[Federal Register Volume 69, Number 174 (Thursday, September 9, 2004)]
[Notices]
[Pages 54652-54653]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-20365]


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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 2005 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 2005 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 2005.

DATES: The fiscal year 2005 rates contained in this notice are 
effective for services occurring on or after October 1, 2004.

FOR FURTHER INFORMATION CONTACT: Christine Gavlick, Office of Medical 
Benefits and Reimbursement Systems, TRICARE Management Activity, 
telephone (303) 676-3841.

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 2005, Medicare has recommended a rate 
of increase of 3.3 percent for hospitals and units excluded from the 
prospective payment system. TRICARE will adopt this update factor for 
FY 2005 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 2004 updated by 3.3 
percent for FY

[[Page 54653]]

2005. Partial hospitalization rates for full day and half day programs 
will also be updated by 3.3 percent for FY 2005. The cap amount for 
high volume hospitals and units will also be updated by the 3.3 percent 
for FY 2005. The beneficiary cost-share for low volume hospitals and 
units will also be updated by the 3.3 percent for FY 2005. Consistent 
with Medicare, the wage portion of the regional rate subject to the 
area wage adjustment is 71.56 percent for FY 2005.
    The following reflect an update of 3.3 percent for FY 2005.

Regional Specific Rates for Psychiatric Hospitals and Units with Low 
Tricare Volume

------------------------------------------------------------------------
                United States census region                     Rate@
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Northeast:
    New England............................................         $638
Mid-Atlantic...............................................          614
Midwest:
    East North Central.....................................          530
    West North Central.....................................          500
South:
    South Atlantic.........................................          632
    East South Central.....................................          685
    West South Central.....................................          576
West:
    Mountain...............................................          575
    Pacific................................................          679
@Wage portion of the rate, subject to the area wage               71.56%
 adjustment................................................
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    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 $169 per day or 25 percent of 
the hospital billed charges effective for services rendered on or after 
October 1, 2004.
    Cap Amount: Updated cap amount for hospitals and units with high 
TRICARE volume is $802 per day for FY 2005.
    The following reflect an update of 3.3 percent for FY 2005.

Partial Hospitalization Rates for Full-Day and Half-Day Programs FY 
2005

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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,               $256             $192
     CT)..............................
    Mid-Atlantic (NY, NJ, PA).........              277              208
Midwest:
    East North Central (OH, IN, IL,                 244              183
     MI, WI)..........................
    West North Central (MN, IA, MO,                 244              183
     ND, SD, NE, KS)..................
South:
    South Atlantic (DE, MD, DC, VA,                 263              197
     WV, NC, SC, GA, FL)..............
    East South Central (KY, TN, AL,                 284              213
     MS)..............................
    West South Central (AR, LA, TX,                 284              213
     OK)..............................
West:
    Mountain (MT, ID, WY, CO, NM, AZ,               287              216
     UT, NV)..........................
    Pacific (WA, OR, CA, AK, HI)......              281              211
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    The above rates are effective for services rendered on or after 
October 1, 2004.

    Dated: September 2, 2004.
L.M. Bynum,
Alternate OSD Federal Register, Liaison Officer, Department of Defense.
[FR Doc. 04-20365 Filed 9-8-04; 8:45 am]
BILLING CODE 5001-06-P