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 Code of Federal Regulations (CFR)
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,
DHA 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 (FR) Home Page found on the CMS website.
The reimbursement amounts in the current FY IPPS FR represent
the maximum add on payment 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
FR 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 FR, 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.