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Notice

Cost of Hospital and Medical Care Treatment Furnished by the United States; Certain Rates Regarding Recovery From Tortiously Liable Third Persons

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Information about this document as published in the Federal Register.

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Start Preamble

By virtue of the authority vested in the President by section 2(a) of Public Law 87-693 (76 Stat. 593; 42 U.S.C. 2652), and delegated to the Director of the Office of Management and Budget by Executive Order No. 11541 of July 1, 1970 (35 FR 10737), the two sets of rates outlined below are hereby established. These rates are for use in connection with the recovery, from tortiously liable third persons, of the cost of hospital and medical care and treatment furnished by the United States (Part 43, Chapter I, Title 28, Code of Federal Regulations) through three separate Federal agencies. The rates have been established in accordance with the requirements of OMB Circular A-25, requiring reimbursement of the full cost of all services provided and will remain in effect until further notice. The rates for VA that were published in the Federal Register on October 31, 2000 remain in effect until further notice. The rates are as follows:

1. Department of Defense

The Department of Defense (DoD) reimbursement rates for inpatient, outpatient, and other services are provided in accordance with Title 10, United States Code, section 1095. Due to size, the sections containing the Drug Reimbursement Rates (section III.D.) and the rates for Ancillary Services Requested by Outside Providers (section III.E.) are not included in this package. Those rates are available from the TRICARE Management Activity's Uniform Business Office web site: http://www.tricare.osd.mil/​ebc/​rm_​home/​imcp/​ubo/​ubo_​01.htm. The medical and dental service rates in this package (including the rates for ancillary services and other procedures requested by outside providers) are effective October 1, 2001. Pharmacy rates are updated on an as needed basis.

2. Health and Human Services

The tortiously liable rates for Indian Health Service health facilities are based on Medicare cost reports. The obligations for the Indian Health Service hospitals participating in the cost report project were identified and combined with applicable obligations for area offices costs and headquarters costs. The hospital obligations were summarized for each major cost center providing medical services and distributed between inpatient and outpatient. Total inpatient costs and outpatient costs were then divided by the relevant workload statistic (inpatient day, outpatient visit) to produce the inpatient and outpatient rates. In calculation of the rates, the Department's unfunded retirement liability cost and capital and equipment depreciation costs were incorporated to conform to requirements set forth in OMB Circular A-25.

In addition, the obligations for each cost center include obligations from certain other accounts, such as Medicare and Medicaid collections and the Contract Health fund, that were used to support the inpatient and outpatient workload. Obligations were excluded for certain cost centers that primarily support workloads outside of the directly operated hospitals or clinics (public health nursing, public health nutrition, health education). These obligations are not a part of the traditional cost of hospital operations and do not contribute directly to the inpatient and outpatient visit workload.

Separate rates per inpatient day and outpatient visit were computed for Alaska and the rest of the United States. Start Printed Page 66478This gives proper weight to the higher cost of operating medical facilities in Alaska.

1. Department of Defense

For the Department of Defense, effective October 1, 2001 and thereafter:

Inpatient, Outpatient and Other Rates and Charges

I. Inpatient Rates 1 2

Per inpatient dayInternational military education & training (IMET)Interagency & other Federal agency sponsored patientsOther (full/third party)
A. Burn Center$3,550.00$6,156.00$6,492.00
B. All Other Inpatient Services (Based on Diagnosis Related Groups (DRG) 3

1. Average FY 2002 Direct Care Inpatient Reimbursement Rates

Adjusted standard amountIMETInteragencyOther (full/third party)
Large Urban$3,625.00$6,170.00$6,486.00
Other Urban/Rural3,771.006,694.007,069.00
Overseas3,958.009,293.009,742.00

2. Overview

The inpatient rates are based on the cost per DRG, which is the inpatient full reimbursement rate per hospital discharge weighted to reflect the intensity of the principal diagnosis, secondary diagnoses, procedures, patient age, etc. involved. The average cost per Relative Weighted Product (RWP) for large urban, other urban/rural, and overseas facilities will be published annually as an inpatient adjusted standardized amount (ASA) (see paragraph I.B.1, above). The ASA will be applied to the RWP for each inpatient case, determined from the DRG weights, outlier thresholds, and payment rules published annually for hospital reimbursement rates under the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) pursuant to 32 CFR 199.14(a)(1), including adjustments for length of stay (LOS) outliers. An outlier refers to a patient's LOS, which is either atypically short or long. They are determined by short or long stay outlier thresholds. Inliers, i.e., those patients who fall within the bounds of the outlier thresholds, receive DRG weights that represent their relative resource intensity.

Each Military Treatment Facility (MTF) providing inpatient care has a separate ASA rate. The MTF-specific ASA rate is the published ASA rate adjusted for area wage differences and indirect medical education (IME) for the discharging hospital (see Attachment 1). The MTF-specific ASA rate submitted on the claim is the rate that payers will use for reimbursement purposes. An example of how to apply a specific military treatment facility's ASA rate to a DRG standardized weight to arrive at the costs to be recovered is contained in paragraph I.B.3. below.

3. Example of Adjusted Standardized Amounts for Inpatient Stays

Figure 1 shows examples for a non-teaching hospital (Reynolds Army Community Hospital) in Other Urban/Rural areas.

a. The cost to be recovered is the MTF cost for medical services provided. Billings will be at the third party rate.

b. DRG 020: Nervous System Infection Except Viral Meningitis. The RWP (i.e. the DoD measure of workload credit derived from biometrics dispositions weighted by CHAMPUS DRG weights) for an inlier case is the CHAMPUS weight of 2.0860. (DRG statistics shown are from FY 2000.)

c. The MTF-applied ASA rate is $6,849.00 (Reynolds Army Community Hospital's third party rate as shown in Attachment 1).

d. The MTF cost to be recovered is the RWP factor (2.0860) in subparagraph 3.b., above, multiplied by the amount ($6,849.00) in subparagraph 3.c., above which equals $14,287.00

e. Cost to be recovered is $14,287.00.

Figure 1.—Third Party Billing Examples

DRG No.DRG descriptionDRG weightArithmetic mean LOSGeometric mean LOSShort stay thresholdLong stay threshold
020Nervous System Infection Except Viral Meningitis2.08607.75.5129
HospitalLocationArea wage rate indexIME adjustmentGroup ASAMTF-Applied ASA
Reynolds Army Community HospitalOther Urban/Rural.89961.0$7,069.00$6,849.00
PatientLength of stayDays above thresholdRelative weighted productTPC
Inlier *Outlier **TotalAmount ***
#17 days02.08600002.0860$14,287.00
#221 days02.08600002.086014,287.00
Start Printed Page 66479
#335 days62.0860.75102.837019,431.00
 * DRG Weight
 ** Outlier calculation = 33 percent of per diem weight X number of outlier days. The outlier must meet the criteria determined by the outlier threshold, i.e., the number of days beyond which hospitalization LOS is considered outside the typical range. These are specific for each DRG.
  =.33 (DRG Weight/Geometric Mean LOS) × (Patient LOS−Long Stay Threshold)
  =.33 (2.0860/5.5) × (35 - 29)
  =.33 (.37927) × 6 (take out to five decimal places)
  =.12516 X 6 (carry to five decimal places)
  =.7510 (carry to four decimal places)
 *** MTF-Applied ASA × Total RWP

II. Outpatient Rates

A. Per Clinic Visit12

MEPRS Code 4Clinical serviceInternational military education & training (IMET)Interagency & other federal agency sponsored patientsOther (full/third party)
1. Medical Care
BAAInternal Medicine$50.00$199.00$210.00
BABAllergy61.00113.00119.00
BACCardiology107.00199.00209.00
BAEDiabetic74.00137.00144.00
BAFEndocrinology (Metabolism)124.00231.00243.00
BAGGastroenterology146.00272.00286.00
BAHHematology225.00419.00442.00
BAIHypertension198.00369.00388.00
BAJNephrology180.00334.00352.00
BAKNeurology136.00254.00267.00
BALOutpatient Nutrition51.0095.00100.00
BAMOncology158.00294.00310.00
BANPulmonary Disease144.00267.00281.00
BAORheumatology116.00216.00228.00
BAPDermatology93.00172.00182.00
BAQInfectious Disease151.00282.00297.00
BARPhysical Medicine94.00175.00184.00
BASRadiation Therapy142.00264.00278.00
BATBone Marrow Transplant154.00287.00302.00
BAUGenetic343.00639.00673.00
BAVHyperbaric276.00513.00540.00
2. Surgical Care
BBAGeneral Surgery162.00302.00318.00
BBBCardiovascular and Thoracic Surgery291.00541.00570.00
BBCNeurosurgery169.00314.00331.00
BBDOphthalmology106.00198.00209.00
BBEOrgan Transplant717.001,335.001,406.00
BBFOtolaryngology117.00217.00229.00
BBGPlastic Surgery134.00249.00262.00
BBHProctology95.00177.00186.00
BBIUrology131.00244.00257.00
BBJPediatric Surgery72.00133.00140.00
BBKPeripheral Vascular Surgery83.00155.00163.00
BBLPain Management113.00210.00222.00
BBMVascular and Interventional Radiology351.00653.00688.00
3. Obstetrical and Gynecological (OB-GYN) Care
BCAFamily Planning75.00139.00146.00
BCBGynecology98.00182.00191.00
BCCObstetrics78.00145.00153.00
BCDBreast Cancer Clinic147.00274.00289.00
4. Pediatric Care
BDAPediatric71.00133.00140.00
BDBAdolescent75.00139.00146.00
BDCWell Baby49.0091.0096.00
Start Printed Page 66480
5. Orthopaedic Care
BEAOrthopaedic112.00208.00219.00
BEBCast63.00117.00123.00
BECHand Surgery60.00112.00118.00
BEEOrthotic Laboratory72.00134.00141.00
BEFPodiatry63.00117.00124.00
BEZChiropractic30.0056.0058.00
6. Psychiatric and/or Mental Health Care
BFAPsychiatry121.00226.00238.00
BFBPsychology75.00140.00148.00
BFCChild Guidance71.00132.00139.00
BFDMental Health118.00219.00231.00
BFESocial Work113.00211.00222.00
BFFSubstance Abuse110.00206.00216.00
7. Family Practice/Primary Medical Care
BGAFamily Practice84.00156.00165.00
BHAPrimary Care82.00152.00160.00
BHBMedical Examination82.00152.00160.00
BHCOptometry57.00106.00112.00
BHDAudiology48.0090.0094.00
BHESpeech Pathology91.00169.00178.00
BHFCommunity Health67.00125.00131.00
BHGOccupational Health90.00167.00176.00
BHHTRICARE Outpatient58.00108.00114.00
BHIImmediate Care113.00211.00222.00
8. Emergency Medical Care
BIAEmergency Medical142.00264.00278.00
9. Flight Medical Care
BJAFlight Medicine98.00183.00192.00
10. Underseas Medical Care
BKAUnderseas Medicine57.00107.00113.00
11. Rehabilitative Services
BLAPhysical Therapy43.0081.0085.00
BLBOccupational Therapy87.00162.0070.00

B. Ambulatory Procedure Visit (APV)—Per Visit5

MEPRS Code 4Clinical ServiceInternational Military Education & Training (IMET)Interagency & Other Federal Agency Sponsored PatientsOther (Full/Third Party)
BBSurgical Care1,068.001,987.002,093.00
BEOrthopaedic Care1,315.002,448.002,577.00
All OtherB clinics other than BB and BE, to include those B clinics where: 1. There is an APU established within DoD guidelines AND 2. There is a rate established for that clinic in section IIA. Some B clinics, such as BF, BI, BJ and BL, perform the type of services where the establishment of an APU would not be within appropriate clinical guidelines297.00553.00582.00
Start Printed Page 66481

III. Other Rates and Charges 1 2

A. Per Each

MEPRS code 4Clinical serviceInternational military education & training (IMET)Interagency & other Federal agency sponsored patientsOther (full/third party)
FBIImmunization$18.00$34.00$36.00
B. Family Member Rate (formerly Military Dependents Rate)11.90
C. Subsistence Rate.15
 Standard Rate8.10
 Discount Rate6.75

D. Reimbursement Rates For Drugs Requested By Outside Providers 6

E. Ancillary Services Requested by an Outside Provider—Per Procedure 7

MEPRS code 4Clinical serviceInternational military education & training (IMET)Interagency & other Federal agency sponsored patientsOther (full/third party)
DBLaboratory procedures requested by an outside provider current procedural terminology (CPT) 2001 weight multiplier$19.00$28.00$29.00
DC, DIRadiology procedures requested by an outside provider CPT 2001 weight multiplier38.0054.0057.00

F. Dental Rate—Per Procedure 11

MEPRS code 4Clinical serviceInternational military education & training (IMET)Interagency & other Federal agency sponsored patientsOther (full/third party)
Dental services ADA code weight multiplier$31.00$73.00$77.00

G. Ambulance Rate—Per Hour 12

MEPRS code 4Clinical serviceInternational military education & training (IMET)Interagency & other Federal agency sponsored patientsOther (full/third party)
FEAAmbulance$67.00$124.00$131.00

H. AirEvac Rate—Per Trip (24 hour period) 13

MEPRS code 4Clinical serviceInternational military education & training (IMET)Interagency & other Federal agency sponsored patientsOther (full/third party)
AirEvac Services—Ambulatory$257.00$479.00$505.00
AirEvac Services—Litter751.001,397.001,471.00

I. Observation Rate—Per hour 14

MEPRS code 4Clinical serviceInternational military education & training (IMET)Interagency & other Federal agency sponsored patientsOther (full/third party)
Observation Services—Hour$13.00$24.00$26.00
Start Printed Page 66482

IV. Elective Cosmetic Surgery Procedures and Rates

Cosmetic surgery procedureInternational classification diseases (ICD-9)Current procedural terminology (CPT) 8FY 2002 charge 9Amount of Charge
Mammaplasty—augmentation85.50, 85.32, 85.3119325, 19324, 19318Inpatient Charge per DRG or APV(a) (b)
Mastopexy85.6019316Inpatient Charge per DRG Or APV or applicable Outpatient Clinic Rate(a b c)
Facial Rhytidectomy86.82, 86.2215824Inpatient Charge per DRG or APV(a b)
Blepharoplasty08.70, 08.4415820, 15821, 15822, 15823Inpatient Charge per DRG or APV or applicable Outpatient Clinic Rate(a b c)
Mentoplasty (Augmentation/Reduction)76.68, 76.6721208, 21209Inpatient Charge per DRG or APV or applicable Outpatient Clinic Rate(a b c)
Abdominoplasty86.8315831Inpatient Charge per DRG or APV or applicable Outpatient Clinic Rate(a b c)
Lipectomy Suction per region 1086.8315876, 15877, 15878, 15879Inpatient Charge per DRG or APV or applicable Outpatient Clinic Rate
Rhinoplasty21.87, 21.8630400, 30410Inpatient Charge per DRG Or APV or applicable Outpatient Clinic Rate(a b c)
Scar Revisions beyond CHAMPUS86.841578Inpatient Charge per DRG or APV or applicable Outpatient Clinic Rate(a b c)
Mandibular or Maxillary Repositioning76.4121194Inpatient Charge per DRG or APV or applicable Outpatient Clinic Rate(a b c)
Dermabrasion86.2515780Inpatient Charge per DRG or APV or applicable Outpatient Clinic Rate(a b c)
Hair Restoration86.6415775Inpatient Charge per DRG or APV or applicable Outpatient Clinic Rate(a b c)
Removing Tattoos86.2515780Inpatient Charge per DRG or APV or applicable Outpatient Clinic Rate(a b c)
Chemical peel86.2415790Inpatient charge per DRG or APV or applicable Outpatient clinic rate(a b c)
Arm/thigh dermolipectomy86.8315836/15832Inpatient charge per DRG or APV(a b)
Refractive surgeryAPV or applicable outpatient clinic rate(b c e)
Radial keratotomy65771
Other procedure (if applies to laser or other refractive surgery)66999
Otoplasty69300APV or applicable outpatient clinic rate(b c)
Brow lift86.315839Inpatient charge per DRG or APV or applicable outpatient clinic rate(a b c)

Notes on Cosmetic Surgery Charges

a Charges for Inpatient surgical care services are based on the cost per DRG. (See notes 8 through 10, below, for further details on reimbursable rates.)

b Charges for ambulatory procedure visits (formerly same day surgery) are listed in section II.B. (See notes 8 through 10, below, for further details on reimbursable rates.) The ambulatory procedure visit (APV) rate is used if the elective cosmetic surgery is performed in an ambulatory procedure unit (APU).

c Charges for outpatient clinic visits are listed in sections II.A. The outpatient clinic rate is not used for services provided in an APU. The APV rate should be used in these cases.

d Charge is solely determined by the location of where the care is provided and is not to be based on any other criteria. An APV rate can only be billed if the location has been established as an APU following all required DoD guidelines and instructions.

e Refer to Office of the Assistant Secretary of Defense (Health Affairs) policy on Vision Correction Via Laser Surgery For Non-Active Duty Beneficiaries, April 7, 2000, for further guidance on billing for these services. It can be downloaded from: http://www.tricare.osd.mil/​policy/​2000poli.htm.

Notes on Reimbursable Rates

1 Percentages can be applied when preparing bills for both inpatient and outpatient services. Pursuant to the provisions of 10 U.S.C. 1095, the inpatient Diagnosis Related Groups and inpatient per diem percentages are 96 percent hospital and 4 percent professional charges. The outpatient per visit percentages are 89 percent outpatient services and 11 percent professional charges.

2 DoD civilian employees located in overseas areas shall be rendered a bill when services are performed.

3 The cost per Diagnosis Related Group (DRG) is based on the inpatient full reimbursement rate per hospital discharge, weighted to reflect the intensity of the principal and secondary diagnoses, surgical procedures, and patient demographics involved. The adjusted standardized amounts (ASA) per Relative Weighted Product (RWP) for use in the direct care system is comparable to procedures used by the Centers for Medicare and Medicaid Services (CMS) and the Civilian Health and Medical Program for the Uniformed Services (CHAMPUS). These expenses include all direct care expenses associated with direct patient care. The average cost per RWP for large urban, other urban/rural, and overseas will be published annually as an adjusted standardized amount (ASA) and will include the cost of inpatient professional services. The DRG rates will apply to reimbursement from all sources, not just third party payers.

MTFs without inpatient services, whose providers are performing inpatient care in a civilian facility for a DoD beneficiary, can bill payers the percentage of the charge that represents professional services as provided in1 above. The ASA rate used in these cases, based on the absence of a ASA rate for the facility, will be based on the average ASA rate for the type of metropolitan statistical area the MTF resides, large urban, other urban/rural, or overseas (see paragraph I.B.1.). The Uniform Business Office must receive documentation of care provided in order to produce a bill.

4 The Medical Expense and Performance Reporting System (MEPRS) code is a three digit code which defines the summary account and the subaccount within a functional category in the DoD medical system. MEPRS codes are used to ensure that consistent expense and operating performance data is reported in the DoD military medical system. An example of the MEPRS hierarchical arrangement follows: Start Printed Page 66483Outpatient Care (Functional Category), B (MEPRS CODE), Medical Care (Summary Account), BA (MEPRS CODE), Internal Medicine (Subaccount), BAA (MEPRS CODE).

5 Ambulatory procedure visit is defined in DoD Instruction 6025.8, “Ambulatory Procedure Visit (APV),” dated September 23, 1996, as immediate (day of procedure) pre-procedure and immediate post-procedure care requiring an unusual degree of intensity and provided in an ambulatory procedure unit (APU). An APU is a location or organization within an MTF (or freestanding outpatient clinic) that is specially equipped, staffed, and designated for the purpose of providing the intensive level of care associated with APVs. Care is required in the facility for less than 24 hours. All expenses and workload are assigned to the MTF-established APU associated with the referring clinic. The BB and BE APV rates are to be used only by clinics that are subaccounts under these summary accounts (see4 for an explanation of MEPRS hierarchical arrangement). The All Other APV rate is to be used only by those clinics that are not a subaccount under BB or BE. In addition, APV rates may only be utilized for clinics where there is a clinic rate established. For example, BLC, Neuromuscular Screening, no longer has an established rate. Therefore, an APU cannot be defined and an APV cannot be billed for this clinic.

6 Third party payers (such as insurance companies) shall be billed for prescription services when beneficiaries who have medical insurance obtain medications from MTFs that are prescribed by providers external to the MTF (e.g., physicians and dentists). Eligible beneficiaries (family members or retirees with medical insurance) are not liable personally for this cost and shall not be billed by the MTF. Medical Services Account (MSA) patients, who are not beneficiaries as defined in 10 U.S.C. 1074 and 1076, are charged at the “Other” rate if they are seen by an outside provider and only come to the MTF for prescription services. The standard cost of medications ordered by an outside provider includes the DoD-wide average cost of the drug, calculated by lowest cost for the generic drugs with the same dosage and strength. The prescription charge is calculated by multiplying the number of units (e.g., tablets or capsules) by the unit cost and adding $6.00 for the cost of dispensing the prescription. Dispensing costs include overhead, supplies, and labor, etc. to fill the prescription.

The list of drug reimbursement rates is too large to include in this document. Those rates are available from the TRICARE Management Activity's Uniform Business Office web site, http://www.tricare.osd.mil/​ebc/​rm_​home/​imcp/​ubo/​ubo_​01.htm.

7 The list of rates for ancillary services requested by outside providers and obtained at a Military Treatment Facility is too large to include in this document. Those rates are available from the TRICARE Management Activity's Uniform Business Office website, http://www.tricare.osd.mil/​ebc/​rm_​home/​imcp/​ubo/​ubo_​01.htm.

Charges for ancillary services requested by an outside provider (e.g., physicians and dentists) are relevant to the Third Party Collection Program. Third party payers (such as insurance companies) shall be billed for ancillary services when beneficiaries who have medical insurance obtain services from the MTF which are prescribed by providers external to the MTF. Laboratory and Radiology procedure costs are calculated by multiplying the DoD-established weight for the Physicians' Current Procedural Terminology (CPT) 2001 code by either the laboratory or radiology multiplier (section III.E.). Radiology procedures performed by Nuclear Medicine use the same methodology as Radiology for calculating a charge because their workload and expenses are included in the establishment of the Radiology multiplier.

Eligible beneficiaries (family members or retirees with medical insurance) are not personally liable for this cost and shall not be billed by the MTF. MSA patients, who are not beneficiaries as defined by 10 U.S.C. 1074 and 1076, are charged at the “Other” rate if they are seen by an outside provider and only come to the MTF for ancillary services.

8 The attending physician is to complete the CPT 2001 code to indicate the appropriate procedure followed during cosmetic surgery. The appropriate rate will be applied depending on the treatment modality of the patient: ambulatory procedure visit, outpatient clinic visit or inpatient surgical care services.

9 Family members of active duty personnel, retirees and their family members, and survivors shall be charged elective cosmetic surgery rates. Elective cosmetic surgery procedure information is contained in section IV. The patient shall be charged the rate as specified in the FY 2002 reimbursable rates for an episode of care. The charges for elective cosmetic surgery are at the full reimbursement rate (designated as the “Other” rate) for inpatient care services based on the cost per DRG, ambulatory procedure visits as contained in section II.B. or the appropriate outpatient clinic rate in sections II.A. The patient is responsible for the cost of the implant(s) and the prescribed cosmetic surgery rate. (Note: The implants and procedures used for the augmentation mammaplasty are in compliance with Federal Drug Administration guidelines.)

10 Each regional lipectomy shall carry a separate charge. Regions include head and neck, abdomen, flanks, and hips.

11 Dental service rates are based on a dental rate multiplied by the DoD established weight for the American Dental Association (ADA) code performed. For example, for ADA code 00270, bite wing single film, the weight is 0.15. The weight of 0.15 is multiplied by the appropriate rate, IMET, IAR, or Full/Third Party rate to obtain the charge. If the Full/Third Party rate is used, then the charge for this ADA code will be $11.55 ($77 × .15 = $11.55).

The list of ADA codes and weights for dental services is too large to include in this document. Those rates are available from the TRICARE Management Activity's Uniform Business Office web site, http://www.tricare.osd.mil/​ebc/​rm_​home/​imcp/​ubo/​ubo_​01.htm.

12 Ambulance charges shall be based on hours of service in 15 minute increments. The rates listed in section III.G. are for 60 minutes or 1 hour of service. Providers shall calculate the charges based on the number of hours (and/or fractions of an hour) that the ambulance is logged out on a patient run. Fractions of an hour shall be rounded to the next 15 minute increment (e.g., 31 minutes shall be charged as 45 minutes).

13 Air in-flight medical care reimbursement charges are determined by the status of the patient (ambulatory or litter) and are per patient during a 24-hour period. The appropriate charges are billed only by the Air Force Global Patient Movement Requirement Center (GPMRC). These charges are only for the cost of providing medical care. Flight charges are billed by GPMRC separately.

14 Observation Services are billed at the hourly charge. Begin counting when the patient is placed in the observation bed and round to the nearest hour. For example, if a patient has received 1 hour and 20 minutes of observation, then you bill for 1 hour of service. If the status of a patient changes to inpatient, the charges for observation services are added to the DRG assigned to the case and not separately billed. If a patient is released from observation status and is sent to an APV, the charges for observation services are not billed separately but are added to the APV rate to recover all expenses.

15 Subsistence is billed under the Medical Services Account (MSA) Program only. The MSA office shall collect subsistence charges from all persons, including inpatients and transient patients not entitled to food service at Government expense. Please refer to DoD 6010.15-M, Military Treatment Facility Uniform Business Office (UBO) Manual, April 1997 and the DoD 7000.14-R, “Department of Defense Financial Management Regulation”, Volume 12, Chapter 19 for guidance on the the use of these rates.

Attachment 1.—FY02 Adjusted Standardized Amounts (ASA) by Military Treatment Facility

DMISIDMTF nameServFull cost rateInteragency rateIMET rateTPC rate
0003Lyster AH—Ft. RuckerA$6,703$6,348$3,576$6,703
0005Bassett ACH—Ft. WainwrightA7,2416,8563,8637,241
00063rd Med Grp—Elmendorf AFBF7,1096,7323,7937,109
Start Printed Page 66484
000956th Med Grp—Luke AFBF6,4746,1593,6186,474
001460th Med Grp—Travis AFBF9,9469,4195,3069,946
0024NH Camp PendletonN8,6878,2644,8558,687
0028NH LemooreN7,0346,6613,7527,034
0029NH San DiegoN10,90410,3746,09410,904
0030NH Twenty Nine PalmsN6,5966,2743,6866,596
0032Evans ACH—Ft. CarsonA6,9856,6153,7266,985
003310th Med Grp—USAF AcademyF7,0626,6873,7677,062
0037Walter Reed AMC—Washington DCA10,3849,8785,80310,384
0038NH PensacolaN8,7048,2424,6438,704
0039NH JacksonvilleN8,5398,1234,7728,539
004296th Med Grp—Eglin AFBF8,7478,2834,6668,747
00456th Med Grp—MacDill AFBF6,4826,1673,6236,482
0047Eisenhower AMC—Ft. GordonA8,6778,2174,6298,677
0048Martin ACH—Ft. BenningA8,1187,6884,3318,118
0049Winn ACH—Ft. StewartA6,9896,6183,7286,989
0052Tripler AMC—Ft. ShafterA10,1349,5975,40610,134
0053366th Med Grp—Mountain Home AFBF7,0566,6823,7647,056
0055375th Med Grp—Scott AFBF8,5798,1614,7948,579
0056NH Great LakesN6,5386,2203,6546,538
0057Irwin AH—Ft. RileyA6,4986,1543,4676,498
0060Blanchfield ACH—Ft CampbellA6,5776,2283,5096,577
0061Ireland ACH—Ft. KnoxA6,4676,1243,4506,467
0064Bayne-Jones ACH—Ft. PolkA6,6026,2523,5226,602
006689th Med Grp—Andrews AFBF8,8078,3784,9228,807
0067NNMC BethesdaN10,91310,3826,09910,913
007381st Med Grp—Keesler AFBF10,2139,6715,44810,213
0075Wood ACH—Ft. Leonard WoodA6,5726,2233,5066,572
007855th Med Grp—Offutt AFBF9,2458,7554,9329,245
007999th Med Grp—Nellis AFBF6,4956,1793,6306,495
008449th Med Grp—Holloman AFBF7,0686,6933,7717,068
0086Keller ACH—West PointA7,3426,9533,9177,342
0089Womack AMC—Ft. BraggA7,5867,1844,0477,586
0091NH Camp LeJeuneN6,6946,3393,5716,694
0092NH Cherry PointN6,8096,4483,6326,809
0093319th Med Grp—Grand Forks AFBF6,9666,5973,7166,966
00945th Med Grp—Minot AFBF6,9656,5953,7156,965
009574th Med Grp—Wright-Patterson AFBF11,38510,7816,07311,385
0098Reynolds ACH—Ft. SillA6,8496,4863,6546,849
0100NH NewportN6,4866,1703,6256,486
010120th Med Grp—Shaw AFBF7,0286,6563,7497,028
0104NH BeaufortN6,9406,5723,7026,940
0105Moncrief ACH—Ft. JacksonA7,0116,6393,7407,011
010628th Med Grp—Ellsworth AFBF7,0496,6753,7607,049
0108Wm Beaumont AMC—Ft. BlissA8,5758,1204,5758,575
0109Brooke AMC—Ft. Sam HoustonA9,4048,9465,2559,404
0110Darnall AH—Ft. HoodA7,9047,4854,2167,904
01127th Med Grp— Dyess AFBF6,9996,6283,7346,999
011382nd Med Grp—Sheppard AFBF6,9706,6003,7186,970
011759th Med Wing F—Lackland AFBF9,9779,4915,5759,977
01201st Med Grp—Langley AFBF6,4216,1083,5886,421
0121McDonald ACH—Ft. EustisA6,1035,8063,4116,103
0123Dewitt AH—Ft. BelvoirA8,1317,7354,5448,131
0124NH PortsmouthN8,3557,9494,6698,355
0125Madigan AMC—Ft. LewisA11,84711,2186,32011,847
0126NH BremertonN8,4007,9554,4818,400
0127NH Oak HarborN6,7096,3823,7496,709
0131Weed ACH—Ft. IrwinA7,0646,6893,7697,064
060695th CSH—HeidelbergA9,7429,2933,9589,742
0607Landstuhl Rgn MCA9,7429,2933,9589,742
060967th CSH—WurzburgA9,7429,2933,9589,742
0612121st Gen Hosp—SeoulA9,7429,2933,9589,742
0615NH Guantanamo BayN9,7429,2933,9589,742
0616NH Roosevelt RoadsN9,7429,2933,9589,742
0617NH NaplesN9,7429,2933,9589,742
0618NH RotaN9,7429,2933,9589,742
0620NH GuamN9,7429,2933,9589,742
0621NH OkinawaN9,7429,2933,9589,742
0622NH YokosukaN9,7429,2933,9589,742
0623NH KeflavikN9,7429,2933,9589,742
0624BH SigonellaN9,7429,2933,9589,742
Start Printed Page 66485
063348th Med Grp—RAF LakenheathF9,7429,2933,9589,742
063539th Med Grp—Incirlik ABF9,7429,2933,9589,742
063851st Med Grp—Osan ABF9,7429,2933,9589,742
063935th Med Grp—MisawaF9,7429,2933,9589,742
0640374th Med Grp—Yokota ABF9,7429,2933,9589,742
080552nd Med Grp—SpangdahlemF9,7429,2933,9589,742
080831st Med Grp—AvianoF9,7429,2933,9589,742

2. Department of Health and Human Services

For the Department of Health and Human Services, Indian Health Service, effective October 1, 2001 and thereafter:

Hospital Care Inpatient Day
General Medical Care
Alaska$2,025
Rest of the United States1,571
Outpatient Medical Treatment
Outpatient Visit
Alaska363
Rest of the United States196

Beginning October 1, 2001, the rates prescribed herein superceded those established by the Director of the Office of Management and Budget October 31, 2000 (FR Doc. 00-27726).

Start Signature

Mitchell Daniels, Jr.,

Director, Office of Management and Budget.

End Signature End Preamble

[FR Doc. 01-31663 Filed 12-21-01; 8:45 am]

BILLING CODE 3110-01-P