In accordance with Title 10,
United States Code (USC), Section 1079(i)(2), the amount to be paid
to hospitals, Skilled Nursing Facilities (SNFs), and other institutional
providers under the TRICARE program, “shall be determined to the extent
practicable in accordance with the same reimbursement rules as apply
to payments to providers of services of the same type under Medicare.”
This statutory authority has been implemented through an Interim
Final Rule (IFR) with Request for Comment, published in the
Federal
Register on September 3, 2020, amending the TRICARE regulation
by adding
32 CFR 199.14(a)(1)(iii)(E)(5) to
allow adoption of Medicare NTAP payment adjustments to TRICARE DRG
reimbursements. Under the amended TRICARE regulation, any Medicare
approved NTAP reimbursement of hospitals subject to the Medicare
program as required under 42 CFR 412.88 will be adopted or adopted
as modified for TRICARE unless the Assistant Secretary of Defense
for Health Affairs (ASD(HA)) determines that it is not practicable
for TRICARE to adopt the Medicare NTAP. The Director, Defense Health
Agency will issue necessary guidance regarding any Medicare NTAP
not adopted by the ASD(HA) or any modification of a Medicare NTAP
deemed necessary for adoption by TRICARE.
4.1 Payment
Method
4.1.1 NTAP payment adjustments apply
for discharges on or after January 1, 2020.
4.1.2 The contractor
shall reimburse hospitals subject to NTAPs using the list of NTAPs
and reimbursement rules in the current Fiscal Year (FY) IPPS Final
Rule Home Page found on the CMS website. The reimbursement amounts
in the current FY IPPS Final rule represent the maximum add on payment
that will be provided for each NTAP.
4.1.3 The contractor
shall determine each procedure code eligible for an NTAP payment
according to 42 CFR 412.87, which provides the reference to the
most recent
Federal Register with a list of approved
NTAPs and the procedure codes used to identify use of the technology.
Each year in the IPPS Final Rule, the list of NTAPs is updated by
CMS.
4.1.3.1 The contractor shall maintain
a list of procedure codes eligible for NTAP payments.
4.1.3.2 The contractor shall update
the list of procedure codes eligible for NTAPs within ten business
days of publication by CMS.
4.1.4 The contractor
shall also determine the maximum NTAP payment amount for each technology according
to 42 CFR 412.87, which provides the reference to the most recent
Federal
Register with the maximum payment for each approved NTAP.
Each year the maximum NTAP payment amounts are updated by CMS.
4.1.4.1 The contractor shall maintain
a list of the maximum NTAP payment amounts for each technology.
4.1.4.2 The contractor shall update
the list of the maximum NTAP payment amounts for each technology within
ten business days of publication by CMS.
4.1.5 The contractor
shall apply the separate NTAP payment using the appropriate formula
from the IPPS Final Rule and as documented in 42 CFR 412.88. The
contractor shall calculate for each eligible NTAP case on a claim,
the appropriate NTAP payment, where the payment rate is equal to
the lesser of:
• The designated percentage of
the amount by which the total covered costs of the case exceed the
Medicare Severity (MS)-DRG payment, as determined by CMS, as published
in the current FY IPPS Final Rule, or
• The maximum NTAP payment amount
for the specific technology, as determined by CMS.
The resulting NTAP amount shall
then be reimbursed in addition to the MS-TRICARE DRG payment amount.