[Federal Register: September 9, 2004 (Volume 69, Number 174)]
[Notices]
[Page 54652-54653]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr09se04-54]
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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 2005 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 volume 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 2005 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 2005.
DATES: The fiscal year 2005 rates contained in this notice are
effective for services occurring on or after October 1, 2004.
FOR FURTHER INFORMATION CONTACT: Christine Gavlick, Office of Medical
Benefits and Reimbursement Systems, TRICARE Management Activity,
telephone (303) 676-3841.
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. For fiscal year 2005, Medicare has recommended a rate
of increase of 3.3 percent for hospitals and units excluded from the
prospective payment system. TRICARE will adopt this update factor for
FY 2005 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 2004 updated by 3.3
percent for FY
[[Page 54653]]
2005. Partial hospitalization rates for full day and half day programs
will also be updated by 3.3 percent for FY 2005. The cap amount for
high volume hospitals and units will also be updated by the 3.3 percent
for FY 2005. The beneficiary cost-share for low volume hospitals and
units will also be updated by the 3.3 percent for FY 2005. Consistent
with Medicare, the wage portion of the regional rate subject to the
area wage adjustment is 71.56 percent for FY 2005.
The following reflect an update of 3.3 percent for FY 2005.
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............................................ $638
Mid-Atlantic............................................... 614
Midwest:
East North Central..................................... 530
West North Central..................................... 500
South:
South Atlantic......................................... 632
East South Central..................................... 685
West South Central..................................... 576
West:
Mountain............................................... 575
Pacific................................................
679@Wage portion of the rate, subject to the area wage 71.56%
adjustment................................................
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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 $169 per day or 25 percent of
the hospital billed charges effective for services rendered on or after
October 1, 2004.
Cap Amount: Updated cap amount for hospitals and units with high
TRICARE volume is $802 per day for FY 2005.
The following reflect an update of 3.3 percent for FY 2005.
Partial Hospitalization Rates for Full-Day and Half-Day Programs FY
2005
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Full-day rate
United States census region (6 hours or Half-day rate
more) (3-5 hours)
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Northeast:
New England (ME, NH, VT, MA, RI, $256 $192
CT)..............................
Mid-Atlantic (NY, NJ, PA)......... 277 208
Midwest:
East North Central (OH, IN, IL, 244 183
MI, WI)..........................
West North Central (MN, IA, MO, 244 183
ND, SD, NE, KS)..................
South:
South Atlantic (DE, MD, DC, VA, 263 197
WV, NC, SC, GA, FL)..............
East South Central (KY, TN, AL, 284 213
MS)..............................
West South Central (AR, LA, TX, 284 213
OK)..............................
West:
Mountain (MT, ID, WY, CO, NM, AZ, 287 216
UT, NV)..........................
Pacific (WA, OR, CA, AK, HI)...... 281 211
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The above rates are effective for services rendered on or after
October 1, 2004.
Dated: September 2, 2004.
L.M. Bynum,
Alternate OSD Federal Register, Liaison Officer, Department of Defense.
[FR Doc. 04-20365 Filed 9-8-04; 8:45 am]
BILLING CODE 5001-06-P