• Letter or Testimony
  • January 29, 2020

CHA Comments on Proposed Changes to TRICARE Reimbursement Methodology for Children's Hospitals

CHA submitted a comment letter to the Department of Defense (DoD) that requested additional time and information before providing specific input on a proposal to modify the TRICARE reimbursement methodology for outpatient services at children's hospitals. Under the proposal, TRICARE would use the Medicare Outpatient Prospective Payment System (OPPS) methodology for children's hospitals, with modifications to address the complexity of the services the hospitals provide. Children's hospitals that partner with TRICARE care for more than 2 million children of the country's military families. TRICARE represents a small percentage of these hospitals' case and payor mix overall, but is disproportionately significant for some children's hospitals.

The comment letter expresses appreciation for DoD's recognition of the uniqueness of the care provided by children's hospitals. At the same time, we note that there may be unintended financial and administrative implications of the proposed changes and that more time and information is needed to enable affected hospitals to assess the rule's impact.

CHA contact: Jan Kaplan