[Federal Register Volume 77, Number 123 (Tuesday, June 26, 2012)]
[Notices]
[Pages 38042-38043]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-15504]


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DEPARTMENT OF DEFENSE

Office of the Secretary


TRICARE; Implementation of TRICARE Transitional Outpatient 
Payments

AGENCY: Department of Defense (DoD).

ACTION: Notice of TRICARE Transitional Outpatient Payments (TTOPs)

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SUMMARY: This notice informs hospitals of TRICARE's Transitional 
Outpatient Payments (TTOPs) under TRICARE's Outpatient Prospective 
Payment System (OPPS).

DATES: The TTOPs are effective January 1, 2010.

ADDRESSES: TRICARE Management Activity (TMA), Medical Benefits and 
Reimbursement Branch, 16401 East Centretech Parkway, Aurora, CO 80011-
9066.

FOR FURTHER INFORMATION CONTACT: Ms. Martha M. Maxey, TMA, Medical 
Benefits and Reimbursement Branch, telephone (303) 676-3627.

SUPPLEMENTARY INFORMATION: With implementation of the Medicare OPPS, 
certain hospitals were eligible to receive additional transitional 
outpatient payments (TOPS) if the payments they received under the OPPS 
were less than the payments they could have received for the same 
services under the payment system in effect before the OPPS. Medicare 
refers to these transitional payments as hold harmless TOPs and they 
applied to small rural hospitals with 100 or fewer beds and rural Sole 
Community Hospitals (SCHs) with 100 or fewer beds. TRICARE's OPPS Final 
Rule, published in the Federal Register (73 FR 74945) on December 10, 
2008, states Agency will adopt the hold harmless TOPs for rural 
hospitals having 100 or fewer beds and SCHs. Medicare's hold harmless 
TOPs was scheduled to expire January 1, 2010. TRICARE delayed 
implementation of its OPPS for small rural hospitals with 100 or fewer 
beds and rural SCHs with 100 or fewer beds until January 1, 2010, with 
the expectation that the Medicare TOPs would expire, negating the need 
to implement the TRICARE TOPs provision. The Patient Protection and 
Affordable Care Act (PPACA) extended the hold harmless provision under 
Medicare, beyond January 1, 2010; therefore TRICARE will need to

[[Page 38043]]

implement TOPS as of January 1, 2010. The PPACA also expanded the hold 
harmless provision to all SCHs.
    TTOPs will be made to qualifying hospitals that have OPPS costs 
that are greater than their TRICARE allowed amounts using a method 
similar to Medicare. TRICARE will pay an amount equal to 85 percent of 
the difference between the estimated OPPS costs and the OPPS payment.
    The process for determining the TTOPs will be outlined in a future 
revision to the TRICARE Reimbursement Manual. The TRICARE Reimbursement 
Manual is available at http://manuals.tricare.osd.mil/.

    Dated: June 20, 2012.
Patricia Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2012-15504 Filed 6-25-12; 8:45 am]
BILLING CODE 5001-06-P