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DOD/DODOASHA RIN: 0720-AB47 Publication ID: Fall 2017 
Title: TRICARE; Reimbursement of Long-Term Care Hospitals and Inpatient Rehabilitation Facilities 

The Department of Defense, Defense Health Agency, is revising its reimbursement of Long-Term Care Hospitals (LTCHs) and Inpatient Rehabilitation Facilities (IRFs). Revisions are in accordance with the statutory provision at title 10, United States Code, section 1079(i)(2) that requires TRICARE payment methods for institutional care 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. 32 CFR 199.2 includes a definition for "Hospital, long-term (tuberculosis, chronic care, or rehabilitation)." This rule deletes this definition and creates separate definitions for "Long Term Care Hospital" and "Inpatient Rehabilitation Facility" in accordance with Centers for Medicare and Medicaid Services (CMS) classification criteria. Under TRICARE, LTCHs and IRFs (both freestanding rehabilitation hospitals and rehabilitation hospital units) are currently paid the lower of a negotiated rate (if they are a network provider) or billed charges (if they are a non-network provider). Although Medicare’s reimbursement methods for LTCHs and IRFs are different, to the Defense Health Agency is adopting both the Medicare LTCH and IRF Prospective Payment System (PPS) methods simultaneously to align with our statutory requirement to reimburse like Medicare. This rule sets forth the regulation modifications that are necessary for TRICARE to adopt Medicare’s LTCH and IRF Prospective Payment Systems and rates applicable for inpatient services provided by LTCHs and IRFs to TRICARE beneficiaries. 

Agency: Department of Defense(DOD)  Priority: Economically Significant 
RIN Status: Previously published in the Unified Agenda Agenda Stage of Rulemaking: Final Rule Stage 
Major: Yes  Unfunded Mandates: No 
EO 13771 Designation: Fully or Partially Exempt 
CFR Citation: 32 CFR 199   
Legal Authority: 5 U.S.C. 301    10 U.S.C. ch. 55   
Legal Deadline:  None
Action Date FR Cite
NPRM  01/26/2015  80 FR 3926   
NPRM Comment Period End  03/27/2015 
Second NPRM  08/31/2016  81 FR 59934   
Second NPRM Comment Period End  10/31/2016 
Final Action  02/00/2018 
Regulatory Flexibility Analysis Required: Yes  Government Levels Affected: Federal 
Small Entities Affected: Businesses  Federalism: No 
Included in the Regulatory Plan: No 
RIN Data Printed in the FR: Yes 
Agency Contact:
Ann N. Fazzini
Department of Defense
Office of Assistant Secretary for Health Affairs
1200 Defense Pentagon,
Washington, DC 20301
Phone:303 676-3803