60112 Federal Register / Vol. 71, No. 197 / Thursday, October 12, 2006 / Notices 

reporting burden (time and financial 

resources) is minimized, collection 

instruments are clearly understood, and 

the impact of collection requirement on 

respondents can be properly assessed. 

Currently, the Corporation is 

soliciting comments concerning the 

proposed renewal of its Learn and Serve 

America Progress Report. These reports 

must be completed by all Learn and 

Serve America grantees in order to 

ensure appropriate Federal oversight, 

determine progress toward meeting 

program objectives and to make 

decisions related to continuation 

funding. 

Copies of the information collection 

requests can be obtained by contacting 

the office listed in the addresses section 

of this notice. 

DATES: Written comments must be 

submitted to the individual and office 

listed in the ADDRESSES section by 

December 11, 2006. 

ADDRESSES: You may submit comments, 

identified by the title of the information 

collection activity, by any of the 

following methods: 

(1) By mail sent to: Corporation for 

National and Community Service, Learn 

and Serve America; Attention: Cara 

Patrick; 1201 New York Avenue, NW., 

Washington, DC 20525. 

(2) By hand delivery or by courier to 

the Corporation’s mailroom at Room 

6010 at the mail address given in 

paragraph (1) above, between 9 a.m. and 

4 p.m. Monday through Friday, except 

Federal holidays. 

(3) By fax to: (202) 606–3477, 

Attention: Cara Patrick, Learn and Serve 

America. 

(4) Electronically through the 

Corporation’s e-mail address system: 

cpatrick@cns.gov. 

FOR FUTHER INFORMATION CONTACT: Cara 

Patrick, (202) 606–6905, or by e-mail at 

cpatrick@cns.gov. 

SUPPLEMENTARY INFORMATION: The 

Corporation is particularly interested in 

comments that: 

• Evaluate whether the proposed 

collection of information is necessary 

for the proper performance of the 

functions of the Corporation, including 

whether the information will have 

practical utility; 

• 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; 

• Enhance the quality, utility, and 

clarity of the information to be 

collected; and 

• Minimize the burden of the 

collection of information on those who 

are expected to respond, including the 

use of appropriate automated, 

electronic, mechanical, or other 

technological collection techniques or 

other forms of information technology 

(e.g., permitting electronic submissions 

of responses). 

Background 

Learn and Serve America provides 

grants to state education agencies, 

higher education institutions, tribes and 

U.S. Territories, national nonprofits and 

state commissions on national and 

community service to implement 

service-learning programs. To ensure 

appropriate oversight of Federal funds, 

Learn and Serve America requires all 

grant recipients to submit Progress 

Reports describing grant activities and 

progress toward approved program 

objectives. Information received from 

the reports informs continuation 

funding decisions and how to target 

training and technical assistance. 

Progress Report instructions will be 

available from the agency Web site and 

should be completed through our grants 

management system, eGrants. 

Type of Review: Renewal. 

Agency: Corporation for National and 

Community Service. 

Title: Learn and Serve America 

Progress Report. 

OMB Number: 3045–0089. 

Agency Number: None. 

Affected Public: State and Local 

Government, Not-for-profit institutions. 

Total Respondents: 103. 

Frequency: Twice annually. 

Average Time per Response: 2 hours. 

Estimated Total Burden Hours: 412 

hours. 

Total Burden Cost (capital/startup): 

None. 

Total Burden Cost (operating/ 

maintenance): None. 

Comments submitted in response to 

this notice will be summarized and/or 

included in the request for Office of 

Management and Budget approval of the 

information collection request; they will 

also become a matter of public record. 

Dated: October 3, 2006. 

Amy Cohen, 

Director, Learn and Serve America. 

[FR Doc. E6–16839 Filed 10–11–06; 8:45 am] 

BILLING CODE 6050–$$–P 

DEPARTMENT OF DEFENSE 

Office of the Secretary 

TRICARE; Civilian Health and Medical 

Program of the Uniformed Services 

(CHAMPUS); Fiscal Year 2007 

Diagnosis Related Group (DRF) 

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 

conform to changes made to the 

Medicare Prospective Payment System 

(PPS). 

It also provides the updated fixed loss 

cost outliner threshold, cost-to-charge 

ratios and the Internet address for 

accessing the updated adjusted 

standardized amount and DRG relative 

weights to be used for FY 2007 under 

the TRICARE DRG-based payment 

system. 

DATES: Effective 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, 2006. 

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 Systems, 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 32993) 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. 


rwilkins on PROD1PC63 with NOTICES
Federal Register / Vol. 71, No. 197 / Thursday, October 12, 2006 / Notices 60113 

I. Medicare PPS Changes Which Affect 

the TRICARE DRG-Based Payment 

System 

Following is a discussion of the 

changes CMS had 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 is 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 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 FY 2007, CMS will 

implement classification changes, 

including surgical hierarchy changes. 

The TRICARE Grouper will incorporate 

all changes made to the Medicare 

Grouper, with the exception of the presurgical hierarchy changes, which will 

remain the same as FY 2006. 

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 ASA shall equal 69.7 

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 

final updated hospital market basket 

used for the Medicare PPS for all 

hospitals subject to the TRICARE DRGbased payment system according to 

CMS’ August 18, 2006, final rule. 

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 FY 2007, the 

fixed loss cost outlier threshold is based 

on the sum of the applicable DRG-based 

payment rate plus any amounts payable 

for IDME plus a fixed dollar amount. 

Thus, for FY 2007, 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 

$22,639 (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 FY 2007 TRICARE National 

Operating Standard Cost as a Share of 

Total Costs (NOSCASTC) used in 

calculating the cost outlier threshold is 

0.925. 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 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 

FY 2007 is 1.00. 

H. Expansion of the Post Acute Care 

Transfer Policy 

For FY 2007 TRICARE is adopting 

CMS’ expanded post acute care transfer 

policy according to CMS’ final rule 

published August 18, 2006. 

I. Blood Clotting Factor 

For FY 2007, TRICARE is adopting 

CMS’ payment methodology for blood 

clotting factor according to CMS’ final 

rule published August 18, 2006. 

II. Cost to Charge Ratio 

While CMS uses hospital-specific cost 

to charge ratios, TRICARE uses a 

national cost to charge ratio. For FY 

2007, the cost-to-charge ratio used for 

the TRICARE DRG-based payment 

system for acute care hospitals and 

neonates will be 0.3897 which is 

increased to 0.3967 to account for bad 

debts. 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 0.4282. 

III. 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 FY 2007 and which is a result of 

the changes described above. The 

implementing regulations for the 


rwilkins on PROD1PC63 with NOTICES
60114 Federal Register / Vol. 71, No. 197 / Thursday, October 12, 2006 / Notices 

TRICARE/CHAMPUS DRG-based 

payment system are in 32 CFR part 199. 

Dated: October 5, 2006. 

L.M. Bynum, 

Alternate OSD Federal Register Liaison 

Officer, Department of Defense. 

[FR Doc. 06–8624 Filed 10–11–06; 8:45 am] 

BILLING CODE 5001–06–M 

DEPARTMENT OF DEFENSE 

Office of the Secretary 

TRICARE Formerly Known as the 

Civilian Health and Medical Program of 

the Uniformed Services (CHAMPUS); 

Fiscal Year 2007 Mental Health Rate 

Updates 

AGENCY: Office of the Secretary, DoD. 

ACTION: Notice of updated mental 

health per diem rates. 

SUMMARY: This notice provides for the 

updating of hospital-specific per diem 

rates for high volume providers and 

regional per diem rates for low volume 

providers; the updated cap per diem for 

high volume providers; the beneficiary 

per diem cost-share amount for low 

volume providers for FY 2007 under the 

TRICARE Mental Health Per Diem 

Payment System; and the updated per 

diem rates for both full-day and half-day 

TRICARE Partial Hospitalization 

Programs for fiscal year 2007. 

DATES: Effective Date: The fiscal year 

2007 rates contained in this notice are 

effective for services occurring on or 

after October 1, 2006. 

FOR FURTHER INFORMATION CONTACT: 

Christine Covie, Office of Medical 

Benefits and Reimbursement Systems, 

TRICARE Management Activity, 

telephone (303) 676–3841. 

SUPPLEMENTARY INFORMATION: The final 

rule published in the Federal Register 

on September 6, 1988, (53 FR 34285) set 

forth reimbursement changes that were 

effective for all inpatient hospital 

admissions in psychiatric hospitals and 

exempt psychiatric units occurring on 

or after January 1, 1989. The final rule 

published in the Federal Register on 

July 1, 1993, (58 FR 35–400) set forth 

maximum per diem rates for all partial 

hospitalization admissions on or after 

September 29, 1993. Included in these 

final rules were provisions for updating 

reimbursement rates for each federal 

fiscal year. As stated in the final rules, 

each per diem shall be updated by the 

Medicare update factor for hospitals and 

units exempt from the Medicare 

Prospective Payment System. For fiscal 

year 2007, Medicare has recommended 

a rate of increase of 3.4 percent for 

hospitals and units excluded from the 

prospective payment system. TRICARE 

will adopt this update factor for FY 

2007 as the final update factor. 

Hospitals and units with hospitalspecific rates (hospitals and units with 

high TRICARE volume) and regional 

specific rates for psychiatric hospitals 

and units with low TRICARE volume 

will have their TRICARE rates for FY 

2006 updated by 3.4 percent for FY 

2007. Partial hospitalization rates for 

full day and half day programs will also 

be updated by 3.4 percent for FY 2007. 

The cap amount for high volume 

hospitals and units will also be updated 

by the 3.4 percent for FY 2007. The 

beneficiary cost-share for low volume 

hospitals and units will also be updated 

by the 3.4 percent for FY 2007. 

Consistent with Medicare, the wage 

portion of the regional rate subject to the 

area wage adjustment is 75.665 percent 

for FY 2007. 


rwilkins on PROD1PC63 with NOTICES