[Federal Register Volume 80, Number 207 (Tuesday, October 27, 2015)]
[Notices]
[Pages 65716-65717]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-27234]


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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 2016 Mental 
Health Rate Updates

AGENCY: Department of Defense.

ACTION: Notice of Updated Mental Health Rates for Fiscal Year 2016.

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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-diem rates for both full-day and half-day TRICARE 
Partial Hospitalization Programs for Fiscal Year 2016.

DATES: Effective Date: The Fiscal Year 2016 rates contained in this 
notice are effective for services on or after October 1, 2015.

ADDRESSES: Defense Health Agency (DHA), Medical Benefits and 
Reimbursement Section, 16401 East Centretech Parkway, Aurora, CO 80011-
9066.

FOR FURTHER INFORMATION CONTACT: Elan Green, Medical Benefits and 
Reimbursement Section, DHA, 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 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 2016, the market 
basket rate is 2.4 percent. This year, Medicare applied two reductions 
to its market basket amount: (1) A 0.5 percent reduction for economy-
wide productivity required by section 3401(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 0.2 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 2016 updated by 2.4 percent.
    Partial hospitalization rates for full-day programs also will be 
updated by 2.4 percent for Fiscal Year 2016. Partial hospitalization 
rates for programs of less than 6 hours (with a minimum of three hours) 
will be paid a per diem rate of 75 percent of the rate for a full-day 
program.
    The cap amount for high-volume hospitals and units also will be 
updated by the 2.4 percent for Fiscal Year 2016.
    The beneficiary cost share for low-volume hospitals and units also 
will be updated by the 2.4 percent for Fiscal Year 2016.
    Per Title 32 Code of Federal Regulations (CFR), Part 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 
69.6 percent for Fiscal Year 2016. 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 62.0 percent.
    Additionally, 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 2.4 percent for Fiscal Year 
2016.

  Regional-Specific Rates for Psychiatric Hospitals and Units With Low
                   Tricare Volume for Fiscal Year 2016
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                                                               Regional
                United States census region                      rate
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Northeast:
  New England..............................................         $871
  Mid-Atlantic.............................................          840
Midwest:
  East North Central.......................................          726
  West North Central.......................................          685

[[Page 65717]]

 
South:
  South Atlantic...........................................          864
  East South Central.......................................          924
  West South Central.......................................          787
West:
  Mountain.................................................          786
  Pacific..................................................          930
  Puerto Rico..............................................          593
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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 $229 per day or 25 percent of 
the hospital billed charges effective for services rendered on or after 
October 1, 2015. Cap Amount: Updated cap amount for hospitals and units 
with high TRICARE volume is $1,096 per day for services on or after 
October 1, 2015.
    The following reflects an update of 2.4 percent for Fiscal Year 
2016 for the full day partial hospitalization rates. Partial 
hospitalization rates for programs of less than 6 hours (with a minimum 
of three hours) will be paid a per diem rate of 75 percent of the rate 
for a full-day program.

    Partial Hospitalization Rates for Full-Day and Half-Day Programs
                           [Fiscal year 2016]
------------------------------------------------------------------------
                                      Full-day rate  (6    Half-day rate
    United States census region         hours or more)      (3-5 hours)
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Northeast:
    New England (Maine, N.H., Vt.,                  $349            $262
     Mass., R.I., Conn.)...........
Mid-Atlantic:
    (N.Y., N.J., Penn.)............                  380             285
Midwest:
    East North Central (Ohio, Ind.,                  335             251
     Ill., Mich., Wis.)............
West North Central:
    (Minn., Iowa, Mo., N.D., S.D.,                   335             251
     Neb., Kan.)...................
South:
    South Atlantic (Del., Md., DC,                   357             268
     Va., W.Va., N.C., S.C., Ga.,
     Fla.).........................
East South Central:
    (Ky., Tenn., Ala., Miss.)......                  388             291
West South Central:
    (Ark., La., Texas, Okla.)......                  388             291
West:
    Mountain (Mon., Idaho, Wyo.,                     391             293
     Col., N.M., Ariz., Utah, Nev.)
    Pacific (Wash., Ore., Calif.,                    385             289
     Alaska, Hawaii)...............
Puerto Rico........................                  250             188
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    The above rates are effective for services rendered on or after 
October 1, 2015.

    Dated: October 21, 2015.
Aaron Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2015-27234 Filed 10-26-15; 8:45 am]
BILLING CODE 5001-06-P