[Federal Register Volume 70, Number 143 (Wednesday, July 27, 2005)]
[Notices]
[Page 43400]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-14844]


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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 Puerto Rico 
Region Specific Mental Health Rates

AGENCY: Office of the Secretary, DoD.

ACTION: Notice of rate setting; establishment of region specific Puerto 
Rico Mental Health rates.

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SUMMARY: This notice provides for the establishment of a Puerto Rico 
region specific per diem rates for low volume providers; the 
establishment of region specific per diem rates for both full-day and 
half-day TRICARE Partial Hospitalization Programs under the TRICARE 
Mental Health Per Diem Payment System for fiscal year 2005.

EFFECTIVE DATE: The fiscal year 2005 rates contained in this notice are 
effective for services occurring on or after September 1, 2005.

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 
methodologies that were effective for all inpatient hospital admissions 
in psychiatric hospitals and exempt psychiatric units occurring on or 
after January 1, 1989. This final rule uses regionally established per 
diems to pay hospitals that do not have enough CHAMPUS discharges upon 
which to base a valid hospital-specific rate. Regional rates 
incorporate adjustments for area wage differences, indirect medical 
educations costs and pass through payments for direct medical education 
costs. Mental Health partial hospitalization programs are also 
reimbursed according to regional per diems. The Mental Health regional 
per diems are applied utilizing the designated Federal Census regions. 
By 32 CFR 199.14(a)(2)(viii)(E), the commonwealth of Puerto Rico is 
subject to TRICARE's mental halth reimbursement methodologies. Since 
Puerto Rico is not incorporated in a Federal Census Region, this notice 
establishes a Puerto Rico region specific per diem as well as region 
specific rates for partial hospitalization programs, both full day and 
half-day programs. TRICARE additionally published in the Federal 
Register on July 1, 1993, (58 FR 35-400) final rules that 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 has incorporated 
this update factor for FY 2005 in the determinaion of the region 
specific Puerto Rico rates. 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 reflects the Puerto Rico region specific rates:

   Region Specific Rates for Psychiatric Hospitals and Units With Low
                             Tricare Volume
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                     United States region                        Rate1
------------------------------------------------------------------------
Puerto Rico..................................................   $434.00
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\1\ 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 $169 per day or 25 percent of 
the hospital billed charges effective for services rendered on or after 
October 1, 2004.

 Puerto Rico Region Specific Partial Hospitalization Rates For Full-Time
                    Day and Half-Day Programs FY 2005
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                                   Full-day rate  (6     (Half-day rate
     United States region           hours or more)         (3-5 hours)
------------------------------------------------------------------------
Puerto Rico...................  $183..................             $138
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    The above rates are effective for services rendered on or after 
September 1, 2005.

    Dated: July 22, 2005.
L.M. Bynum,
Alternate OSD Federal Register, Liaison Officer, Department of Defense.
[FR Doc. 05-14844 Filed 7-26-05; 8:45 am]
BILLING CODE 5001-06-M