Federal Register / Vol. 78, No. 153 / Thursday, August 8, 2013 / Rules and Regulations 48303 

DEPARTMENT OF TRANSPORTATION 

Federal Aviation Administration 

14 CFR Parts 71 

[Docket FAA No. FAA–2013–0147; Airspace 

Docket No. 13–AWP–1] 

Establishment of Class E Airspace; 

Tuba City, AZ 

AGENCY: Federal Aviation 

Administration (FAA), DOT. 

ACTION: Final rule; correction. 

SUMMARY: This action corrects a final 

rule published in the Federal Register 

May 29, 2013 that establishes Class E en 

route airspace at the Tuba City VHF 

Omni-Directional Radio Range Tactical 

Air Navigational Aid (VORTAC), Tuba 

City, AZ. In that rule, an error was made 

in the legal description for Tuba City, 

identifying the region as ANM instead 

of AWP. 

DATES: Effective Date: 0901 UTC, August 

22, 2013. The Director of the Federal 

Register approves this incorporation by 

reference action under 1 CFR Part 51, 

subject to the annual revision of FAA 

Order 7400.9 and publication of 

conforming amendments. 

FOR FURTHER INFORMATION CONTACT: 

Eldon Taylor, Federal Aviation 

Administration, Operations Support 

Group, Western Service Center, 1601 

Lind Avenue SW., Renton, WA 98057; 

telephone (425) 203–4537. 

SUPPLEMENTARY INFORMATION: 

History 

The FAA published a final rule in the 

Federal Register establishing Class E en 

route airspace at the Tuba City 

VORTAC, Tuba City, AZ (78 FR 32086, 

May 29, 2013). In the regulatory text, the 

region identifier ANM was incorrect, 

and is now corrected to AWP. 

Correction to Final Rule 

Accordingly, pursuant to the 

authority delegated to me, the legal 

description as published in the Federal 

Register on May 29, 2013 (78 FR 32086), 

Airspace Docket No. 13–AWP–1, FR 

Doc. 2013–12623, is corrected as 

follows: 

§ 71.1 [Amended] 

■ On page 32087, column 1, line 4, 

remove ANM AZ E6 Tuba City, AZ 

[NEW], and insert AWP AZ E6 Tuba 

City, AZ [Corrected]. 

Issued in Seattle, Washington, on July 29, 

2013. 

Christopher Ramirez, 

Manager, Operations Support Group, Western 

Service Center. 

[FR Doc. 2013–18869 Filed 8–7–13; 8:45 am] 

BILLING CODE 4910–13–P 

DEPARTMENT OF DEFENSE 

Office of the Secretary 

32 CFR Part 199 

[DOD–2010–HA–0072] 

RIN 0720–AB41 

TRICARE; Reimbursement of Sole 

Community Hospitals and Adjustment 

to Reimbursement of Critical Access 

Hospitals 

AGENCY: Office of the Secretary, 

Department of Defense (DoD). 

ACTION: Final rule. 

SUMMARY: This Final Rule implements 

for Sole Community Hospitals (SCHs) 

the statutory provision at title 10, 

United States Code (U.S.C.), section 

1079(j)(2) that TRICARE payment 

methods for institutional care be 

determined, to the extent practicable, in 

accordance with the same 

reimbursement rules as those that apply 

to payments to providers of services of 

the same type under Medicare. This 

Final Rule implements a reimbursement 

methodology similar to that applicable 

to Medicare beneficiaries for inpatient 

services provided by SCHs. It will be 

phased in over a several-year period. 

This Final Rule also provides for special 

reimbursement for labor/delivery and 

nursery services in SCHs and creates a 

possible General Temporary Military 

Contingency Payment Adjustment 

(GTMCPA) for inpatient services in 

SCHs and for Critical Access Hospitals 

(CAHs). 

DATES: This rule is effective October 7, 

2013. 

Applicability Date: The regulations 

setting forth the revised reimbursement 

system shall be applicable for all 

admissions to Sole Community 

Hospitals and Critical Access Hospitals 

commencing on or after the first day of 

the month which is at least 120 days 

from the date of publication of this rule 

in the Federal Register. 

FOR FURTHER INFORMATION CONTACT: Ann 

Fazzini, TRICARE Management Activity 

(TMA), Medical Benefits and 

Reimbursement Branch, telephone (303) 

676–3803. 

SUPPLEMENTARY INFORMATION: 

I. Executive Summary 

A. Purpose of the Final Rule 

The purpose of this Final Rule is to 

implement for SCHs the statutory 

requirement that TRICARE inpatient 

care ‘‘payments shall be determined to 

the extent practicable in accordance 

with the same reimbursement rules as 

apply to payments to providers of 

services of the same type under 

Medicare.’’ Medicare pays SCHs the 

greater of the amount under the general 

inpatient prospective payment system 

method based on diagnosis-related 

groups (DRGs) or an amount based on 

the hospital’s reported costs. TRICARE 

pays for most hospital care under a 

DRG-based prospective payment system 

similar to Medicare’s, but exempted 

SCHs from this system, instead paying 

them billed charges. Paying billed 

charges is fiscally imprudent and 

inconsistent with TRICARE’s governing 

statute. Paying SCHs under a method 

similar to Medicare’s is prudent, 

practicable, and harmonious with the 

statute. The Final Rule will transition 

over a several year period from the 

current billed charge method to the new 

method. The transition will be gradual 

to reduce the impact on the SCHs. 

Network SCHs will have payment 

reductions limited to 10 percent per 

year. Non-network SCHs will have 

reductions limited to 15 percent per 

year. 

The legal authority for this Final Rule 

is 10 U.S.C. 1079(j)(2). 

B. Summary of the Major Provisions of 

the Final Rule 

1. Ultimate Payment Method for SCHs 

Following the transition period, 

TRICARE will reimburse SCHs for 

inpatient care the higher of the DRGbased amount applicable to most 

hospitals or an amount approximating 

the SCH’s costs. The cost-based amount 

will be determined by applying the 

SCH’s most recent Medicare cost-tocharge ratio (CCR) to the SCH’s charges. 

Individual claims will be paid under 

this cost-based method, followed by a 

year-end review to determine whether 

in the aggregate the DRG-based method 

would have paid more. If so, TRICARE 

will pay the SCH the aggregate 

difference. 

2. Transition Period 

To protect SCHs from sudden 

significant reductions, the Final Rule 

will gradually transition from the base 

year of paying 100 percent of allowable 

charges (which is either the billed 

charge or, in the case of network 

hospitals, a voluntary discounted 

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