[Federal Register Volume 76, Number 228 (Monday, November 28, 2011)]
[Notices]
[Pages 72911-72912]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-30514]


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

DEPARTMENT OF DEFENSE

Office of the Secretary


TRICARE, Formerly Known as the Civilian Health and Medical 
Program of the Uniformed Services (CHAMPUS); Fiscal Year 2012 Mental 
Health Rate Updates

AGENCY: Office of the Secretary, Department of Defense.

ACTION: Notice of updated mental health rates for Fiscal Year 2012.

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

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 Fiscal Year 2012.

DATES: Effective Date: The Fiscal Year 2012 rates contained in this 
notice are effective for services on or after October 1, 2011.

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

FOR FURTHER INFORMATION CONTACT: Elan Green, Medical Benefits and 
Reimbursement Branch, TMA, telephone (303) 676-3907.

SUPPLEMENTARY INFORMATION: The final rule published in the Federal 
Register (FR) 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 35400) 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 2012, the market 
basket rate is 3.0 percent. This year, Medicare applied two reductions 
to its market basket amount: (1) A 1.0 percent reduction for economy-
wide productivity required by section 3410(a) of the Patient Protection 
and Affordable Care Act (PPACA) which amended section 1886(b)(3)(B) of 
the Social Security Act, and (2) a 0.1 percent point adjustment as 
required by section 1886(b)(3)(B)(xii) of the Act as added and amended 
by sections 3401 and 10319(a) of the PPACA. These two reductions do not 
apply to TRICARE. 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 2012 updated by 3.0 percent
    Partial hospitalization rates for full-day and half-day programs 
also will be updated by 3.0 percent for Fiscal Year 2012.
    The cap amount for high-volume hospitals and units also will be 
updated by the 3.0 percent for Fiscal Year 2012.
    The beneficiary cost share for low-volume hospitals and units also 
will be updated by the 3.0 percent for Fiscal Year 2012.
    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 2012. 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 3.0 percent for Fiscal Year 
2012.

  Regional-Specific Rates for Psychiatric Hospitals and Units With Low
                   Tricare Volume for Fiscal Year 2012
------------------------------------------------------------------------
                                                               Regional
                United States Census Region                      rate
------------------------------------------------------------------------
Northeast:
    New England............................................         $787
    Mid-Atlantic...........................................          758
Midwest:
    East North Central.....................................          655
    West North Central.....................................          618
South:
    South Atlantic.........................................          780
    East South Central.....................................          834
    West South Central.....................................          711
West:
    Mountain...............................................          710
    Pacific................................................          838
    Puerto Rico............................................           53
------------------------------------------------------------------------

    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 $208 per day or 25 percent of 
the hospital billed charges effective for services rendered on or after 
October 1, 2011.
    Cap Amount: Updated cap amount for hospitals and units with high 
TRICARE volume is $ 989 per day for services on or after October 1, 
2011.
    The following reflect an update of 3.0 percent for Fiscal Year 2012 
for the partial hospitalization rates.

    Partial Hospitalization Rates for Full-Day and Half-Day Programs
                           [Fiscal year 2012]
------------------------------------------------------------------------
                                    Full-day rate  (6  Half-day rate  (3-
    United States Census Region       hours or more)        5 hours)
------------------------------------------------------------------------
Northeast:
    New England (Maine, N.H., Vt.,               $315               $234
     Mass., R.I., Conn.)..........
Mid-Atlantic:
    (N.Y., N.J., Penn.)...........                343                258
Midwest:
    East North Central (Ohio,                     302                225
     Ind., Ill., Mich., Wis.).....

[[Page 72912]]

 
West North Central:
    (Minn., Iowa, Mo., N.D., S.D.,                302                225
     Neb., Kan.)..................
South:
    South Atlantic (Del., Md., DC,                323                244
     Va., W.Va., N.C., S.C., Ga.,
     Fla.)........................
East South Central:
    (Ky., Tenn., Ala., Miss.).....                350                264
West South Central:
    (Ark., La., Texas, Okla.).....                350                264
West:
    Mountain (Mon., Idaho, Wyo.,                  353                267
     Col., N.M., Ariz., Utah,
     Nev.)........................
    Pacific (Wash., Ore., Calif.,                 347                260
     Alaska, Hawaii)..............
Puerto Rico.......................                225                170
------------------------------------------------------------------------

    The above rates are effective for services rendered on or after 
October 1, 2011.

    Dated: November 22, 2011.
Aaron Siegel,
Alternate OSD Federal Register Liaison Officer,
    Department of Defense.
[FR Doc. 2011-30514 Filed 11-25-11; 8:45 am]
BILLING CODE 5001-06-P