[Federal Register Volume 59, Number 190 (Monday, October 3, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-24388]


[[Page Unknown]]

[Federal Register: October 3, 1994]


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DEPARTMENT OF DEFENSE
Office of the Secretary

 

Civilian Health and Medical Program of the Uniformed Services 
(CHAMPUS); Fiscal Year 1995 Updates

AGENCY: Office of the Secretary, DoD.

ACTION: Notice of updated mental health per diem rates.

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SUMMARY: This notice provides for the updating of hospital-specific per 
diem rates for high volume providers and regional per diem rates for 
low volume providers; the updated cap per diem for high volume 
providers; the beneficiary per diem cost-share amount for low volume 
providers to be used for FY 1995 under the CHAMPUS Mental Health Per 
Diem Payment System; and the updated per diem rates for both full-day 
and half-day CHAMPUS Partial Hospitalization Programs for fiscal year 
1995.

EFFECTIVE DATE: The rates contained in this notice are effective for 
services occurring on or after October 1, 1994.

ADDRESSES: Office of the Civilian Health and Medical Program of the 
Uniformed Services (OCHAMPUS), Program Development Branch, Aurora, CO 
80045-6900.
    For copies of the Federal Register containing this notice,contact 
the Superintendent of Documents, U.S. Government Printing Office, 
Washington, DC 20402, (202) 783-3238.
    The charge for the Federal Register is $1.50 for each issue payable 
by check or money order to the Superintendent of Documents.

FOR FURTHER INFORMATION CONTACT:
Stan Regensberg, Program Development Branch, OCHAMPUS, telephone (303) 
361-1342. To obtain copies of this document, see the ADDRESSES section 
above. Questions regarding payment of specific claims under the CHAMPUS 
Mental Health Per Diem Payment System should be addressed to the 
appropriate CHAMPUS contractor.

SUPPLEMENTARY INFORMATION: The final rule published in the Federal 
Register on September 6, 1988, (52 FR 34285) set forth reimbursement 
changes that were effective for all inpatient hospital admissions in 
psychiatric hospitals and exempt psychiatric units occurring on or 
after January 1, 1989. The final rule published in the Federal Register 
on July 1, 1993, (58 FR 35-400) set forth maximum per diem rates for 
all partial hospitalization admissions on or after September 29, 1993. 
Included in these final rules were provisions for updating 
reimbursement rates for each federal fiscal year. As stated in the 
final rules, each per diem shall be updated by the Medicare update 
factor for hospitals and units exempt from the Medicare Prospective 
Payment System. Medicare has recommended an update factor of 3.7 
percent for federal fiscal year 1995 for hospitals and units excluded 
from the prospective payment system. CHAMPUS will adopt this update 
factor for FY 1995 as the final update factor. Hospitals and units with 
hospital-specific rates (hospitals and units with high CHAMPUS volume) 
will have their FY 1994 CHAMPUS per diem rates updated by 3.7 percent 
for FY 1995.

    The following reflect an update of 3.7 percent.

  Regional Specific Rates for Psychiatric Hospitals and Units With Low  
                             Champus Volume                             
------------------------------------------------------------------------
                  United States census region                    Rate\2\
------------------------------------------------------------------------
Northeast:                                                              
  New England.................................................      $515
  Mid-Atlantic................................................       492
Midwest:                                                                
  East North Central..........................................       426
  West North Central..........................................       402
South:                                                                  
  South Atlantic..............................................       509
  East South Central..........................................       550
  West South Central..........................................       463
West:                                                                   
  Mountain....................................................       462
  Pacific.....................................................       545
------------------------------------------------------------------------
\2\The wage portion of the rate, subject to the area wage adjustment, is
  71.40 percent.                                                        
                                                                        

Beneficiary Cost-Share: Beneficiary cost-share (other than dependents 
of active duty members) for care paid on the basis of a regional per 
diem rate is the lower of $137 per day or 25 percent of the hospital 
billed charges effective for services rendered on or after October 1, 
1994.
Cap Amount: Cap amount for hospitals and units with high CHAMPUS volume 
is $760 per day.
CHAMPUS Partial Hospitalization Programs will have their FY 1994 
CHAMPUS per diem rates updated by 3.7 percent for FY 1995.

    The following reflect an update of 3.7 percent.

    Partial Hospitalization Rates for Full-Day and Half-Day Programs    
------------------------------------------------------------------------
                                                      Full-day  Half-day
                                                       rate (6  rate (3-
            United States census regions               hrs or   5 hours)
                                                        more)           
------------------------------------------------------------------------
Northeast:                                                              
  New England (ME, NH, VT, MA, RI, CT)..............      $211      $159
  Mid-Atlantic (NY, NJ, PA).........................       230       173
Midwest:                                                                
  East North Central (OH, IN, IL, MI, WI)...........       205       154
  West North Central (MN, IA, MO, ND, SD, NE, KS)...       202       152
South:                                                                  
  South Atlantic (DE, MD, DC, VA, WV, NC, SC, GA,                       
   FL)..............................................       218       164
  East South Central (KY, TN, AL, MS)...............       237       178
  West South Central (AR, LA, TX, OK)...............       234       176
West:                                                                   
  Mountain (MT, ID, WY, CO, NM, AZ, UT, NV).........       243       183
  Pacific (WA, OR, CA, AK, HI)......................       239       180
------------------------------------------------------------------------

    Dated: September 26, 1994.
L.M. Bynum,
 Alternate OSD Federal Register Liaison Office, Department of Defense.
[FR Doc. 94-24388 Filed 9-30-94; 8:45 am]
BILLING CODE 5000-04-M