[Federal Register Volume 63, Number 187 (Monday, September 28, 1998)]
[Notices]
[Pages 51564-51566]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-25780]


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DEPARTMENT OF DEFENSE

Office of the Secretary


TRICARE Formerly Known as the Civilian Health and Medical Program 
of the Uniformed Services (CHAMPUS); Fiscal Year 1999 Mental Health 
Rate 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 for FY 1999 under the

[[Page 51565]]

TRICARE Mental Health Per Diem Payment System; and the updated per diem 
rates for both full-day and half-day TRICARE Partial Hospitalization 
Programs for fiscal year 1999.

EFFECTIVE DATE: The rates contained in this notice are effective for 
services occurring on or after October 1, 1998.

FOR FURTHER INFORMATION CONTACT: Stan Regensberg, Office of Medical 
Benefits and Reimbursement Systems, TRICARE Management Activity, 
telephone (303) 676-3742.

SUPPLEMENTARY INFORMATION: The final rule published in the Federal 
Register on September 6, 1988, (53 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. The final rule published in the Federal 
Register March 7, 1995, (60 FR 12419) set forth retaining all per diems 
in effect at the end of fiscal year 1995 with no additional updates for 
fiscal years 1996 and 1997. Medicare recommended a rate of increase of 
0 percent for federal fiscal year 1998 for hospitals and units excluded 
from the prospective payment system. For fiscal year 1999, Medicare has 
recommended a rate of increase of 2.4 percent for hospitals and units 
excluded from the prospective payment system. TRICARE will adopt this 
update factor for FY 1999 as the final update factor. Hospitals and 
units with hospital-specific rates (hospitals and units with high 
TRICARE volume) and regional specific rates for psychiatric hospitals 
and units with low TRICARE volume will have their TRICARE rates for FY 
1998 updated by 2.4 percent for FY 1999. Partial hospitalization rates 
for full day and half day programs will also be 2 updated by 2.4 
percent for FY 1999. The cap amount for high volume hospitals and units 
will also be updated by the 2.4 percent for FY 1999. The beneficiary 
cost-share of low volume hospitals and units will also be updated by 
the 2.4 percent for FY 1999. Consistent with Medicare, the wage portion 
of the regional rate subject to the area wage adjustment will remain at 
71.1 percent for FY 1999.
    The following reflect an update of 2.4 percent.

  Regional Specific Rates for Psychiatric Hospitals and Units With Low
                             CHAMPUS Volume
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               United States census region                   Rate \1\
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Northeast:
    New England.........................................            $527
    Mid-Atlantic........................................             504
Midwest:
    East North Central..................................             436
    West North Central..................................             412
South:
    South Atlantic......................................             521
    East South Central..................................             563
    West South Central..................................             474
West:
    Mountain............................................             473
    Pacific.............................................            558
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\1\ Wage portion of the rate, subject to the area wage adjustment--71.1
  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 $140 per day or 25 percent of 
the hospital billed charges effective for services rendered on or after 
October 1, 1998.
    Cap Amount: Updated cap amount for hospitals and units with high 
CHAMPUS volume is $660 per day for FY 1999.
    The following reflect an update of 2.4 percent.

    Partial Hospitalization Rates for Full-Day and Half-Day Programs
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                                           Full-day rate
       United States census region          (6 hours or    Half-day rate
                                               more)        (3-5 hours)
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Northeast:
    New England (ME, NH, VT, MA, RI, CT)            $216            $163
    Mid-Atlantic (NY, NJ, PA)...........             236             177
Midwest:
    East North Central (OH, IN, IL, MI,
     WI)................................             210             158
    West North Central (MN, IA, MO, ND,
     SD, NE, KS)........................             207             156
South:
    South Atlantic (DE, MD, DC, VA, WV,
     NC, SC, GA, FL)....................             223             168
    East South Central (KY, TN, AL, MS).             243             182
    West South Central (AR, LA, TX, OK).             240             180
West:
    Mountain (MT, ID, WY, CO, NM, AZ,
     UT, NV)............................             249             187
    Pacific (WA, OR, CA, AK, HI)........             245             184
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[[Page 51566]]

    Dated: September 21, 1998.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 98-25780 Filed 9-25-98; 8:45 am]
BILLING CODE 5000-04-p