70554 Federal Register / Vol. 65, No. 227 / Friday, November 24, 2000 / Notices

[FR Doc. 00–29931 Filed 11–22–00; 8:45 am]

BILLING CODE 5001–10–C

DEPARTMENT OF DEFENSE

Office of the Secretary

Civilian Health and Medical Program of

the Uniformed Services (CHAMPUS);

Fiscal Year 2001 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/

CHAMPUS DRG-based payment system

in order to conform to changes made to

the Medicare Prospective Payment

System (PPS).

It also provides the updated fixed loss

cost outlier threshold, cost-to-charge

ratios and the Internet address for

accessing the updated adjusted

standardized amounts, DRG relative

weights, and beneficiary cost-share per

diem rates to be used for FY 2001 under

the TRICARE/CHAMPUS DRG-based

payment system.

EFFECTIVE DATES: The rates, weights and

Medicare PPS changes which affect the

TRICARE/CHAMPUS DRG-based

payment system contained in this notice

are effective for admissions occurring on

or after October 1, 2000.

ADDRESSES: TRICARE Management

Activity (TMA), Medical Benefits and

Reimbursement Systems, 16401 East

Centretech Parkway, Aurora, CO 80011–

9043.

For copies of the Federal Register

containing this notice, contact the

Superintendent of Documents, U.S.

Government Printing Office,

Washington, DC 20402, (202) 783–3238.

The charge for the Federal Register is

$1.50 for each issue payable by check or

money order to the Superintendent of

Documents.

FOR FURTHER INFORMATION CONTACT:

Marty Maxey, Medical Benefits and

Reimbursement Systems, TMA,

telephone (303) 676–3627.

To obtain copies of this document, see

the ADDRESSES section above. Questions

regarding payment of specific claims

under the TRICARE/CHAMPUS DRGbased 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/

CHAMPUS, is that the TRICARE/

CHAMPUS DRG-based payment system

is modeled on the Medicare PPS, and

that, whenever practicable, the

TRICARE/CHAMPUS system will

follow the same rules that apply to the

Medicare PPS. HCFA 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.

Federal Register / Vol. 65, No. 227 / Friday, November 24, 2000 / Notices 70555

I. Medicare PPS Changes Which Affect

the TRICARE/CHAMPUS DRG-Based

Payment System

Following is a discussion of the

changes the Health Care Financing

Administration (HCFA) has made to the

Medicare PPS that affect the TRICARE/

CHAMPUS DRG-based payment system.

A. DRG Classifications

Under both the Medicare PPS and the

TRICARE/CHAMPUS 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/CHAMPUS DRGbased payment system is the same as the

current Medicare Grouper with two

modifications. The TRICARE/

CHAMPUS 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, 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 tranplants 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 FY 2001, HCFA will implement

classification changes, including

surgical hierarchy changes. The

CHAMPUS Grouper will incorporate all

changes made to the Medicare Grouper.

B. Wage Index and Medicare

Geographic Classification Review Board

Guidelines

TRICARE/CHAMPUS will continue to

use the same wage index amounts used

for the Medicare PPS. In addition,

TRICARE/CHAMPUS will duplicate all

changes with regard to the wage index

for specific hospitals that are

redesignated by the Medicare

Geographic Classification Review Board.

C. Hospital Market Basket

TRICARE/CHAMPUS will update the

adjusted standardized amounts

according to the final updated hospital

market basket used for the Medicare

PPS according to HCFA’s August 1,

2000, final rule.

D. Outlier Payments

Since TRICARE/CHAMPUS does not

include capital payments in our DRGbased payments, we will use the fixed

loss cost outlier threshold calculated by

HFCA for paying cost outliers in the

absence of capital prospective

payments. For FY 2001, 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 2001, in order for a case

to qualify for cost outlier payments, the

costs must exceed the TRICARE/

CHAMPUS DRG base payment rate

(wage adjusted) for the DRG plus the

IDME payment plus $16,036 (wage

adjusted). The marginal cost factor for

cost outliers continues to be 80 percent.

E. Blood Clotting Factor

For FY 2001, TRICARE/CHAMPUS

will use the following HCPCS codes and

payment rates for blood clotting factors:

J7190 Factor VIII (antihemophilic

factor—human): $0.85 per unit

J7191 Factor VIII (antihemophilic

factor—porcine): 2.09 per unit

J7192 Factor VIII (antihemophilic

factor—recombinant): 1.12 per unit

J7194 Factor IX (complex): 0.31 per unit

J7198 Anti-inhibitor: 1.43 per unit

Q0160 Factor IX (antihemophilic factor,

purified, Non-recombinant): 1.05

per unit

Q0161 Factor IX (antihemophilic factor,

recombinant): 1.12 per unit

F. Indirect Medical Education (IDME)

Adjustment

The Balanced Budget Refinement Act

of 1999, modified the transition for the

IDME adjustment that was established

by the Balanced Budget Act of 1997.

The new multiplier for the IDME

adjustment factor for TRICARE/

CHAMPUS for FY 2001 is 1.16.

II. Cost to Charge Ratio

For FY 2001, the cost-to-charge ratio

used for the TRICARE/CHAMPUS DRGbased payment system will be 0.5353,

which is increased to 0.5408 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

0.5913.

III. Updated Rates and Weights

The updated rates and weights are

accessible through the Internet at

www.tricare.osd.mil under the heading

TRICARE Provider Information. Table 1

provides the ASA rates and Table 2

provides the DRG weights to be used

under the TRICARE/CHAMPUS DRGbased payment system during FY 2001

and which is a result of the changes

described above. The implementing

regulations for the TRICARE/CHAMPUS

DRUG-based payment system are in 32

CFR part 199.

Dated: November 16, 2000.

L.M. Bynum,

Alternate OSD Federal Register Liaison

Officer, Department of Defense.

[FR Doc. 00–29935 Filed 11–22–00; 8:45 am]

BILLING CODE 5001–10–M

DEPARTMENT OF DEFENSE

Office of the Secretary

Defense Science Board Task Force on

Improving Fuel Efficiency of Weapons

Platforms; Notice of Meeting

SUMMARY: The Defense Science Board

Task Force on Improving Fuel

Efficiency of Weapons Platforms will

meet in closed session on November 15–

16, 2000, at the Institute for Defense

Analyses, 1801 N. Beauregard Street,

Alexandria, VA 22311–1772.

The mission of the Defense Science

Board is to advise the Secretary of

Defense and the Under Secretary of

Defense for Acquisition and Technology

on scientific and technical matters as

they affect the perceived needs of the

Department of Defense. At this meeting,

the Task Force will review fuel-efficient

technologies, including new or

improved fuels, engines, Alternative

Fueled Vehicles, and other advanced

technologies and assess their

operational, logistical, cost, and

environmental impacts for a range of

practical implementation scenarios.

Due to critical mission requirements,

there is insufficient time to provide

timely notice required by Section

10(a)(2) of the Federal Advisory

Committee Act and Subsection 101–

6.1015(b) of the GSA Final Rule on

Federal Advisory Committee

Management, 41 CFR part 101–6, which

further requires publication at least 15

calendar days prior to the meeting of the

Task Force on November 15–16, 2000.

Persons interested in further

information should call Commander

Brian D. Hughes, USN, at (703) 695–

4157.