Temporary transitional payment adjustments might be in place for all hospitals, each network and non-network, so as to buffer the preliminary decline in payments upon implementation of TRICARE’s OPPS. While TRICARE intends to remain as true as possible to Medicare’s basic OPPS methodology, there shall be some deviations required to accommodate TRICARE’s unique profit construction and beneficiary inhabitants as authorized under the provisions of 10 U.S.C. 1079. The allowed charge relevant to the citizens of the neighborhood or state as established by native or state regulatory authority, excluding title XIX of the Social Security Act or different welfare program, when extended to CHAMPUS beneficiaries by consent or agreement. Prior to implementation of the SCH reimbursement technique described in paragraph of this part, any hospital that has certified for particular therapy beneath the Medicare prospective fee system as an SCH and has not given up that classification is exempt. The hospital-specific per diems and the regional per diems calculated for the bottom period pursuant to paragraphs of this section shall remain in impact for federal fiscal yr 1989; there might be no further replace for fiscal yr 1989. The similar area wage indexes used for the CHAMPUS DRG-based cost system (see paragraph of this section) shall be utilized to the wage portion of the applicable regional per diem fee for every day of the admission.

Leave a Reply