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.