2.1 Information
provided by DHA. The following specific data, which is necessary
to determine the payment amount under the TRICARE DRG-based payment
system, will be provided to the contractors by DHA. Updates to these
data will be provided
in accordance with the TRICARE
Program plan year.
2.1.1 DRG weighting factors.
2.1.2 Adjusted Standardized
Amounts (ASAs) (urban and rural), including the labor-related and nonlabor-related
portions.
2.1.3 Area
wage indexes.
2.1.4 Outlier cutoffs for each DRG.
2.1.5 Geometric mean
Length-Of-Stay (LOS) for each DRG.
2.1.6 Per diem cost-share for beneficiaries other
than dependents of active duty members.
2.1.7 Children’s hospital differentials (national
and hospital-specific).
2.1.8 The ratio of interns and residents to beds
for those hospitals subject to the Medicare Prospective Payment
System (PPS), as listed in Centers for Medicare and Medicaid Services’
(CMSs’) most recently available Provider Specific File.
2.1.9 The Indirect
Medical Education (IDME) factors for all hospitals subject to the
TRICARE DRG-based payment system.