and other 

appropriate Federal regulations. 

Such subcommittees or workgroups 

shall not work independently of the 

chartered Task Force, and shall report 

all their recommendations and advice to 

the Task Force for full deliberation and 

discussion. Subcommittees or 

workgroups have no authority to make 

decisions on behalf of the chartered 

Task Force nor can they report directly 

to the Department of Defense or any 

Federal officers or employees who are 

not Task Force members. 

Subcommittee members, who are not 

Task Force members, shall be appointed 

in the same manner as the Task Force 

members. 

The Task Force shall meet at the call 

of the Task Force’s Designated Federal 

Officer, in consultation with the 

Chairperson. The estimated number of 

Task Force meetings is six per year. 

The Designated Federal Officer, 

pursuant to DoD policy, shall be a fulltime or permanent part-time DoD 

employee, and shall be appointed in 

accordance with established DoD 

policies and procedures. In addition, the 

Designated Federal Officer is required to 

be in attendance at all meetings, 

however, in the absence of the 

Designated Federal Officer, the 

Alternate Designated Federal Officer 

shall attend the meeting. 

Pursuant to 41 CFR 102–3.105(j) and 

102–3.140, the public or interested 

organizations may submit written 

statements to the Defense Task Force on 

Sexual Assault in the Military Services 

membership about the Task Forces’ 

mission and functions. Written 

statements may be submitted at any 

time or in response to the stated agenda 

of planned meeting of the Defense Task 

Force on Sexual Assault in the Military 

Services. 

All written statements shall be 

submitted to the Designated Federal 

Officer for the Defense Task Force on 

Sexual Assault in the Military Services, 

and this individual will ensure that the 

written statements are provided to the 

membership for their consideration. 

Contact information for Defense Task 

Force on Sexual Assault in the Military 

Services’ Designated Federal Officer can 

be obtained from the GSA’s FACA 

Database—https://www.fido.gov/ 

facadatabase/public.asp. 

The Designated Federal Officer, 

pursuant to 41 CFR 102–3.150, will 

announce planned meetings of the 

Defense Task Force on Sexual Assault in 

the Military Services. The Designated 

Federal Officer, at that time, may 

provide additional guidance on the 

submission of written statements that 

are in response to the stated agenda for 

the planned meeting in question. 

Dated: September 28, 2009. 

Patricia L. Toppings, 

OSD Federal Register Liaison Officer, 

Department of Defense. 

[FR Doc. E9–23739 Filed 9–30–09; 8:45 am] 

BILLING CODE 5001–06–P 

DEPARTMENT OF DEFENSE 

Office of the Secretary 

TRICARE; Civilian Health and Medical 

Program of the Uniformed Services 

(CHAMPUS); Fiscal Year 2010 

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 DRGbased payment system in order to 


PWALKER on DSK8KYBLC1PROD with NOTICES
50786 Federal Register / Vol. 74, No. 189 / Thursday, October 1, 2009 / Notices 

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 (FY) 2010 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, 2009. 

ADDRESSES: TRICARE Management 

Activity (TMA), Medical Benefits and 

Reimbursement Systems, 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. 

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. 

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 


PWALKER on DSK8KYBLC1PROD with NOTICES
Federal Register / Vol. 74, No. 189 / Thursday, October 1, 2009 / Notices 50787 

final updated hospital market basket 

used for the Medicare PPS for all 

hospitals subject to the TRICARE DRGbased payment system according to 

CMS’ August 27, 2009, final rule. For 

Fiscal Year 2010, the market basket is 

2.1 percent. 

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 

2010, the 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 fixeddollar amount. Thus, for Fiscal Year 

2010, in order for a case to qualify for 

cost outlier payments, the costs must 

exceed the TRICARE DRG base payment 

rate (wage adjusted) for the DRG plus 

the IDME payment plus $21,358 (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 2010 TRICARE 

National Operating Standard Cost as a 

Share of Total Costs (NOSCASTC) used 

in calculating the cost outlier threshold 

is 0.923. 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 Prescription 

Drug Improvement and Modernization 

Act (MMA) 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 2010 is 1.02. 

H. Expansion of the Post-Acute-Care 

Transfer Policy 

For Fiscal Year 2010 TRICARE is 

adopting CMS’ expanded post-acutecare transfer policy according to CMS’ 

final rule published August 27, 2009. 

I. Blood Clotting Factor 

For Fiscal Year 2010, TRICARE is 

adopting CMS’ payment methodology 

for blood clotting factor according to 

CMS’ final rule published August 18, 

2006. 

J. Cost-to-Charge Ratio 

While CMS uses hospital-specific 

cost-to-charge ratios, TRICARE uses a 

national cost-to-charge ratio. For Fiscal 

Year 2010, the cost-to-charge ratio used 

for the TRICARE DRG-based payment 

system for acute care hospitals and 

neonates will be 0.3740. 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 0.4047. 

K. 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 2010. The 

implementing regulations for the 

TRICARE/CHAMPUS DRG-based 

payment system are in 32 CFR part 199. 

Dated: September 25, 2009. 

Patricia L. Toppings, 

OSD Federal Register Liaison Officer, 

Department of Defense. 

[FR Doc. E9–23738 Filed 9–30–09; 8:45 am] 

BILLING CODE 5001–06–P 

DEPARTMENT OF DEFENSE 

Department of the Army 

[Docket No. USA–2009–0018] 

Submission for OMB Review; 

Comment Request 

ACTION: Notice. 

The Department of Defense has 

submitted to OMB for clearance, the 

following proposal for collection of 

information under the provisions of the 

Paperwork Reduction Act (44 U.S.C. 

Chapter 35). 

DATES: Consideration will be given to all 

comments received by November 2, 

2009. 

Title, Form and OMB Number: 

Terminal and Transfer Facilities 

Descriptions, IWR Forms 1–9; OMB 

Control Number 0710–0007. 

Type of Request: Extension. 

Number of Respondents: 1,262. 

Responses per Respondent: 1. 

Annual Responses: 1,262. 

Average Burden per Response: 15 

minutes. 

Annual Burden Hours: 316. 

Needs and Uses: Data gathered and 

published as one of the 56 Port Series 

Reports, relating to terminals, transfer 

facilities, storage facilities, and 

intermodal transportation. This 

information is used in navigation, 

planning, safety, National security, 

emergency operations, and general 

interest studies and activities. 

Respondents are terminal and transfer 

facility operators. These data are 

essential to the Waterborne Commerce 

Statistics Center in Exercising their 

enforcement and quality control 

responsibilities in the collection of data 

from vessel reporting companies. 

Affected Public: Business or other forprofit; Federal government; and State, 

Local or Tribal government. 

Frequency: Annually. 

Respondent’s Obligation: Voluntary. 

OMB Desk Officer: Mr. Jim Laity. 

Written comments and 

recommendations on the proposed 

information collection should be sent to 

Mr. Laity at the Office of Management 

and Budget, Desk Officer for DoD, Room 

10236, New Executive Office Building, 

Washington, DC 20503. 

You may also submit comments, 

identified by docket number and title, 

by the following method: 

• Federal eRulemaking Portal: http:// 

www.regulations.gov. Follow the 

instructions for submitting comments. 

Instructions: All submissions received 

must include the agency name, docket 

number and title 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. 

DoD Clearance Officer: Ms. Patricia 

Toppings 

Written requests for copies of the 

information collection proposal should 

be sent to Ms. Toppings at WHS/ESD/ 

Information Management Division, 1777 

North Kent Street, RPN, Suite 11000, 

Arlington, VA 22209–2133. 


PWALKER on DSK8KYBLC1PROD with NOTICES