[Federal Register Volume 67, Number 179 (Monday, September 16, 2002)]
[Notices]
[Pages 58404-58405]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-23410]


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DEPARTMENT OF DEFENSE

Office of the Secretary


TRICARE; Civilian Health and Medical Program of the Uniformed 
Services (CHAMPUS); Fiscal Year 2003 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 2003 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 2003.

EFFECTIVE DATE: The fiscal year 2003 rates contained in this notice are 
effective for services occurring on or after October 1, 2002.

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,

[[Page 58405]]

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 2003, Medicare has recommended a rate of 
increase of 3.5 percent for hospitals and units excluded from the 
prospective payment system. TRICARE will adopt this update factor for 
FY 2003 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 2002 updated by 3.5 
percent for FY 2003. Partial hospitalization rates for full day and 
half day programs will also be updated by 3.5 percent for FY 2003. The 
cap amount for high volume hospitals and units will also be updated by 
the 3.5 percent for FY 2003. The beneficiary cost-share for low volume 
hospitals and units will also be updated by the 3.5 percent for FY 
2003. Consistent with Medicare, the wage portion of the regional rate 
subject to the area wage adjustment is 71.556 percent for FY 2003.
    The following reflect an update of 3.5 percent.

  Regional Specific Rates for Psychiatric Hospitals and Units with Low
                             TRICARE Volume
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                 United States census region                     Rate@
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Northeast:
  New England................................................       $598
  Mid-Atlantic...............................................        574
Midwest:
  East North Central.........................................        496
  West North Central.........................................        468
South:
  South Atlantic.............................................        592
  East South Central.........................................        641
  West South Central.........................................        540
South:
  South Atlantic.............................................        592
  East South Central.........................................        641
  West South Central.........................................        540
West:
  Mountain...................................................        539
  Pacific....................................................       635
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@Wage portion of the rate, subject to the area wage adjustment--71.556
  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 $159 per day or 25 percent of 
the hospital billed charges effective for services rendered on or after 
October 1, 2002
    Cap Amount: Updated cap amount for hospitals and units with high 
TRICARE volume is $750 per day for FY 2003.
    The following reflect an update of 3.5 percent for FY 2003.

Partial Hospitalization Rates for Full-Day and Half-Day Programs FY 2003
------------------------------------------------------------------------
                                                     Full-day
                                                     rate  (6   Half-day
            United States census region              hours or  rate  (3-
                                                      more)     5 hours)
------------------------------------------------------------------------
Northeast:
  New England (ME, NH, VT, MA, RI, CT)............       $240       $181
  Mid-Atlantic (NY, NJ, PA).......................        259        195
Midwest:
  East North Central (OH, IN, IL, MI, WI).........        228        171
  West North Central (MN, IA, MO, ND, SD, NE, KS).        228        171
South:
  South Atlantic (DE, MD, DC, VA, WV, NC, SC, GA,         247        185
   FL)............................................
  East South Central (KY, TN, AL, MS).............        266        200
  West South Central (AR, LA, TX, OK).............        266        200
West:
  Mountain (MT, ID, WY, CO, NM, AZ, UT, NV).......        269        202
  Pacific (WA, OR, CA, AK, HI)....................        263        198
------------------------------------------------------------------------

    The above rates are effective for services rendered on or after 
October 1, 2002.

    Dated: September 9, 2002.
Patricia L. Toppings,
Alternate OSD Federal Register, Liaison Officer, Department of Defense.
[FR Doc. 02-23410 Filed 9-13-02; 8:45 am]
BILLING CODE 5001-08-P