[Federal Register Volume 64, Number 168 (Tuesday, August 31, 1999)]
[Notices]
[Pages 47487-47488]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-22567]


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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 2000 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 2000 under the 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 2000. It also 
corrects partial hospitalization per diem rates for fiscal year 1999 
that were published September 28, 1998.

EFFECTIVE DATE: The fiscal year 2000 rates contained in this notice are 
effective for services occurring on or after October 1, 1999.

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. For fiscal year 2000, Medicare has recommended a rate 
of increase of 2.9 percent for hospitals and units excluded from the 
prospective payment system. TRICARE will adopt this update factor for 
FY 2000 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 2000 updated by 2.9 
percent for FY 2000. Partial hospitalization rates for full day and 
half day programs will also be updated by 2.9 percent for FY 2000. The 
cap amount for high volume hospitals and units will also be updated by 
the 2.9 percent for FY 2000. The beneficiary cost-share of low volume 
hospitals and units will also be updated by the 2.9 percent for FY 
2000. Consistent with Medicare, the wage portion of the regional rate 
subject to the area wage adjustment will remain at 71.1 percent for FY 
2000.
    The following reflect an update of 2.9 percent.

[[Page 47488]]



  Regional Specific Rates for Psychiatric Hospitals and Units with Low
                             Tricare Volume
------------------------------------------------------------------------
                  United States census region                     Rate@
------------------------------------------------------------------------
Northeast:
    New England................................................     $542
    Mid-Atlantic...............................................      519
Midwest:
    East North Central.........................................      449
    West North Central.........................................      424
South:
    South Atlantic.............................................      536
    East South Central.........................................      579
    West South Central.........................................      488
West:
    Mountain...................................................      487
    Pacific....................................................      574
------------------------------------------------------------------------
@ 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 $144 per day or 25 percent of 
the hospital billed charges effective for services rendered on or after 
October 1, 1999.
    Cap Amount: Updated cap amount for hospitals and units with high 
TRICARE volume is $679 per day for FY 2000.
    The following reflect an update of 2.9 percent for FY 2000.

Partial Hospitalization Rates For Full-Day and Half-Day Programs FY 2000
------------------------------------------------------------------------
                                           Full-day rate
       United States census region          (6 hours or    Half-day rate
                                               more)        (3-5 hours)
------------------------------------------------------------------------
Northeast:
    New England (ME, NH, VT, MA, RI, CT)            $218            $164
    Mid-Atlantic (NY, NJ, PA)...........             234             176
Midwest:
    East North Central (OH, IN, IL, MI,              206             155
     WI)................................
    West North Central (MN, IA, MO, ND,              206             155
     SD, NE, KS)........................
South:
    South Atlantic (DE, MD, DC, VA, WV,              223             167
     NC, SC, GA, FL)....................
    East South Central (KY, TN, AL, MS).             241             181
    West South Central (AR, LA, TX, OK).             241             181
West:
    Mountain (MT, ID, WY, CO, NM, AZ,                244             183
     UT, NV)............................
    Pacific (WA, OR, CA, AK, HI)........             238             179
------------------------------------------------------------------------

    The following reflect a correction to the partial hospitalization 
rates for FY 1999.

Partial Hospitalization Rates For Full-Day and Half-Day Programs FY 1999
------------------------------------------------------------------------
                                           Full-day rate
       United States census region          (6 hours or    Half-day rate
                                               more)        (3-5 hours)
------------------------------------------------------------------------
Northeast:
    New England (ME, NH, VT, MA, RI, CT)            $212            $159
    Mid-Atlantic (NY, NJ, PA)...........             227             170
Midwest:
    East North Central (OH, IN, IL, MI,              200             150
     WI)................................
    West North Central (MN, IA, MO, ND,              200             150
     SD, NE, KS)........................
South:
    South Atlantic (DE, MD, DC, VA, WV,              217             163
     NC, SC, GA, FL)....................
    East South Central (KY, TN, AL, MS).             234             176
    West south Central (AR, LA, TX, OK).             234             176
West:
    Mountain (MT, ID, WY, CO, NM, AZ,                237             178
     UT, NV)............................
    Pacific (WA, OR, CA, AK, HI)........             231             173
------------------------------------------------------------------------

    These partial hospitalization rates are the new calculated rates 
that reflect the 2.4 percent increase for FY 1999. The FY 2000, 2.9 
percent increase, effective October 1, 1999, is applied to these new 
calculated rates.

    Dated: August 25, 1999.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 99-22567 Filed 8-30-99; 8:45 am]
BILLING CODE 5001-10-M