Federal Register #2026-13515

TRICARE Demonstration Project for Pre-Hospital Blood Transfusion Ambulance Add-On Reimbursement

This opportunity from the Defense Health Agency (DHA) under the Department of Defense is a five-year demonstration project to test add-on reimbursement for pre-hospital blood transfusions (PHBT) in ambulance settings. - Government Buyer: - Department of Defense - Defense Health Agency (DHA) - OEMs and Vendors: - No specific OEMs or blood suppliers named; central involvement of blood product manufacturers and ambulance providers - Products/Services Requested: - Blood products for transfusion during ambulance transport: - Low Titer O+ and O- Whole Blood - Packed Red Blood Cells (PRBCs) - Plasma - Professional services for transfusion administration (CPT 36430) - Notable Requirements: - Eligible providers: TRICARE-authorized ground and air ambulance companies licensed for pre-hospital blood transfusions - Eligible beneficiaries: TRICARE Prime, Select, and TRICARE for Life members - Reimbursement based on Medicare OPPS rates (HCPCS P9010) or actual blood supplier costs, plus a set rate for transfusion administration - Demonstration aims to improve trauma patient outcomes, reduce care costs, and enhance access - Estimated total project cost: $5.2 million over five years - Specific cost-sharing and eligibility rules apply - No administrative or procedural contract details included

Description

The Department of Defense is announcing a five-year demonstration project under the TRICARE program to test separate add-on reimbursement for medically necessary blood products and professional services administered by authorized ambulance providers in pre-hospital settings. The project aims to evaluate if this payment modification improves health outcomes for trauma patients, impacts total cost of care, enhances beneficiary access to care and network adequacy, and is feasible as a permanent change to TRICARE ambulance reimbursement. Eligible beneficiaries include those covered under TRICARE Prime, Select, or for Life, excluding certain plans and claims outside the U.S. The demonstration will run from January 1, 2027, to December 31, 2031, with possible extensions or early termination by the Defense Health Agency.

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