60660 Federal Register / Vol. 72, No. 206 / Thursday, October 25, 2007 / Notices 

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.’’

B. Wage Index and Medicare 

Geographic Classification Review Board 

Guidelines 

TRICARE will continue to use the 

same wage index amounts used for the 

Medicare Prospective Payment System 

(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 the Centers for 

Medicare and Medicaid Services’ (CMS) 

percentage of labor related share of the 

standardized amount. For wage index 

values greater than 1.0, the labor related 

portion of the Adjusted Standardized 

Amount (ASA) shall equal 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’s August 22, 2007, 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 

passthrough basis), we will use the FY 

2007 (published in CMS’ August 18, 

2006) fixed loss cost outlier threshold 

calculated by CMS for paying cost 

outliers in the absence of capital 

prospective payments. For TRICARE’s 

FY 2008 update, 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 

2008, 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 $22,649 (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 2008 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 2008 is 1.02. 

H. Expansion of the Post-Acute Care 

Transfer Policy 

For FY 2008, TRICARE continues to 

use the post-acute care transfer policy 

that was published in CMS’ final rule on 

August 18, 2006. 

I. Blood Clotting Factor 

For FY 2008, 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 

2008, the cost-to-charge ratio used for 

the TRICARE DRG-based payment 

system for acute care hospitals and 

neonates will be 0.3818 which is 

increased to 0.3888 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 0.4198. 

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 2008 and which is a result of 

the changes described above. The 

implementing regulations for the 

TRICARE/CHAMPUS DRG-based 

payment system are in 32 CFR Part 199. 

Dated: October 19, 2007. 

L.M. Bynum, 

Alternate OSD Federal Register Liaison 

Officer, Department of Defense. 

[FR Doc. E7–21014 Filed 10–24–07; 8:45 am] 

BILLING CODE 5001–06–P 

DEPARTMENT OF DEFENSE 

Office of the Secretary 

Notice of closed meeting 

AGENCY: Defense Intelligence Agency, 

National Defense Intelligence College. 

ACTION: Notice of closed meeting. 

SUMMARY: Pursuant to the provisions of 

Subsection (d) of section 10 of Public 

Law 92–463, as amended by section 5 of 

Public Law 94–409, notice is hereby 

given that a closed meeting of the DIA 

National Defense Intelligence College 

Board of Visitors has been scheduled as 

follows: 

DATES: Tuesday, 8 January 2008, 0800 to 

1700; and Wednesday, 9 January 2008, 

0800 to 1200. 

ADDRESSES: National Defense 

Intelligence College, Washington, DC 

20340–5100. 

FOR FURTHER INFORMATION CONTACT: Mr. 

A. Denis Clift, President, DIA National 

Defense Intelligence College, 

Washington, DC 20340–5100 (202/231–

3344). 

SUPPLEMENTARY INFORMATION: The entire 

meeting is devoted to the discussion of 

classified information as defined in 

section 552b(c)(1), Title 5 of the U.S. 

Code and therefore will be closed. The 

Board will discuss several current 

critical intelligence issues and advise 

the Director, DIA, as to the successful 

accomplishment of the mission assigned 

to the National Defense Intelligence 

College. 

mstockstill on PROD1PC66 with NOTICES

Federal Register / Vol. 72, No. 206 / Thursday, October 25, 2007 / Notices 60661 

Dated: October 19, 2007. 

L.M. Bynum, 

OSD Federal Register, Liaison Officer, DOD. 

[FR Doc. 07–5275 Filed 10–24–07; 8:45 am] 

BILLING CODE 5001–06–M 

DEPARTMENT OF DEFENSE 

Department of the Army 

Notice of Availability of the Final 

Programmatic Environmental Impact 

Statement (PEIS) for Army Growth and 

Force Structure Realignment 

AGENCY: Department of the Army, DoD. 

ACTION: Notice of availability (NOA). 

SUMMARY: The Department of the Army 

announces the availability of the Final 

PEIS for the growth and realignment of 

the U.S. Army. Pursuant to the National 

Environmental Policy Act (NEPA), the 

Department of the Army has prepared a 

PEIS that evaluates the potential 

environmental and socioeconomic 

effects associated with alternatives for 

growing and realigning the Army’s force 

structure. The Army’s preferred 

alternative identified in the Final PEIS 

is Alternative 3 which will allow the 

Army to grow and restructure its forces 

to accommodate modular forces 

initiatives and critical shortfalls, while 

adding six Brigade Combat Teams 

(BCTs) to the Army’s end strength. 

Potential impacts have been analyzed at 

installations that are being considered 

for the stationing of 1,000 or more 

additional Soldiers. 

DATES: The waiting period for the final 

PEIS will end 30 days after publication 

of an NOA in the Federal Register by 

the U.S. Environmental Protection 

Agency. 

ADDRESSES: To obtain a copy of the 

Final PEIS contact: Public Affairs Office, 

U.S. Army Environmental Command, 

Building E4460, Attention: IMAE–PA 

5179 Hoadley Road, Aberdeen Proving 

Ground, MD 21010–5401. Questions 

may also be sent to: 

PublicComments@aec.apgea.army.mil. 

FOR FURTHER INFORMATION CONTACT: 

Public Affairs Office at (410) 436–2556; 

facsimile at (410) 436–1693 (during 

normal business hours Monday through 

Friday). 

SUPPLEMENTARY INFORMATION: The 

Proposed Action and analysis within 

the Final PEIS covers those activities 

needed to increase the Army’s end 

strength and realign its force structure 

from Fiscal Year 2008 through Fiscal 

Year 2013 to a size and composition that 

is better able to meet national security 

and defense requirements. The 

Proposed Action involves stationing 

decisions to align Army forces in 

support of military transformation, unit 

equipment and training readiness, and 

Soldier and Family quality of life needs. 

To implement the Proposed Action, new 

units must be stationed at locations that 

are able to accommodate unit training, 

garrison operations, maintenance 

activities, and Soldiers and their 

Families. In addition, final stationing 

locations must support the strategic 

deployment and mobilization 

requirements of the nation’s Combatant 

Commanders to ensure they will have 

the forces necessary to support regional 

contingency operations and planning 

requirements. 

The Final PEIS examines major Army 

training installations and their ability to 

support new unit stationing actions in 

connection with the growth and 

realignment of the U.S. Army. The Final 

PEIS provides the Army senior 

leadership with a hard look at 

environmental and socioeconomic 

impacts associated with the Proposed 

Action and informs the decision-making 

process for selecting the final stationing 

locations for new units. This effort 

includes analysis of specific actions that 

will need to be taken (such as the 

construction of housing and quality of 

life facilities, the construction of new 

training ranges and infrastructure, and 

changes in the intensity of use of 

maneuver land and firing ranges) to 

station new units as part of the Army’s 

overall efforts to grow and realign the 

force. 

After reviewing a full range of 

alternative sites, 17 installations capable 

of supporting the Army’s growth and 

realignment have been evaluated for 

their ability to support three action 

alternatives. The installations carried 

forward for analysis included: Georgia: 

Fort Benning and Fort Stewart; Texas: 

Fort Bliss and Fort Hood: North 

Carolina: Fort Bragg; Kentucky: Fort 

Campbell and Fort Knox; Colorado: Fort 

Carson; New York: Fort Drum; 

California: Fort Hunter-Liggett and Fort 

Irwin; Washington: Fort Lewis and 

Yakima Training Center; Louisiana: Fort 

Polk; Kansas: Fort Riley; New Mexico: 

White Sands Missile Range; Arizona: 

Yuma Proving Ground. Each of these 

installations could receive 1,000 or 

more additional soldiers as part of 

alternatives being examined. 

Alternatives carried forward for 

analysis in the Final PEIS included: (1) 

Implementing Army force structure 

modifications between Fiscal Year 2008 

and Fiscal Year 2013 to support the 

Army’s Modular Transformation and 

Global Defense Posture Review (GDPR) 

decisions; (2) Executing those actions 

discussed as part of Alternative 1 and, 

in addition, adding approximately 

30,000 Combat Support (CS) and 

Combat Service Support (CSS) soldiers 

to the Army to address critical shortfalls 

in high demand military skills in both 

Active Army and Reserve components; 

(3) Executing those actions proposed in 

Alternatives 1 and 2 and, in addition, 

grow the Army by up to six Active Duty 

BCTs. Additional BCTs would be 

stationed at existing or newly 

established Army stationing locations 

within the continental United States. In 

addition to these alternatives, the No 

Action Alternative is described and its 

impacts are fully assessed and 

considered. 

The Army’s preferred alternative 

identified in the Final PEIS is to 

implement Alternative 3. This 

alternative allows for full support of 

Army modularity initiatives by adding 

necessary CS Soldiers to the Army’s 

Active and Reserve components while 

increasing the size of the Army by six 

BCTs. Analysis within the Final PEIS 

covers those activities required to 

implement unit stationing actions 

associated with Army growth and 

realignment. 

Site-specific action that will need to 

be taken to support the preferred 

alternative include the construction of 

housing and quality of life facilities (i.e., 

gymnasiums, hospitals, shopping areas), 

the construction of new training ranges 

and infrastructure, and changes in the 

intensity of use of maneuver land and 

firing ranges associated with the 

increased frequency of training events. 

Stationing decisions made as part of this 

effort will also consider strategic 

military and national security 

considerations. New stationing actions 

must take place at locations that, if 

selected, are capable of supporting the 

National Security Strategy (2006), the 

Quadrennial Defense Review (QDR 

2006), National Military Strategy, and 

the Army Campaign Plan (ACP). 

Direct, indirect, and cumulative 

impacts of the Proposed Action have 

been considered in the Final PEIS and 

identification of the environmental and 

socioeconomic impacts associated with 

various unit stationing actions at each of 

the 17 installations was carried forward 

for analysis. Impacts at sites would 

result from construction and training 

activities related to the growth and 

realignment of Army forces. Significant 

impacts to resources could be direct and 

long term. Decisions from the PEIS will 

be tiered into site-specific NEPA 

analyses at the installation level, as 

specific stationing decisions are 

determined. The Final PEIS provides 

Army planners and decision makers 

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