Any drug, device, or medical therapy or process, the security and efficacy of which have not been established, as described in this paragraph , is unproved and cannot be cost-shared by CHAMPUS except as approved beneath paragraph 199.4 of this part. Therapeutic absences from an inpatient facility, except when such absences are specifically included in a remedy plan permitted by the Director, OCHAMPUS, or a designee. For cost-sharing provisions check with § 199.14, paragraph . Services and supplies associated to inpatient stays in hospitals or different approved institutions above the suitable level required to offer essential medical care.


CHAMPUS will adjust the labor portion of the standardized amounts in accordance with the hospital’s area wage index. The wage adjusted DRG cost may also be multiplied by 1.2 for a person identified with COVID-19 and/or Coronavirus discharged during the Secretary of Health and Human Services’ declared public health emergency . Any discharge with a length-of-stay less than 1.94 commonplace deviations from the DRG’s arithmetic LOS shall be categorized as a short-stay outlier. Short-stay outliers shall be reimbursed at 200 percent of the per diem fee for the DRG for each coated day of the hospital keep, to not exceed the DRG quantity. The per diem price shall equal the DRG amount divided by the arithmetic mean length-of-stay for the DRG. The preliminary standardized amounts, updated for inflation, shall be divided by a system standardization factor in order that whole DRG outlays, given the database distribution across hospitals and analysis, are equal to the entire charges reduced to prices.

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