[Federal Register: September 29, 2003 (Volume 68, Number 188)]
[Notices]
[Page 55943-55944]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr29se03-52]
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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 2004 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 volumes 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 2004 under the TRICARE Mental Health Per Diem Payment
System; and the updated per diem rates for both full-day and half-day
TRICARE Partial Hospitalization Programs for fiscal year 2004.
EFFECTIVE DATE: The fiscal year 2004 rates contained in this notice are
effective for services occurring on or after October 1, 2003.
FOR FURTHER INFORMATION CONTACT: Stan Regensberg, Office of Medical
Benefits and Reimbursement Systems, TRICARE Management Activity,
telephone (303) 676-3742.
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 admission 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 2004, Medicare has recommended a rate
of increase of 3.4 percent for hospitals and units excluded from the
prospective payment system. TRICARE will adopt this update factor for
FY 2004 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 2003 updates by 3.4
percent for FY 2004. Partial hospitalization rates for full day and
half day programs will also be updated by 3.4 percent for FY 2004. The
cap amount for high volume hospitals and units will also be updated by
the 3.4 percent for FY 2004. The beneficiary cost-share for low volume
hospitals and units will also be updated by the 3.4 percent for FY
2004. Consistent with Medicare, the wage portion of the regional rate
subject to the area wage adjustment is 71.56 percent for FY 2004.
The following reflect an update of 3.4 percent.
[[Page 55944]]
Regional Specific Rates for Psychiatric Hospitals and Units With Low
Tricare Volume
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United States census region Rate*
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Northeast:
New England............................................... $618
Mid-Atlantic.............................................. 594
Midwest:
East North Central........................................ 513
West North Central........................................ 484
South:
South Atlantic............................................ 612
East South Central........................................ 663
West South Central........................................ 558
West:
Mountain.................................................. 557
Pacific................................................... 657
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* Wage portion of the rate, subject to the area wage adjustment: 71.56
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 $164 per day or 25 percent of
the hospital billed charges effective for services rendered on or after
October 1, 2003
Cap Amount: Updated cap amount for hospitals and units with high
TRICARE volume is $776 per day for FY 2004.
The following reflect an update of 3.4 percent for FY 2004.
Partial Hospitalization Rates for Full-Day and Half-Day Programs FY 2004
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Full-day
rate (6 Half-day
United States census region hours or rate (3-5
more) hours)
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Northeast:
New England (ME, NH, VT, MA, RI, CT)...... $248 $186
Mid-Atlantic (NY, NJ, PA)................. 268 201
Midwest:
East North Central (OH, IN, IL, MI, WI)... 236 177
West North Central (MN, IA, MO, ND, SD, 236 177
NE, KS)..................................
South:
South Atlantic (DE, MD, DC, VA, NY, NC, 255 191
SC, GA, FL)..............................
East South Central (KY, TN, AL, MS)....... 275 206
West South Central (AR, LA, TX, OK)....... 275 206
West:
Mountain (MT, ID, WY, CO, NM, AZ, UT, NV). 278 209
Pacific (WA, OR, CA, AK, HI).............. 272 204
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The above rates are effective for services rendered on or after
December 1, 2003.
Dated: September 22, 2003.
Patricia L. Toppings,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 03-24441 Filed 9-26-03; 8:45 am]
BILLING CODE 5001-08-M