Fed Regist. 1996 Feb 21;61(35):6541-2.
This final rule establishes a new rule under the Third Party Collection program for determining the reasonable costs of health care services provided by facilities of the uniformed services in cases in which care is provided under TRICARE Resource Sharing Agreements. For purposes of the Third Party Collection program such services will be treated the same as other services provided by facilities of the uniformed services. The final rule also lowers the high cost ancillary threshold value from $60 to $25 per 24-hour day for patients that come to the uniformed services facility for ancillary services requested by a source other than a uniformed services facility. The reasonable costs of such services will be accumulated on a daily basis. The Department of Defense is now implementing TRICARE, a major structural reform of the military health care system, featuring adoption of managed care practices in military hospitals and by special civilian contract provider networks. Consistent with TRICARE, as part of the Third Party Collection Program, DoD is transitioning to a billing and collection system in which all costs borne by DoD Medical Treatment Facilities (MTFs) will be billed by the MTF providing the care. Thus, all care performed within the facility, plus an added amount for supplemental care purchased by the facility, will be billed by the MTF. Conversely, care provided outside the MTF under other arrangements will be billed by the provider of that care.
本最终规则根据第三方托收计划制定了一项新规则，用于确定在依据《军人家属及遗属健康保险资源共享协议》提供医疗服务的情况下，军队医疗机构所提供医疗服务的合理费用。就第三方托收计划而言，此类服务将被视为与军队医疗机构提供的其他服务同等对待。最终规则还将非军队医疗机构要求军队医疗机构提供辅助服务的患者的高成本辅助服务门槛值从每24小时60美元降至25美元。此类服务的合理费用将按日累计。国防部目前正在实施《军人家属及遗属健康保险》，这是军事医疗系统的一项重大结构性改革，其特点是在军事医院以及通过特殊的民用合同供应商网络采用管理式医疗做法。与《军人家属及遗属健康保险》一致，作为第三方托收计划的一部分，国防部正在过渡到一种计费和托收系统，即国防部医疗治疗机构（MTF）承担的所有费用将由提供护理的MTF进行计费。因此，该机构内提供的所有护理，加上该机构购买的补充护理的额外费用，将由MTF进行计费。相反，在其他安排下由MTF以外的机构提供的护理将由该护理的提供者进行计费。
