[Federal Register Volume 73, Number 219 (Wednesday, November 12, 2008)]
[Notices]
[Pages 66864-66865]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E8-26759]


-----------------------------------------------------------------------

DEPARTMENT OF DEFENSE

Office of the Secretary


TRICARE, Formerly Known as the Civilian Health and Medical 
Program of the Uniformed Services (CHAMPUS); Fiscal Year (FY) 2009 
Mental Health Rate Updates

AGENCY: Department of Defense.

ACTION: Notice of updated mental health rates for FY 2009.

-----------------------------------------------------------------------

SUMMARY: This notice provides the updated regional per diem rates for 
low volume mental health providers; the update factor for hospital-
specific per diems; the updated cap per diem for high-volume providers; 
the beneficiary per diem cost share amount for low-volume providers; 
and, the updated per diem rates for both full-day and half-day TRICARE 
Partial Hospitalization Programs for FY 2009.

DATES: Effective Date: The FY 2009 rates contained in this notice are 
effective for services on or after October 1, 2008.

FOR FURTHER INFORMATION CONTACT: Ann N. Fazzini, Medical Benefits and 
Reimbursement Branch, TRICARE Management Activity, telephone (303) 676-
3803.

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 66865]]

each per diem shall be updated by the Medicare update factor for 
hospitals and units exempt from the Medicare Prospective Payment System 
(i.e., the update factor for inpatient psychiatric facilities). For FY 
2009, Medicare has recommended a rate of increase of 3.2 percent. 
TRICARE will adopt this update factor for FY 2009 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 2008 updated by 3.2 percent for FY 2009. Partial 
hospitalization rates for full-day and half-day programs will also be 
updated by 3.2 percent for FY 2009. The cap amount for high-volume 
hospitals and units will also be updated by the 3.2 percent for FY 
2009. The beneficiary cost share for low volume hospitals and units 
will also be updated by 3.2 percent for FY 2009.
    Per Title 32, Code of Federal Regulations (CFR), Part 199.14, the 
same area wage indexes used for the CHAMPUS DRG-based payment system 
shall be applied to the wage portion of the applicable regional per 
diem for each day of the admission. The wage portion shall be the same 
as that used for the CHAMPUS DRG-based payment system. For wage index 
values greater than 1.0, the wage portion of the regional rate subject 
to the area wage adjustment is 69.7 percent for FY 2009. For wage index 
values less than or equal to 1.0, the wage portion of the regional rate 
subject to the area wage adjustment is 62 percent. Additionally, Title 
32, CFR Part 199.14, requires that hospital specific and regional per 
diems shall be updated by the Medicare update factor for hospitals and 
units exempt from the Medicare prospective payment system.
    The following reflect an update of 3.2 percent for FY 2009.

  Regional Specific Rates for Psychiatric Hospitals and Units With Low
                   TRICARE Volume for Fiscal Year 2009
------------------------------------------------------------------------
                                                               Regional
                 United States Census Region                     rate
------------------------------------------------------------------------
Northeast:
  New England...............................................        $730
  Mid-Atlantic..............................................         703
Midwest:
  East North Central........................................         607
  West North Central........................................         573
South:
  South Atlantic............................................         723
  East South Central........................................         774
  West South Central........................................         659
West:
  Mountain..................................................         658
  Pacific...................................................         778
  Puerto Rico...............................................         496
------------------------------------------------------------------------

    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 $193 per day or 25 percent of 
the hospital billed charges effective for services rendered on or after 
October 1, 2008.
    Cap Amount: Updated cap amount for hospitals and units with high 
TRICARE volume is $917 per day for FY 2009.
    The following reflect an update of 3.2 percent for FY 2009.

    Partial Hospitalization Rates for Full-Day and Half-Day Programs
                           [Fiscal year 2009]
------------------------------------------------------------------------
                                           Full-day rate
       United States Census Region          (6 hours or    Half-day rate
                                               more)        (3-5 hours)
------------------------------------------------------------------------
Northeast:
    New England (Maine, N.H., Vt.,                  $293            $221
     Mass., R.I., Conn.)................
Mid-Atlantic:
    (N.Y., N.J., Penn.).................             318             239
Midwest:
    East North Central (Ohio, Ind.,                  280             209
     Ill., Mich., Wis.).................
West North Central:
    (Minn., Iowa, Mo., N.D., S.D., Neb.,             280             209
     Kan.)..............................
South:
    South Atlantic (Del., Md., D.C.,                 301             226
     Va., W.Va., N.C., S.C., Ga., Fla.).
East South Central:
    (Ky., Tenn., Al., Miss.)............             325             245
West South Central:
    (Ark., La., Texas, Okla.)...........             325             245
West:
    Mountain (Mon., Idaho, Wyo., Col.,               328             248
     N.M., Ariz., Utah, Nev.)...........
    Pacific (Wash., Ore., Calif.,                    322             241
     Alaska, Hawaii)....................
Puerto Rico.............................             209             158
------------------------------------------------------------------------

    The above rates are effective for services rendered on or after 
October 1, 2008.

    Dated: November 4, 2008.
Patricia L. Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. E8-26759 Filed 11-10-08; 8:45 am]
BILLING CODE 5001-06-P