[Federal Register Volume 68, Number 188 (Monday, September 29, 2003)]
[Notices]
[Pages 55943-55944]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-24441]


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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 2004 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 volumes 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 2004 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 2004.

EFFECTIVE DATE: The fiscal year 2004 rates contained in this notice are 
effective for services occurring on or after October 1, 2003.

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 admission 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 2004, Medicare has recommended a rate 
of increase of 3.4 percent for hospitals and units excluded from the 
prospective payment system. TRICARE will adopt this update factor for 
FY 2004 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 2003 updates by 3.4 
percent for FY 2004. Partial hospitalization rates for full day and 
half day programs will also be updated by 3.4 percent for FY 2004. The 
cap amount for high volume hospitals and units will also be updated by 
the 3.4 percent for FY 2004. The beneficiary cost-share for low volume 
hospitals and units will also be updated by the 3.4 percent for FY 
2004. Consistent with Medicare, the wage portion of the regional rate 
subject to the area wage adjustment is 71.56 percent for FY 2004.
    The following reflect an update of 3.4 percent.

[[Page 55944]]



  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...............................................      $618
    Mid-Atlantic..............................................       594
Midwest:
    East North Central........................................       513
    West North Central........................................       484
South:
    South Atlantic............................................       612
    East South Central........................................       663
    West South Central........................................       558
West:
    Mountain..................................................       557
    Pacific...................................................      657
------------------------------------------------------------------------
* Wage portion of the rate, subject to the area wage adjustment: 71.56
  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 $164 per day or 25 percent of 
the hospital billed charges effective for services rendered on or after 
October 1, 2003
    Cap Amount: Updated cap amount for hospitals and units with high 
TRICARE volume is $776 per day for FY 2004.
    The following reflect an update of 3.4 percent for FY 2004.

Partial Hospitalization Rates for Full-Day and Half-Day Programs FY 2004
------------------------------------------------------------------------
                                                  Full-day
                                                  rate (6      Half-day
          United States census region             hours or    rate (3-5
                                                   more)        hours)
------------------------------------------------------------------------
Northeast:
    New England (ME, NH, VT, MA, RI, CT)......         $248         $186
    Mid-Atlantic (NY, NJ, PA).................          268          201
Midwest:
    East North Central (OH, IN, IL, MI, WI)...          236          177
    West North Central (MN, IA, MO, ND, SD,             236          177
     NE, KS)..................................
South:
    South Atlantic (DE, MD, DC, VA, NY, NC,             255          191
     SC, GA, FL)..............................
    East South Central (KY, TN, AL, MS).......          275          206
    West South Central (AR, LA, TX, OK).......          275          206
West:
    Mountain (MT, ID, WY, CO, NM, AZ, UT, NV).          278          209
    Pacific (WA, OR, CA, AK, HI)..............          272          204
------------------------------------------------------------------------

    The above rates are effective for services rendered on or after 
December 1, 2003.

    Dated: September 22, 2003.
Patricia L. Toppings,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 03-24441 Filed 9-26-03; 8:45 am]
BILLING CODE 5001-08-M