Change in Critical Access Hospital (CAH) Reimbursement

Effective June 1, 2006, TRICARE reimbursement for sole community hospitals (SCH) or critical access hospitals (CAH) that were previously registered on both the CAH and the SCH lists is changing per a directive from the TRICARE Management Activity (TMA).

TRICARE had previously designated hospitals as either an SCH or CAH designation or both. For hospitals designated as both SCH and CAH, TRICARE reimbursed the facility as an SCH. However, TMA changed these designations and these hospitals now have either an SCH or a CAH classification. Hospitals designated as CAH on TMA's website, www.tricare.mil/drgrates/, will now be reimbursed under the Diagnosis Related Groups (DRG)-based payment system. 

According to TMA, the June 1, 2006, effective date is for admissions on or after June 1, 2006.  For admissions before June 1, 2006, TMA has indicated that the SCH list takes precedence over the CAH list if a facility was listed on both the CAH and SCH lists. 

For additional information, please refer to the TRICARE Reimbursement Manual, Chapter 6, Section 4, at www.tricare.mil.