[Federal Register Volume 70, Number 235 (Thursday, December 8, 2005)]
[Notices]
[Pages 72994-72995]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-23766]


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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 2006 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 2006 under the TRICARE Mental Health Per Diem

[[Page 72995]]

Payment System; and the updated per diem rates for both full-day and 
half-day TRICARE Partial Hospitalization Programs for fiscal year 2006.

EFFECTIVE DATE: The fiscal year 2006 rates contained in this notice are 
effective for services occurring on or after October 1, 2005.

FOR FURTHER INFORMATION CONTACT: Christine Covie, 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 2006, Medicare has recommended a rate 
of increase of 3.8 percent for hospitals and units excluded from the 
prospective payment system. TRICARE will adopt this update factor for 
FY 2006 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 2005 updated by 3.8 
percent for FY 2006. Partial hospitalization rates for full day and 
half day programs will also be updated by 3.8 percent for FY 2006. The 
cap amount for high volume hospitals and units will also be updated by 
the 3.8 percent for FY 2006. The beneficiary cost-share for low volume 
hospitals and units will also be updated by the 3.8 percent for FY 
2006. Consistent with Medicare, the wage portion of the regional rate 
subject to the area wage adjustment is 71.035 percent for FY 2006. The 
following reflect an update of 3.8 percent for FY 2006:

  Regional Specific Rates for Psychiatric Hospitals and Units With Low
                             TRICARE Volume
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                                                                   Rate
                   United States census region                      \1\
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Northeast:
  New England...................................................    $662
  Mid-Atlantic..................................................     637
Midwest:
  East North Central............................................     550
  West North Central............................................     519
South:
  South Atlantic................................................     656
  East South Central............................................     701
  West South Central............................................     598
West:
  Mountain......................................................     597
  Pacific.......................................................     705
Puerto Rico.....................................................    450
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\1\ Wage portion of the rate, subject to the area wage adjustment 71.035
  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 $175 per day or 25 percent of 
the hospital billed charges effective for services rendered on or after 
October 1, 2005.
    Cap Amount: Updated cap amount for hospitals and units with high 
TRICARE volume is $832 per day for FY 2006.
    The following reflect an update of 3.8 percent for FY 2006.

                    Partial Hospitalization Rates for Full-Day and Half-Day Programs FY 2006
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                                                                             Full-day rate  (6    Half-day rate
                        United States census region                           hours or more)       (3-5 hours)
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Northeast:
    New England (ME, NH, VT, MA, RI, CT)..................................                $266               200
    Mid-Atlantic (NY, NJ, PA).............................................                 288               216
Midwest:
    East North Central (OH, IN, IL, MI, WI)...............................                 253               190
    West North Central (MN, IA, MO, ND, SD, NE, KS).......................                 253               190
South:
    South Atlantic (DE, MD, DC, VA, WV, NC, SC, GA, FL)...................                 273               205
    East South Central (KY, TN, AL, MS)...................................                 295               221
    West South Central (AR, LA, TX, OK)...................................                 295               211
West
    Mountain (MT, ID, WY, CO, NM, AZ, UT, NV).............................                 298               224
    Pacific (WA, OR, CA, AK, HI)..........................................                 292               219
Puerto Rico...............................................................                 190               143
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    The above rates are effective for services rendered on or after 
October 1, 2005.

    Dated: December 2, 2005.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 05-23766 Filed 12-7-05; 8:45 am]
BILLING CODE 5001-06-M