65024 Federal Register / Vol. 65, No. 211 / Tuesday, October 31, 2000 / Notices

change does not involve a significant

hazards consideration.

Dated at Rockville, Maryland, this 25th day

of October 2000.

For the Nuclear Regulatory Commission.

William D. Beckner,

Chief, Technical Specification Branch,

Division of Regulatory Improvement

Programs, Office of Nuclear Reactor

Regulation.

[FR Doc. 00–27941 Filed 10–30–00; 8:45 am]

BILLING CODE 7590–01–P

NUCLEAR REGULATORY

COMMISSION

Draft Regulatory Guides; Issuance,

Availability

The Nuclear Regulatory Commission

has issued for public comment drafts of

two new guides in its Regulatory Guide

Series. This series has been developed

to describe and make available to the

public such information as methods

acceptable to the NRC staff for

implementing specific parts of the

NRC’s regulations, techniques used by

the staff in evaluating specific problems

or postulated accidents, and data

needed by the staff in its review of

applications for permits and licenses.

Draft Regulatory Guide DG–1102,

‘‘Design, Inspection, and Testing

Criteria for Air Filtration and

Adsorption Units of Post-Accident

Engineered-Safety-Feature Atmosphere

Cleanup Systems in Light-Water-Cooled

Nuclear Power Plants,’’ as a proposed

Revision 3 to Regulatory Guide 1.52, is

being developed to describe methods

acceptable to the NRC staff for

complying with the NRC’s regulations

with regard to the design, inspection,

and testing criteria for air filtration and

iodine adsorption units of engineeredsafety-feature atmosphere cleanup

systems in light-water-cooled nuclear

power plants. This guide applies only to

post-accident atmosphere cleanup

systems that are designed to mitigate the

consequences of postulated accidents.

Draft Regulatory Guide DG–1103,

‘‘Design, Inspection, and Testing

Criteria for Air Filtration and

Adsorption Units of Normal Ventilation

Exhaust Systems in Light-Water-Cooled

Nuclear Power Plants,’’ as a proposed

Revision 2 to Regulatory Guide 1.140, is

being developed to present methods

acceptable to the NRC staff for meeting

the NRC’s regulations with regard to the

criteria for air filtration and adsorption

units installed in the normal ventilation

exhaust systems of light-water-cooled

nuclear power plants.

These draft guides have not received

complete staff approval and do not

represent an official NRC staff position.

Comments may be accompanied by

relevant information or supporting data.

Written comments may be submitted to

the Rules and Directives Branch, Office

of Administration, U.S. Nuclear

Regulatory Commission, Washington,

DC 20555. Copies of comments received

may be examined at the NRC Public

Document Room, 11555 Rockville Pike,

Rockville, MD. Comments will be most

helpful if received by December 29,

2000.

You may also provide comments via

the NRC’s interactive rulemaking

website through the NRC home page

(http://www.nrc.gov). This site provides

the availability to upload comments as

files (any format), if your web browser

supports that function. For information

about the interactive rulemaking

website, contact Ms. Carol Gallagher,

(301) 415–5905; e-mail CAG@NRC.GOV.

Electronic copies of these draft guides,

under Accession Numbers

ML003714744 for DG–8026 and

ML003714764 for DG–8027, are

available in NRC’s Public Electronic

Reading Room, which can also be

accessed through NRC’s web site,

<WWW.NRC.GOV>. For information

about the draft guides, contact Mr. J.

Segala at (301) 415–1858; e-mail

JPS1@NRC.GOV.

Although a time limit is given for

comments on these draft guides,

comments and suggestions in

connection with items for inclusion in

guides currently being developed or

improvements in all published guides

are encouraged at any time.

Regulatory guides are available for

inspection at the Commission’s Public

Document Room, 11555 Rockville Pike,

Rockville, MD. Requests for single

copies of draft or final guides (which

may be reproduced) or for placement on

an automatic distribution list for single

copies of future draft guides in specific

divisions should be made in writing to

the U.S. Nuclear Regulatory

Commission, Washington, DC 20555,

Attention: Reproduction and

Distribution Services Section; or by fax

to (301) 415–2289, or by email to

<DISTRIBUTION@NRC.GOV>.

Telephone requests cannot be

accommodated. Regulatory guides are

not copyrighted, and Commission

approval is not required to reproduce

them.

(5 U.S.C. 552(a)).

Dated at Rockville, Maryland, this 19th day

of October 2000.

For the Nuclear Regulatory Commission.

Clare V. Kasputys,

Deputy Director, Program Management,

Policy Development & Analysis Staff, Office

of Nuclear Regulatory Research.

[FR Doc. 00–27939 Filed 10–30–00; 8:45 am]

BILLING CODE 7590–01–P

OFFICE OF MANAGEMENT AND

BUDGET

Cost of Hospital and Medical Care

Treatment Furnished by the United

States; Certain Rates Regarding

Recovery From Tortiously Liable Third

Persons

By virtue of the authority vested in

the President by Section 2(a) of Public

Law 87–693 (76 Stat. 593; 42 U.S.C.

2652), and delegated to the Director of

the Office of Management and Budget

by Executive Order No. 11541 of July 1,

1970 (35 FR 10737), the three sets of

rates outlined below are hereby

established. These rates are for use in

connection with the recovery, from

tortiously liable third persons, of the

cost of hospital and medical care and

treatment furnished by the United States

(Part 43, Chapter I, Title 28, Code of

Federal Regulations) through three

separate Federal agencies. The rates

have been established in accordance

with the requirements of OMB Circular

A–25, requiring reimbursement of the

full cost of all services provided. The

rates are established as follows:

1. Department of Defense

The FY 2001 Department of Defense

(DoD) reimbursement rates for inpatient,

outpatient, and other services are

provided in accordance with Title 10,

United States Code, section 1095. Due to

size, the sections containing the Drug

Reimbursement Rates (section IV.C.)

and the rates for Ancillary Services

Requested by Outside Providers (section

IV.D.) are not included in this package.

Those rates are available from the

TRICARE Management Activity’s

Uniform Business Office website, http:/

/www.tricare.osd.mil/ebc/rm/

rmlhome.html. The medical and

dental service rates in this package

(including the rates for ancillary

services and other procedures requested

by outside providers) are effective

October 1, 2000. Pharmacy rates are

updated on an as needed basis.

2. Health and Human Services

The FY 2001 tortiously liable rates for

Indian Health Service health facilities

are based on Medicare cost reports. The

obligations for the Indian Health Service

hospitals participating in the cost report

Federal Register / Vol. 65, No. 211 / Tuesday, October 31, 2000 / Notices 65025

project were identified and combined

with applicable obligations for area

offices costs and headquarters costs. The

hospital obligations were summarized

for each major cost center providing

medical services and distributed

between inpatient and outpatient. Total

inpatient costs and outpatient costs

were then divided by the relevant

workload statistic (inpatient day,

outpatient visit) to produce the

inpatient and outpatient rates. In

calculation of the rates, the

Department’s unfunded retirement

liability cost and capital and equipment

depreciation costs were incorporated to

conform to requirements set forth in

OMB Circular A–25.

In addition, the obligations for each

cost center include obligations from

certain other accounts, such as Medicare

and Medicaid collections and the

Contract Health fund, that were used to

support the inpatient and outpatient

workload. Obligations were excluded

for certain cost centers that primarily

support workloads outside of the

directly operated hospitals or clinics

(public health nursing, public health

nutrition, health education). These

obligations are not a part of the

traditional cost of hospital operations

and do not contribute directly to the

inpatient and outpatient visit workload.

Separate rates per inpatient day and

outpatient visit were computed for

Alaska and the rest of the United States.

This gives proper weight to the higher

cost of operating medical facilities in

Alaska.

1. Department of Defense

For the Department of Defense,

effective October 1, 2000 and thereafter:

Inpatient, Outpatient and Other Rates

and Charges

1. Inpatient Rates12

Per inpatient day

International Military Education

and Training

(IMET)

Interagency and

other Federal

agency sponsored

patients

Other

(full/third party)

A. Burn Center ........................................................................................................... $4,144.00 $5,694.00 $6,016.00

B. Surgical Care Services (Cosmetic Surgery) ......................................................... 1,895.00 2,604.00 2,752.00

C. All Other Inpatient Services (Based on Diagnosis Related Groups (DRG) 3.

Average FY01 Direct Care Inpatient

Reimbursement Rates

Adjusted standard amount IMET Interagency Other

(full/third party)

Large Urban ..................................................................................................................... $2,986.00 $5,712.00 $6,002.00

Other Urban/Rural ........................................................................................................... 3,468.00 6,633.00 7,004.00

Overseas .......................................................................................................................... 3,872.00 9,045.00 9,489.00

2. Overview

The FY01 inpatient rates are based on

the cost per DRG, which is the inpatient

full reimbursement rate per hospital

discharge weighted to reflect the

intensity of the principal diagnosis,

secondary diagnoses, procedures,

patient age, etc. involved. The average

cost per Relative Weighted Product

(RWP) for large urban, other urban/

rural, and overseas facilities will be

published annually as an inpatient

adjusted standardized amount (ASA)

(see paragraph I.C.1., above). The ASA

will be applied to the RWP for each

inpatient case, determined from the

DRG weights, outlier thresholds, and

payment rules published annually for

hospital reimbursement rates under the

Civilian Health and Medical Program of

the Uniformed Services (CHAMPUS)

pursuant to 32 CFR 199.14(a)(1),

including adjustments for length of stay

(LOS) outliers. Each large urban or other

urban/rural MTF providing inpatient

care has their own ASA rate—The MTFspecific ASA rate is the published ASA

rate adjusted for area wage differences

and indirect medical education (IME)

for the discharging hospital (see

Attachment 1). The MTF-specific ASA

rate submitted on the claim is the rate

that payers will use for reimbursement

purposes. For a more complete

description of the development of MTFASAs and how they are applied refer to

the ASA Primer at http://

www.tricare.osd.mil/org/pae/asa—

primer/asa—primer1.html.

Overseas MTFs use the rates specified

in paragraph I. C. 1. For providers

performing inpatient care at a civilian

facility for a DoD beneficiary, see note

3. An example of how to apply DoD

costs to a DRG standardized weight to

arrive at DoD costs is contained in

paragraph I.C.3., below.

3. Example of Adjusted Standardized

Amounts for Inpatient Stays

Figure 1 shows examples for a nonteaching hospital (Reynolds Army

Community Hospital) in an Other

Urban/Rural area.

a. The cost to be recovered is the

military treatment facility’s cost for

medical services provided. Billings will

be at the third party rate.

b. DRG 020: Nervous System Infection

Except Viral Meningitis. The RWP for

an inlier case is the CHAMPUS weight

of 2.2244. (DRG statistics shown are

from FY 1999.)

c. The MTF-applied ASA rate is

$6,831 (Reynolds Army Community

Hospital’s third party rate as shown in

Attachment 1).

d. The MTF cost to be recovered is the

RWP factor (2.2244) in subparagraph

3.b., above, multiplied by the amount

($6,831) in subparagraph 3.c., above.

e. Cost to be recovered is $15,195.

65026 Federal Register / Vol. 65, No. 211 / Tuesday, October 31, 2000 / Notices

FIGURE 1.—THIRD PARTY BILLING EXAMPLES

DRG number DRG description DRG weight Arithmetic

mean LOS

Geometric

mean LOS

Short stay

threshold

Long stay

threshold

020 ................................................................ Nervous System Infection

Except Viral Meningitis.

2.2244 8.3 5.8 1 29

Hospital Location Area wage

rate index

IME

adjustment

Group

ASA

MTF-applied

ASA

Reynolds Army Community Hospital ....................................... Other urban/rural ......... .9156 1.0 $7,004 $6,831

Patient Length of

stay (days)

Days

above

threshold

Relative weighted product TPC

Amount***

Inlier* Outlier** Total

#1 ....................................................................................................... 7 0 2.2244 000 2.2244 $15,195

#2 ....................................................................................................... 21 0 2.2244 000 2.2244 $15,195

#3 ....................................................................................................... 35 6 2.2244 .7594 2.9838 $20,382

* DRG Weight

**Outlier calculation = 33 percent of per diem weight × number of outlier days

= .33 (DRG Weight/Geometric Mean LOS) × (Patient LOS—Long Stay Threshold)

= .33 (2.2244/5.8) × (35–29)

= .33 (.38352) × 6 (take out to five decimal places)

= .12656 × 6 (carry to five decimal places)

= .7594 (carry to four decimal places)

*** MTF-Applied ASA × Total RWP

II. OUTPATIENT RATES

[Per Visit 1,2]

MEPRS

code 4 Clinical service

International

military education and training (IMET)

Interagency and

other federal

agency sponsored patients

Other

(full/third party)

A. Medical Care:

BAA .............. Internal Medicine ......................................................................................... $147.00 $204.00 $216.00

BAB .............. Allergy ......................................................................................................... 80.00 111.00 117.00

BAC .............. Cardiology ................................................................................................... 129.00 180.00 190.00

BAE .............. Diabetic ....................................................................................................... 105.00 146.00 154.00

BAF .............. Endocrinology (Metabolism) ........................................................................ 151.00 210.00 222.00

BAG .............. Gastroenterology ......................................................................................... 183.00 255.00 269.00

BAH .............. Hematology ................................................................................................. 286.00 398.00 420.00

BAI ............... Hypertension ............................................................................................... 216.00 301.00 318.00

BAJ ............... Nephrology .................................................................................................. 221.00 307.00 324.00

BAK .............. Neurology .................................................................................................... 165.00 229.00 242.00

BAL .............. Outpatient Nutrition ..................................................................................... 69.00 96.00 101.00

BAM ............. Oncology ..................................................................................................... 201.00 280.00 295.00

BAN .............. Pulmonary Disease ..................................................................................... 186.00 259.00 273.00

BAO .............. Rheumatology ............................................................................................. 139.00 194.00 205.00

BAP .............. Dermatology ................................................................................................ 115.00 160.00 169.00

BAQ .............. Infectious Disease ....................................................................................... 181.00 252.00 266.00

BAR .............. Physical Medicine ....................................................................................... 115.00 160.00 169.00

BAS .............. Radiation Therapy ....................................................................................... 169.00 235.00 248.00

BAT .............. Bone Marrow Transplant ............................................................................. 190.00 264.00 279.00

BAU .............. Genetic ........................................................................................................ 330.00 460.00 485.00

BAV .............. Hyperbaric ................................................................................................... 344.00 480.00 506.00

B. Surgical Care:

BBA .............. General Surgery .......................................................................................... 215.00 299.00 316.00

BBB .............. Cardiovascular and Thoracic Surgery ........................................................ 419.00 584.00 616.00

BBC .............. Neurosurgery ............................................................................................... 249.00 347.00 366.00

BBD .............. Ophthalmology ............................................................................................ 130.00 181.00 191.00

BBE .............. Organ Transplant ........................................................................................ 1,106.00 1,541.00 1,625.00

BBF .............. Otolaryngology ............................................................................................ 149.00 207.00 219.00

BBG .............. Plastic Surgery ............................................................................................ 168.00 235.00 247.00

BBH .............. Proctology ................................................................................................... 125.00 174.00 184.00

BBI ............... Urology ........................................................................................................ 164.00 228.00 240.00

BBJ ............... Pediatric Surgery ......................................................................................... 89.00 125.00 131.00

BBK .............. Peripheral Vascular Surgery ....................................................................... 98.00 137.00 145.00

BBL .............. Pain Management ....................................................................................... 138.00 193.00 203.00

BBM ............. Vascular and Interventional Radiology ....................................................... 493.00 687.00 724.00

C. Obstetrical and Gynecological (OB–GYN) Care:

BCA .............. Family Planning ........................................................................................... 76.00 106.00 111.00

Federal Register / Vol. 65, No. 211 / Tuesday, October 31, 2000 / Notices 65027

II. OUTPATIENT RATES—Continued

[Per Visit 1,2]

MEPRS

code 4 Clinical service

International

military education and training (IMET)

Interagency and

other federal

agency sponsored patients

Other

(full/third party)

BCB .............. Gynecology ................................................................................................. 127.00 177.00 187.00

BCC .............. Obstetrics .................................................................................................... 104.00 144.00 152.00

BCD .............. Breast Cancer Clinic ................................................................................... 240.00 334.00 352.00

D. Pediatric Care:

BDA .............. Pediatric ...................................................................................................... 92.00 128.00 134.00

BDB .............. Adolescent ................................................................................................... 83.00 115.00 121.00

BDC .............. Well Baby .................................................................................................... 63.00 87.00 92.00

E. Orthopaedic Care:

BEA .............. Orthopaedic ................................................................................................. 143.00 200.00 211.00

BEB .............. Cast ............................................................................................................. 89.00 123.00 130.00

BEC .............. Hand Surgery .............................................................................................. 76.00 106.00 112.00

BEE .............. Orthotic Laboratory ..................................................................................... 93.00 130.00 137.00

BEF .............. Podiatry ....................................................................................................... 80.00 112.00 118.00

BEZ .............. Chiropractic ................................................................................................. 38.00 53.00 55.00

F. Psychiatric and/or Mental Health Care:

BFA .............. Psychiatry .................................................................................................... 165.00 230.00 242.00

BFB .............. Psychology .................................................................................................. 115.00 160.00 169.00

BFC .............. Child Guidance ............................................................................................ 92.00 128.00 135.00

BFD .............. Mental Health .............................................................................................. 148.00 206.00 217.00

BFE .............. Social Work ................................................................................................. 147.00 205.00 217.00

BFF .............. Substance Abuse ........................................................................................ 141.00 197.00 208.00

G. Family Practice/Primary Medical Care:

BGA .............. Family Practice ............................................................................................ 107.00 149.00 157.00

BHA .............. Primary Care ............................................................................................... 109.00 151.00 160.00

BHB .............. Medical Examination ................................................................................... 111.00 155.00 163.00

BHC .............. Optometry .................................................................................................... 72.00 100.00 105.00

BHD .............. Audiology ..................................................................................................... 52.00 73.00 77.00

BHE .............. Speech Pathology ....................................................................................... 122.00 170.00 180.00

BHF .............. Community Health ....................................................................................... 85.00 118.00 125.00

BHG ............. Occupational Health .................................................................................... 108.00 151.00 159.00

BHH .............. TRICARE Outpatient ................................................................................... 74.00 104.00 109.00

BHI ............... Immediate Care ........................................................................................... 161.00 225.00 237.00

H. Emergency Medical Care:

BIA ............... Emergency Medical ..................................................................................... 173.00 242.00 255.00

I. Flight Medical Care:

BJA ............... Flight Medicine ............................................................................................ 124.00 173.00 182.00

J. Underseas Medical Care:

BKA .............. Underseas Medicine ................................................................................... 77.00 108.00 114.00

K. Rehabilitative Services:

BLA .............. Physical Therapy ......................................................................................... 56.00 79.00 83.00

BLB .............. Occupational Therapy ................................................................................. 75.00 104.00 110.00

III. AMBULATORY PROCEDURE VISIT (APV)

[Per visit 5]

MEPRS

code 4 Clinical service

International

military education and training (IMET)

Interagency and

other federal

agency sponsored patients

Other

(full/third party)

Medical Care:

BB ................ Surgical Care .............................................................................................. $1,313.00 $1,829.00 $1,929.00

BE ................ Orthopaedic Care ........................................................................................ 1,664.00 2,319.00 2,446.00

All Other ....... B clinics other than BB and BE, to include those B clinics where: ............ 378.00 527.00 556.00

1. There is an APU established within DoD guidelines AND—

2. There is a rate established for that clinic in section II. Some B clinics,

such as BF, BI, BJ and BL, perform the type of services where the establishment of an APU would not be within appropriate clinical guidelines.

65028 Federal Register / Vol. 65, No. 211 / Tuesday, October 31, 2000 / Notices

IV. OTHER RATES AND CHARGES 1 2

MEPRS

code 4 Clinical service

International

military education and training (IMET)

Interagency and

other federal

agency sponsored patients

Other

(full/third party)

A. Per Each:

FBI ................ Immunization ............................................................................................... $22.00 $31.00 $32.00

B. Family Member Rate: $11.45 (formerly Military Dependents Rate)

C. Reimbursement Rates For Drugs Requested By Outside Providers: 6 15

D. Ancillary Services Requested by an Outside Provider—Per Procedure: 7 15

DB ................ Laboratory procedures requested by an outside provider CPT ’00 Weight

Multiplier.

15.00 22.00 23.00

DC, DI .......... Radiology procedures requested by an outside provider CPT ’00 Weight

Multiplier.

79.00 115.00 120.00

E. Dental Rate—Per Procedure: 11

Dental Services ADA code weight multiplier .............................................. 73.00 112.00 117.00

F. Ambulance Rate—Per Hour: 12

FEA .............. Ambulance .................................................................................................. 81.00 113.00 120.00

G. AirEvac Rate—Per Trip (24 hour period): 13

AirEvac Services—Ambulatory 339.00 473.00 499.00

AirEvac Services—Litter ............................................................................. 989.00 1,379.00 1,454.00

H. Observation Rate—Per hour—14

Observation Services—Hour ....................................................................... 20.00 28.00 30.00

V. ELECTIVE COSMETIC SURGERY PROCEDURES AND RATES

Cosmetic surgery procedure

International

classification

diseases

(ICD–9)

Current procedural terminology (CPT) 8

FY 2001 Charge 9 Amount of

charge

Mammaplasty—augmentation ...................................................... 85.50 19325 Inpatient Surgical Care

Per Diem or APV

(a)

(b)

85.32 19324

85.31 19318

Mastopexy ..................................................................................... 85.60 19316 Inpatient Surgical Care

Per Diem or APV or

applicable Outpatient Clinic Rate

(a)

(b)

(c)

Facial ............................................................................................ 86.82 15824 Inpatient Surgical Care

Per Diem or APV

(a)

(b)

Rhytidectomy ................................................................................ 86.22

Blepharoplasty .............................................................................. 08.70 15820 Inpatient Surgical Care

Per Diem or APV or

applicable Outpatient Clinic Rate

(a)

(b)

(c)

08.44 15821

15822

15823

Mentoplasty (Augmentation/or Reduction) ................................... 76.68 21208 Inpatient Surgical Care

Per Diem APV or

applicable Outpatient Clinic Rate

(a)

(b)

(c)

76.67 21209

Abdominoplasty ............................................................................ 86.83 15831 Inpatient Surgical Care

Per Diem or APV or

applicable Outpatient Clinic Rate

(a)

(b)

(c)

Lipectomy ...................................................................................... 86.83 15876 Inpatient Surgical Care

Per Diem or APV or

applicable Outpatient Clinic Rate

(a)

(b)

(c)

Suction per region 10 ................................................................... 15877

15878

15879

Rhinoplasty ................................................................................... 21.87 30400 Inpatient Surgical Care

Per Diem or APV or

applicable Outpatient Clinic Rate

(a)

(b)

(c)

21.86 30410

Federal Register / Vol. 65, No. 211 / Tuesday, October 31, 2000 / Notices 65029

V. ELECTIVE COSMETIC SURGERY PROCEDURES AND RATES—Continued

Cosmetic surgery procedure

International

classification

diseases

(ICD–9)

Current procedural terminology (CPT) 8

FY 2001 Charge 9 Amount of

charge

Scar Revisions beyond CHAMPUS .............................................. 86.84 1578l Inpatient Surgical Care

Per Diem or APV or

applicable Outpatient Clinic Rate

(a)

(b)

(c)

Mandibular or Maxillary Repositioning ......................................... 76.41 21194 Inpatient Surgical Care

Per Diem or APV or

applicable Outpatient Clinic Rate

(a)

(b)

(c)

Dermabrasion ............................................................................... 86.25 15780 Inpatient Surgical Care

Per Diem or APV or

applicable Outpatient Clinic Rate

(a)

(b)

(c)

Hair Restoration ............................................................................ 86.64 15775 Inpatient Surgical Care

Per Diem or APV or

applicable Outpatient Clinic Rate

(a)

(b)

(c)

Removing Tattoos ......................................................................... 86.25 15780 Inpatient Surgical Care

Per Diem or APV or

applicable Outpatient Clinic Rate

(a)

(b)

(c)

Chemical Peel ............................................................................... 86.24 15790 Inpatient Surgical Care

Per Diem or APV or

applicable Outpatient Clinic Rate

(a)

(b)

(c)

Arm/Thigh: Dermolipectomy ......................................................... 86.83 15836/ Inpatient Surgical Care

Per Diem or APV

APV or applicable

Outpatient Clinic

Rate

(a)

(b)

(b)

(c)

(e)

Refractive surgery ......................................................................... .......................... 15832

Radial Keratotomy ........................................................................ .......................... 65771

Other Procedure (if applies to laser or other ........................

refractive surgery) ..................................................................

.......................... 66999

Otoplasty ....................................................................................... .......................... 69300 APV or applicable Outpatient Clinic Rate(b)

(c)

Brow Lift ........................................................................................ 86.3 15839 Inpatient Surgical Care

Per Diem or APV or

applicable Outpatient Clinic Rate

(a)

(b)

(c)

Notes on Cosmetic Surgery Charges

aPer diem charges for inpatient surgical

care services are listed in section I.B. (See

notes 8 through 10, below, for further details

on reimbursable rates.) bCharges for ambulatory procedure visits

(formerly same day surgery) are listed in

section III. (See notes 8 through 10, below,

for further details on reimbursable rates.) The

ambulatory procedure visit (APV) rate is used

if the elective cosmetic surgery is performed

in an ambulatory procedure unit (APU). cCharges for outpatient clinic visits are

listed in sections II.A–K. The outpatient

clinic rate is not used for services provided

in an APU. The APV rate should be used in

these cases. dCharge is solely determined by the

location of where the care is provided and is

not to be based on any other criteria. An APV

rate can only be billed if the location has

been established as an APU following all

required DoD guidelines and instructions. eRefer to HA Policy on Vision Correction

Via Laser Surgery For Non-Active Duty

Beneficiaries, April 7, 2000 for further

guidance on billing for these services. It can

be downloaded from http://

www.tricare.osd.mil/policy/2000poli.htm.

Notes on Reimbursable Rates

1Percentages can be applied when

preparing bills for both inpatient and

outpatient services. Pursuant to the

provisions of 10 U.S.C. 1095, the inpatient

Diagnosis Related Groups and inpatient per

diem percentages are 98 percent hospital and

2 percent professional charges. The

outpatient per visit percentages are 89

percent outpatient services and 11 percent

professional charges. 2 DoD civilian employees located in

overseas areas shall be rendered a bill when

services are performed. 3The cost per Diagnosis Related Group

(DRG) is based on the inpatient full

reimbursement rate per hospital discharge,

weighted to reflect the intensity of the

principal and secondary diagnoses, surgical

procedures, and patient demographics

involved. The adjusted standardized amounts

(ASA) per Relative Weighted Product (RWP)

for use in the direct care system is

comparable to procedures used by the Health

Care Financing Administration (HCFA) and

the Civilian Health and Medical Program for

the Uniformed Services (CHAMPUS). These

expenses include all direct care expenses

associated with direct patient care. The

average cost per RWP for large urban, other

urban/rural, and overseas will be published

annually as an adjusted standardized amount

(ASA) and will include the cost of inpatient

professional services. The DRG rates will

apply to reimbursement from all sources, not

just third party payers.

MTFs without inpatient services, whose

providers are performing inpatient care in a

civilian facility for a DoD beneficiary, can bill

payers the percentage of the charge that

represents professional services as provided

in 1 above. The ASA rate used in these cases,

based on the absence of a ASA rate for the

facility, will be based on the average ASA

rate for the type of metropolitan statistical

area the MTF resides, large urban, other

urban/rural, or overseas. (see paragraph

I.C.1.). The Uniform Business Office must

receive documentation of care provided in

order to produce a bill. 4The Medical Expense and Performance

Reporting System (MEPRS) code is a three

65030 Federal Register / Vol. 65, No. 211 / Tuesday, October 31, 2000 / Notices

digit code which defines the summary

account and the sub account within a

functional category in the DoD medical

system. MEPRS codes are used to ensure that

consistent expense and operating

performance data is reported in the DoD

military medical system. An example of the

MEPRS hierarchical arrangement follows:

MEPRS

Code

Outpatient Care (Functional Category).B.

Medical Care (Summary Account).BA.

Internal Medicine (Subaccount) BAA.

5Ambulatory procedure visit is defined in

DoD Instruction 6025.8, ‘‘Ambulatory

Procedure Visit (APV),’’ dated September 23,

1996, as immediate (day of procedure) preprocedure and immediate post-procedure

care requiring an unusual degree of intensity

and provided in an ambulatory procedure

unit (APU). An APU is a location or

organization within an MTF (or freestanding

outpatient clinic) that is specially equipped,

staffed, and designated for the purpose of

providing the intensive level of care

associated with APVs. Care is required in the

facility for less than 24 hours. All expenses

and workload are assigned to the MTFestablished APU associated with the referring

clinic. The BB and BE APV rates are to be

used only by clinics that are subaccounts

under these summary accounts (see 4 for an

explanation of MEPRS hierarchical

arrangement). The All Other APV rate is to

be used only by those clinics that are not a

subaccount under BB or BE. In addition, APV

rates may only be utilized for clinics where

there is a clinic rate established. For

example, BLC, Neuromuscular Screening, no

longer has an established rate. Therefore, an

APU can not be defined and an APV can not

be billed for this clinic. 6Third party payers (such as insurance

companies) shall be billed for prescription

services when beneficiaries who have

medical insurance obtain medications from a

Military Treatment Facility (MTF) that are

prescribed by providers external to the MTF

(e.g., physicians and dentists). Eligible

beneficiaries (family members or retirees

with medical insurance) are not liable

personally for this cost and shall not be

billed by the MTF. Medical Services Account

(MSA) patients, who are not beneficiaries as

defined in 10 U.S.C. 1074 and 1076, are

charged at the ‘‘Other’’ rate if they are seen

by an outside provider and only come to the

MTF for prescription services. The standard

cost of medications ordered by an outside

provider includes the DoD-wide average cost

of the drug, calculated by National Drug Code

(NDC) number. The prescription charge is

calculated by multiplying the number of

units (e.g., tablets or capsules) by the unit

cost and adding $6.00 for the cost of

dispensing the prescription. Dispensing costs

include overhead, supplies and labor, etc. to

fill the prescription.

The list of drug reimbursement rates is too

large to include in this document. Those

rates are available from the TRICARE

Management Activity’s Uniform Business

Office website, http://www.tricare.osd.mil/

ebc/rm/rmlhome.html. 7The list of FY 2001 rates for ancillary

services requested by outside providers and

obtained at a Military Treatment Facility is

too large to include in this document. Those

rates are available from the TRICARE

Management Activity’s Uniform Business

Office website, http://www.tricare.osd.mil/

ebc/rm/rmlhome.html.

Charges for ancillary services requested by

an outside provider (e.g., physicians and

dentists) are relevant to the Third Party

Collection Program. Third party payers (such

as insurance companies) shall be billed for

ancillary services when beneficiaries who

have medical insurance obtain services from

the MTF which are prescribed by providers

external to the MTF. Laboratory and

Radiology procedure costs are calculated by

multiplying the DoD established weight for

the Physicians’ Current Procedural

Terminology (CPT 00) code by either the

laboratory or radiology multiplier (section

IV.D.). Radiology procedures performed by

Nuclear Medicine use the same methodology

as Radiology for calculating a charge because

their workload and expenses are included in

the establishment of the Radiology

multiplier.

Eligible beneficiaries (family members or

retirees with medical insurance) are not

personally liable for this cost and shall not

be billed by the MTF. MSA patients, who are

not beneficiaries as defined by 10 U.S.C.

1074 and 1076, are charged at the ‘‘Other’’

rate if they are seen by an outside provider

and only come to the MTF for ancillary

services. 8The attending physician is to complete

the CPT 00 code to indicate the appropriate

procedure followed during cosmetic surgery.

The appropriate rate will be applied

depending on the treatment modality of the

patient: ambulatory procedure visit,

outpatient clinic visit or inpatient surgical

care services. 9Family members of active duty personnel,

retirees and their family members, and

survivors shall be charged elective cosmetic

surgery rates. Elective cosmetic surgery

procedure information is contained in

section V. The patient shall be charged the

rate as specified in the FY 2001 reimbursable

rates for an episode of care. The charges for

elective cosmetic surgery are at the full

reimbursement rate (designated as the

‘‘Other’’ rate) for inpatient per diem surgical

care services in section I.B., ambulatory

procedure visits as contained in section III.,

or the appropriate outpatient clinic rate in

sections II.A–K. The patient is responsible for

the cost of the implant(s) and the prescribed

cosmetic surgery rate. (Note: The implants

and procedures used for the augmentation

mammaplasty are in compliance with

Federal Drug Administration guidelines.) 10Each regional lipectomy shall carry a

separate charge. Regions include head and

neck, abdomen, flanks, and hips. 11 Dental service rates are based on a dental

rate multiplied by the DoD established

weight for the American Dental Association

(ADA) code performed. For example, for

ADA code 00270, bite wing single film, the

weight is 0.15. The weight of 0.15 is

multiplied by the appropriate rate, IMET,

IAR, or Full/Third Party rate to obtain the

charge. If the Full/Third Party rate is used,

then the charge for this ADA code will be

$17.55 ($117 × .15 = $17.55).

The list of FY 2001 ADA codes and

weights for dental services is too large to

include in this document. Those rates are

available from the TRICARE Management

Activity’s Uniform Business Office website,

http://www.tricare.osd.mil/ebc/rm/

rm_home.html.

12Ambulance charges shall be based on

hours of service in 15 minute increments.

The rates listed in section IV.F. are for 60

minutes or 1 hour of service. Providers shall

calculate the charges based on the number of

hours (and/or fractions of an hour) that the

ambulance is logged out on a patient run.

Fractions of an hour shall be rounded to the

next 15 minute increment (e.g., 31 minutes

shall be charged as 45 minutes). 13Air in-flight medical care reimbursement

charges are determined by the status of the

patient (ambulatory or litter) and are per

patient during a 24 hour period. The

appropriate charges are billed only by the Air

Force Global Patient Movement Requirement

Center (GPMRC). These charges are only for

the cost of providing medical care. Flight

charges are billed by GPMRC separately. 14Observation Services are billed at the

hourly charge. Begin counting when the

patient is placed in the observation bed and

round to the nearest hour. For example, if a

patient has received one hour and 20 minutes

of observation, then you bill for one hour of

service. If the status of a patient changes to

inpatient, the charges for observation services

are added to the DRG assigned to the case

and not separately billed. If a patient is

released from observation status and is sent

to an APV, the charges for observation

services are not billed separately but are

added to the APV rate to recover all

expenses. 15Final rule 32 CFR part 220, published

February 16, 2000, eliminated the dollar

threshold for high cost ancillary services and

the associated term ‘‘high cost ancillary

service.’’ The phrase ‘‘high cost ancillary

service’’ is replaced with the phrase

‘‘ancillary services requested by an outside

provider.’’ The elimination of the threshold

also eliminated the need to bundle costs

whereby a patient is billed if the total cost

of ancillary services in a day (defined as 0001

hours to 2400 hours) exceeds $25.00. The

elimination of the threshold is effective as

per date stated in final rule 32 CFR Part 220.

Federal Register / Vol. 65, No. 211 / Tuesday, October 31, 2000 / Notices 65031

ATTACHMENT 1.—ADJUSTED STANDARDIZED AMOUNTS (ASA) BY MILITARY TREATMENT FACILITY

DMISID MTF name Serv Full cost

rate

Interagency

rate

IMET

rate

TPC

rate

0003 .... Lyster AH—Ft. Rucker .......................................................................................... A ..... $6,637 $6,286 $3,286 $6,637

0004 .... 502nd Med Grp—Maxwell AFB ............................................................................ F ..... 6,984 6,614 3,458 6,984

0005 .... Bassett ACH—Ft. Wainwright ............................................................................... A ..... 7,152 6,774 3,541 7,152

0006 .... 3rd Med Grp—Elmendorf AFB ............................................................................. F ..... 7,041 6,668 3,486 7,041

0009 .... 56th Med Grp—Luke AFB .................................................................................... F ..... 5,986 5,697 2,978 5,986

0014 .... 60th Med Grp—Travis AFB .................................................................................. F ..... 9,912 9,387 4,907 9,912

0018 .... 30th Med Grp—Vandenberg AFB ........................................................................ F ..... 7,035 6,663 3,483 7,035

0019 .... 95th Med Grp—Edwards AFB .............................................................................. F ..... 7,004 6,633 3,468 7,004

0024 .... NH Camp Pendleton ............................................................................................. N ..... 7,614 7,245 3,787 7,614

0028 .... NH Lemoore .......................................................................................................... N ..... 6,997 6,627 3,465 6,997

0029 .... NH San Diego ....................................................................................................... N ..... 9,744 9,273 4,847 9,744

0030 .... NH Twenty Nine Palms ........................................................................................ N ..... 6,111 5,815 3,039 6,111

0032 .... Evans ACH—Ft. Carson ....................................................................................... A ..... 6,946 6,578 3,439 6,946

0033 .... 10th Med Grp—USAF Academy .......................................................................... F ..... 6,994 6,623 3,463 6,994

0037 .... Walter Reed AMC— Washington DC ................................................................... A ..... 9,010 8,574 4,482 9,010

0038 .... NH Pensacola ....................................................................................................... N ..... 8,939 8,465 4,426 8,939

0039 .... NH Jacksonville .................................................................................................... N ..... 7,537 7,173 3,749 7,537

0042 .... 96th Med Grp—Eglin AFB .................................................................................... F ..... 8,309 7,869 4,114 8,309

0043 .... 325th Med Grp—Tyndall AFB .............................................................................. F ..... 7,002 6,631 3,467 7,002

0045 .... 6th Med Grp—MacDill AFB .................................................................................. F ..... 5,991 5,702 2,980 5,991

0047 .... Eisenhower AMC—Ft. Gordon ............................................................................. A ..... 8,550 8,098 4,233 8,550

0048 .... Martin ACH—Ft. Benning ..................................................................................... A ..... 7,987 7,564 3,954 7,987

0049 .... Winn ACH—Ft. Stewart ........................................................................................ A ..... 6,644 6,292 3,289 6,644

0052 .... Tripler AMC—Ft. Shafter ...................................................................................... A ..... 9,533 9,029 4,720 9,533

0053 .... 366th Med Grp—Mountain Home AFB ................................................................ F ..... 6,982 6,612 3,457 6,982

0055 .... 375th Med Grp—Scott AFB .................................................................................. F ..... 7,625 7,256 3,793 7,625

0056 .... NH Great Lakes .................................................................................................... N ..... 6,063 5,770 3,016 6,063

0057 .... Irwin AH—Ft. Riley ............................................................................................... A ..... 6,521 6,176 3,229 6,521

0060 .... Blanchfield ACH—Ft. Campbell ............................................................................ A ..... 6,605 6,255 3,270 6,605

0061 .... Ireland ACH—Ft. Knox ......................................................................................... A ..... 6,829 6,467 3,381 6,829

0064 .... Bayne-Jones ACH—Ft. Polk ................................................................................ A ..... 6,573 6,225 3,254 6,573

0066 .... 89th Med Grp—Andrews AFB .............................................................................. F ..... 8,062 7,672 4,010 8,062

0067 .... NNMC Bethesda ................................................................................................... N ..... 9,786 9,313 4,868 9,786

0073 .... 81st Med Grp—Keesler AFB ................................................................................ F ..... 8,772 8,308 4,343 8,772

0075 .... Wood ACH—Ft. Leonard Wood ........................................................................... A ..... 6,539 6,193 3,237 6,539

0078 .... 55th Med Grp—Offutt AFB ................................................................................... F ..... 8,697 8,236 4,306 8,697

0079 .... 99th Med Grp—Nellis AFB ................................................................................... F ..... 6,002 5,712 2,986 6,002

0083 .... 377th Med Grp—Kirtland AFB .............................................................................. F ..... 6,971 6,602 3,452 6,971

0084 .... 49th Med Grp—Holloman AFB ............................................................................. F ..... 7,004 6,633 3,468 7,004

0086 .... Keller ACH—West Point ....................................................................................... A ..... 7,296 6,909 3,612 7,296

0089 .... Womack AMC—Ft. Bragg .................................................................................... A ..... 7,817 7,403 3,870 7,817

0091 .... NH Camp LeJeune ............................................................................................... N ..... 6,744 6,387 3,339 6,744

0092 .... NH Cherry Point .................................................................................................... N ..... 6,788 6,429 3,361 6,788

0093 .... 319th Med Grp—Grand Forks AFB ...................................................................... F ..... 7,032 6,660 3,482 7,032

0094 .... 5th Med Grp—Minot AFB ..................................................................................... F ..... 6,857 6,494 3,395 6,857

0095 .... 74th Med Grp—Wright-Patterson AFB ................................................................. F ..... 10,371 9,822 5,135 10,371

0096 .... 72nd Med Grp—Tinker AFB ................................................................................. F ..... 6,001 5,711 2,985 6,001

0097 .... 97th Med Grp—Altus AFB .................................................................................... F ..... 6,976 6,607 3,454 6,976

0098 .... Reynolds ACH—Ft. Sill ......................................................................................... A ..... 6,831 6,469 3,382 6,831

0100 .... NH Newport .......................................................................................................... N ..... 6,002 5,712 2,986 6,002

0101 .... 20th Med Grp—Shaw AFB ................................................................................... F ..... 6,964 6,595 3,448 6,964

0103 .... NH Charleston ...................................................................................................... N ..... 6,879 6,514 3,406 6,879

0104 .... NH Beaufort .......................................................................................................... N ..... 6,871 6,507 3,402 6,871

0105 .... Moncrief ACH—Ft. Jackson ................................................................................. A ..... 6,961 6,592 3,446 6,961

0106 .... 28th Med Grp—Ellsworth AFB ............................................................................. F ..... 6,939 6,572 3,436 6,939

0108 .... Wm Beaumont AMC—Ft. Bliss ............................................................................ A ..... 8,329 7,888 4,124 8,329

0109 .... Brooke AMC—Ft. Sam Houston ........................................................................... A ..... 8,511 8,099 4,233 8,511

0110 .... Darnall AH—Ft. Hood ........................................................................................... A ..... 8,606 8,151 4,261 8,606

0112 .... 7th Med Grp—Dyess AFB .................................................................................... F ..... 6,892 6,528 3,413 6,892

0113 .... 82nd Med Grp—Sheppard AFB ........................................................................... F ..... 6,903 6,537 3,418 6,903

0117 .... 59th Med Wing—Lackland AFB ........................................................................... F ..... 8,640 8,222 4,297 8,640

0119 .... 75th Med Grp—Hill AFB ....................................................................................... F ..... 5,983 5,693 2,976 5,983

0120 .... 1st Med Grp—Langley AFB .................................................................................. F ..... 5,954 5,666 2,962 5,954

0121 .... McDonald ACH—Ft. Eustis .................................................................................. A ..... 5,649 5,376 2,810 5,649

0123 .... Dewitt AH—Ft. Belvoir .......................................................................................... A ..... 8,237 7,839 4,097 8,237

0124 .... NH Portsmouth ..................................................................................................... N ..... 7,469 7,107 3,715 7,469

0125 .... Madigan AMC—Ft. Lewis ..................................................................................... A ..... 11,018 10,435 5,455 11,018

0126 .... NH Bremerton ....................................................................................................... N ..... 8,165 7,733 4,043 8,165

0127 .... NH Oak Harbor ..................................................................................................... N ..... 6,283 5,979 3,125 6,283

0129 .... 90th Med Grp—F.E. Warren AFB ........................................................................ F ..... 6,989 6,619 3,460 6,989

65032 Federal Register / Vol. 65, No. 211 / Tuesday, October 31, 2000 / Notices

1 15 U.S.C. 78l(d).

2 17 CFR 240.12d2–2(d).

3 15 U.S.C. 78l(g).

4 17 CFR 200.30–3(a)(1).

ATTACHMENT 1.—ADJUSTED STANDARDIZED AMOUNTS (ASA) BY MILITARY TREATMENT FACILITY—Continued

DMISID MTF name Serv Full cost

rate

Interagency

rate

IMET

rate

TPC

rate

0131 .... Weed ACH—Ft. Irwin ........................................................................................... A ..... 7,003 6,633 3,467 7,003

0449 .... 24th Med Grp—Howard ........................................................................................ F ..... 9,489 9,045 3,872 9,489

0606 .... 95th CSH—Heidelberg ......................................................................................... A ..... 9,489 9,045 3,872 9,489

0607 .... Landstuhl Rgn MC ................................................................................................ A ..... 9,489 9,045 3,872 9,489

0609 .... 67th CSH—Wurzburg ........................................................................................... A ..... 9,489 9,045 3,872 9,489

0612 .... 121st Gen Hosp—Seoul ....................................................................................... A ..... 9,489 9,045 3,872 9,489

0615 .... NH Guantanamo Bay ............................................................................................ N ..... 9,489 9,045 3,872 9,489

0616 .... NH Roosevelt Roads ............................................................................................ N ..... 9,489 9,045 3,872 9,489

0617 .... NH Naples ............................................................................................................. N ..... 9,489 9,045 3,872 9,489

0618 .... NH Rota ................................................................................................................ N ..... 9,489 9,045 3,872 9,489

0620 .... NH Guam .............................................................................................................. N ..... 9,489 9,045 3,872 9,489

0621 .... NH Okinawa .......................................................................................................... N ..... 9,489 9,045 3,872 9,489

0622 .... NH Yokosuka ........................................................................................................ N ..... 9,489 9,045 3,872 9,489

0623 .... NH Keflavik ........................................................................................................... N ..... 9,489 9,045 3,872 9,489

0624 .... BH Sigonella ......................................................................................................... N ..... 9,489 9,045 3,872 9,489

0633 .... 48th Med Grp—RAF Lakenheath ......................................................................... F ..... 9,489 9,045 3,872 9,489

0635 .... 39th Med Grp—Incirlik AB .................................................................................... F ..... 9,489 9,045 3,872 9,489

0638 .... 51st Med Grp—Osan AB ...................................................................................... F ..... 9,489 9,045 3,872 9,489

0639 .... 35th Med Grp—Misawa ........................................................................................ F ..... 9,489 9,045 3,872 9,489

0640 .... 374th Med Grp—Yokota AB ................................................................................. F ..... 9,489 9,045 3,872 9,489

0805 .... 52nd Med Grp—Spangdahlem ............................................................................. F ..... 9,489 9,045 3,872 9,489

0808 .... 31st Med Grp—Aviano ......................................................................................... F ..... 9,489 9,045 3,872 9,489

2. Department of Health and Human

Services

For the Department of Health and

Human Services, Indian Health Service,

effective October 1, 2000 and thereafter:

Hospital Care Inpatient Day

General Medical Care

Alaska—$1,837

Rest of the United States—$1,357

Outpatient Medical Treatment

Outpatient Visit

Alaska—$337

Rest of the United States—$189

For the period beginning October 1,

2000, the rates prescribed herein

superceded those established by the

Director of the Office of Management

and Budget, November 1, 1999 (64 FR

58862).

Jacob J. Lew,

Director, Office of Management and Budget.

[FR Doc. 00–27726 Filed 10–30–00; 8:45 am]

BILLING CODE 3110–01–P

SECURITIES AND EXCHANGE

COMMISSION

Issuer Delisting; Notice of Application

To Withdraw From Listing and

Registration; (CyberSentry, Inc.,

Common Stock, $.001 Par Value) File

No. 1–15871

October 25, 2000.

CyberSentry, Inc., a Delaware

corporation (‘‘Company’’), has filed an

application with the Securities and

Exchange Commission (‘‘Commission’’),

pursuant to section 12(d) of the

Securities Exchange Act of 1934

(‘‘Act’’) 1 and Rule 12d2–2(d)

thereunder,2 to withdraw its Common

Stock, $.001 par value (‘‘Security’’),

from listing and registration on the

American Stock Exchange LLC

(‘‘Amex’’).

The Amex halted trading in the

Security on September 8, 2000, because

of concerns about the company’s ability

to meet the Amex’s continued listing

maintenance requirements. As a result

of preliminary discussions held with the

Amex, the Company determined to

voluntarily withdraw its Security from

listing and registration on the Amex and

to arrange for its quotation in the

unlisted over-the-counter market. As of

the date on which the Company filed its

application with the Commission, the

Company had not effected a new listing

or quotation for its Security. The

Company has stated in its application

that its Board of Directors has

authorized the Company to take actions

necessary to become quoted in the

unlisted over-the-counter market.

The Company has stated in its

application that it has complied with

the rules of the Amex governing the

withdrawal of its Security and that its

application relates solely to the

withdrawal of the Security from listing

and registration on the Amex and shall

have no effect upon the Security’s

continued registration under section

12(g) of the Act.3

Any interested person may, on or

before November 16, 2000, submit by

letter to the Secretary of the Securities

and Exchange Commission, 450 Fifth

Street, NW., Washington, DC 20549–

0609, facts bearing upon whether the

application has been made in

accordance with the rules of the Amex

and what terms, if any, should be

imposed by the Commission for the

protection of investors. The

Commission, based on the information

submitted to it, will issue an order

granting the application after the date

mentioned above, unless the

Commission determines to order a

hearing on the matter.

For the commission, by the Division of

Market Regulation, pursuant to delegated

authority. 4

Jonathan K. Katz,

Secretary.

[FR Doc. 00–27912 Filed 10–03–00; 8:45 am]

BILLING CODE 8010–01–M