# Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); TRICARE Program; Reimbursement
> **US Department of Defense** · Final rule. · Published 1998-09-10 · Effective 1998-10-13 · 63 FR 48439
## Document
- **Document number:** 98-23842
- **Category:** personnel
- **Sub-agency:** US Department of Defense
- **Federal Register citation:** 63 FR 48439
- **CFR reference:** 32 CFR 199
- **Publication date:** 1998-09-10
- **Effective date:** 1998-10-13
## Abstract

This final rule revises certain requirements and procedures for reimbursement under the CHAMPUS program, the purpose of which is to implement a comprehensive managed health care delivery system composed of military medical treatment facilities and CHAMPUS. Issues addressed in this rule include: implementation of changes made to the Medicare Prospective Payment System (PPS) upon which the CHAMPUS DRG-based payment system is modeled and required by law to follow wherever practicable, along with changes to make our DRG-based payment system operate better; clarification of payment reduction for noncompliance with required utilization review procedures; clarification of publication of list of ambulatory surgery procedures; limitation on ambulatory surgery group payment rates; extension of the balance billing limitations currently in place for individual and professional providers to non-institutional, non-professional providers; adjustment of the CHAMPUS maximum allowable charge (CMAC) rate in the small number of cases where the CMAC rate is less than the Medicare rate; implementation of the government-wide debarment rule where any provider excluded or suspended from CHAMPUS shall be excluded from all other programs and activities involving Federal financial assistance, such as Medicare or Medicaid; elimination of the requirement for non- participating providers to file claims; and revision of the ambulatory surgery cost-share information to enable the cost-share to be assessed against the facility claim instead of the primary surgeon's claim.

## Source
- [Federal Register document](https://www.federalregister.gov/documents/1998/09/10/98-23842/civilian-health-and-medical-program-of-the-uniformed-services-champus-tricare-program-reimbursement)
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