[Federal Register Volume 75, Number 10 (Friday, January 15, 2010)]
[Notices]
[Pages 2515-2517]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-598]


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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 2010 Mental 
Health Rate Updates

AGENCY: Office of the Secretary, DoD.

ACTION: Notice of Updated Mental Health Rates for Fiscal Year 2010.

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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-

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diem rates for both full-day and half-day TRICARE Partial 
Hospitalization Programs for Fiscal Year 2010.

DATES: Effective Date: The Fiscal Year 2010 rates contained in this 
notice are effective for services on or after October 1, 2009.

ADDRESSES: TRICARE Management Activity (TMA), Medical Benefits and 
Reimbursement Branch, 16401 East Centretech Parkway, Aurora, CO 80011-
9066.

FOR FURTHER INFORMATION CONTACT: Ann N. Fazzini, Medical Benefits and 
Reimbursement Branch, TMA, 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, each per-diem shall be updated by the Medicare update 
factor for hospitals and units exempt from the Medicare Prospective 
Payment System (i.e., this is the same update factor used for the 
inpatient prospective payment system). For Fiscal Year 2010, Medicare 
has recommended a rate of increase of 2.1 percent. TRICARE will adopt 
this update factor for Fiscal Year 2010 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 Fiscal Year 2010 updated by 2.1 percent.
    Partial hospitalization rates for full-day and half-day programs 
will also be updated by 2.1 percent for Fiscal Year 2010.
    The cap amount for high-volume hospitals and units will also be 
updated by 2.1 percent for Fiscal Year 2010.
    The Standard non-active duty family member cost share for low 
volume hospitals and units will also be updated by 2.1 percent for 
Fiscal Year 2010.
    Per 32 CFR 199.14, the same area wage indexes used for the CHAMPUS 
Diagnosis-Related Group (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 68.8 percent for Fiscal Year 2010. 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, 32 CFR 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 2.1 percent for Fiscal Year 
2010.

  Regional Specific Rates for Psychiatric Hospitals and Units With Low
                   TRICARE Volume for Fiscal Year 2010
------------------------------------------------------------------------
                                                               Regional
                United States census region                      rate
------------------------------------------------------------------------
Northeast:
  New England..............................................         $745
  Mid-Atlantic.............................................          718
Midwest:
  East North Central.......................................          620
  West North Central.......................................          585
South:
  South Atlantic...........................................          738
  East South Central.......................................          790
  West South Central.......................................          673
West:
  Mountain.................................................          672
  Pacific..................................................          794
  Puerto Rico..............................................          506
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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 $197 per day or 25 percent of 
the hospital billed charges effective for services rendered on or after 
October 1, 2009. Cap Amount: Updated cap amount for hospitals and units 
with high TRICARE volume is $936 per day for services on or after 
October 1, 2009.
    The following reflect an update of 2.1 percent for Fiscal Year 2010 
for the partial hospitalization rates.

    Partial Hospitalization Rates for Full-Day and Half-Day Programs
                           [Fiscal year 2010]
------------------------------------------------------------------------
                                    Full-day rate  (6  Half-day rate  (3-
    United States census region       hours or more)        5 hours)
------------------------------------------------------------------------
Northeast:
    New England (Maine, N.H., Vt.,               $299               $222
     Mass., R.I., Conn.)..........
Mid-Atlantic:
    (N.Y., N.J., Penn.)...........                325                244
Midwest:
    East North Central (Ohio,                     286                213
     Ind., Ill., Mich., Wis.).....
West North Central:
    (Minn., Iowa, Mo., N.D., S.D.,                286                213
     Neb., Kan.)..................
South:
    South Atlantic (Del., Md., DC,                307                231
     Va., W.Va., N.C., S.C., Ga.,
     Fla.)........................
East South Central:
    (Ky., Tenn., Ala., Miss.).....                332                250
West South Central:
    (Ark., La., Texas, Okla.).....                332                250
West:
    Mountain (Mon., Idaho, Wyo.,                  335                253
     Col., N.M., Ariz., Utah,
     Nev.)........................
    Pacific (Wash., Ore., Calif.,                 329                246
     Alaska, Hawaii)..............
Puerto Rico.......................                213                161
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    The above rates are effective for services rendered on or after 
October 1, 2009.

    Dated: December 18, 2009.
Patricia Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2010-598 Filed 1-14-10; 8:45 am]
BILLING CODE 5001-06-P