11/29/2019

US Department of Defense Releases Proposed Rule Regarding TRICARE

The US Department of Defense (DoD) released a proposed rule that amends TRICARE reimbursement methodology for ASCs. TRICARE is the healthcare program for uniformed service members, retirees and their families. Currently, TRICARE pays the same rate for all ambulatory surgery services regardless of the site of service. TRICARE calculates a median standard cost per procedure, groups procedures based on similar costs and pays a standard amount for each procedure group (see process here).

Under the new proposal, TRICARE will seek to match definitions and reimbursement methodology with those in the Medicare program. ASCs that have an agreement with Medicare will be considered authorized under TRICARE, although facilities will have to enter a separate participation agreement with DoD. Pediatric ASCs who may not interact with Medicare may still qualify for reimbursement through accreditation. TRICARE proposes to adopt the Medicare ASC-payable list and ASC payment rates in their entirety and follow CMS updates as they occur. ASCs will not be required to report quality data. Ultimately, DoD proposes no transition period between the reimbursement systems and estimates that this alignment will result in cost savings of $40 million in 2018 alone. Comments are accepted on this proposal via regulations.gov until January 28, 2020.