[Federal Register: December 8, 2005 (Volume 70, Number 235)]
[Notices]
[Page 72994-72995]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr08de05-46]
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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 2006 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 2006 under the TRICARE Mental Health Per Diem
[[Page 72995]]
Payment System; and the updated per diem rates for both full-day and
half-day TRICARE Partial Hospitalization Programs for fiscal year 2006.
EFFECTIVE DATE: The fiscal year 2006 rates contained in this notice are
effective for services occurring on or after October 1, 2005.
FOR FURTHER INFORMATION CONTACT: Christine Covie, 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 2006, Medicare has recommended a rate
of increase of 3.8 percent for hospitals and units excluded from the
prospective payment system. TRICARE will adopt this update factor for
FY 2006 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 2005 updated by 3.8
percent for FY 2006. Partial hospitalization rates for full day and
half day programs will also be updated by 3.8 percent for FY 2006. The
cap amount for high volume hospitals and units will also be updated by
the 3.8 percent for FY 2006. The beneficiary cost-share for low volume
hospitals and units will also be updated by the 3.8 percent for FY
2006. Consistent with Medicare, the wage portion of the regional rate
subject to the area wage adjustment is 71.035 percent for FY 2006. The
following reflect an update of 3.8 percent for FY 2006:
Regional Specific Rates for Psychiatric Hospitals and Units With Low
TRICARE Volume
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Rate
United States census region \1\
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Northeast:
New England................................................... $662
Mid-Atlantic.................................................. 637
Midwest:
East North Central............................................ 550
West North Central............................................ 519
South:
South Atlantic................................................ 656
East South Central............................................ 701
West South Central............................................ 598
West:
Mountain...................................................... 597
Pacific....................................................... 705
Puerto Rico..................................................... 450
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\1\ Wage portion of the rate, subject to the area wage adjustment 71.035
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 $175 per day or 25 percent of
the hospital billed charges effective for services rendered on or after
October 1, 2005.
Cap Amount: Updated cap amount for hospitals and units with high
TRICARE volume is $832 per day for FY 2006.
The following reflect an update of 3.8 percent for FY 2006.
Partial Hospitalization Rates for Full-Day and Half-Day Programs FY 2006
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Full-day rate (6 Half-day rate
United States census region hours or more) (3-5 hours)
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Northeast:
New England (ME, NH, VT, MA, RI, CT).................................. $266 200
Mid-Atlantic (NY, NJ, PA)............................................. 288 216
Midwest:
East North Central (OH, IN, IL, MI, WI)............................... 253 190
West North Central (MN, IA, MO, ND, SD, NE, KS)....................... 253 190
South:
South Atlantic (DE, MD, DC, VA, WV, NC, SC, GA, FL)................... 273 205
East South Central (KY, TN, AL, MS)................................... 295 221
West South Central (AR, LA, TX, OK)................................... 295 211
West
Mountain (MT, ID, WY, CO, NM, AZ, UT, NV)............................. 298 224
Pacific (WA, OR, CA, AK, HI).......................................... 292 219
Puerto Rico............................................................... 190 143
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The above rates are effective for services rendered on or after
October 1, 2005.
Dated: December 2, 2005.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 05-23766 Filed 12-7-05; 8:45 am]
BILLING CODE 5001-06-M