[Federal Register: November 12, 2008 (Volume 73, Number 219)]
[Notices]
[Page 66864-66865]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr12no08-56]
-----------------------------------------------------------------------
DEPARTMENT OF DEFENSE
Office of the Secretary
TRICARE, Formerly Known as the Civilian Health and Medical
Program of the Uniformed Services (CHAMPUS); Fiscal Year (FY) 2009
Mental Health Rate Updates
AGENCY: Department of Defense.
ACTION: Notice of updated mental health rates for FY 2009.
-----------------------------------------------------------------------
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 FY 2009.
DATES: Effective Date: The FY 2009 rates contained in this notice are
effective for services on or after October 1, 2008.
FOR FURTHER INFORMATION CONTACT: Ann N. Fazzini, Medical Benefits and
Reimbursement Branch, TRICARE Management Activity, telephone (303) 676-
3803.
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,
[[Page 66865]]
each per diem shall be updated by the Medicare update factor for
hospitals and units exempt from the Medicare Prospective Payment System
(i.e., the update factor for inpatient psychiatric facilities). For FY
2009, Medicare has recommended a rate of increase of 3.2 percent.
TRICARE will adopt this update factor for FY 2009 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 2008 updated by 3.2 percent for FY 2009. Partial
hospitalization rates for full-day and half-day programs will also be
updated by 3.2 percent for FY 2009. The cap amount for high-volume
hospitals and units will also be updated by the 3.2 percent for FY
2009. The beneficiary cost share for low volume hospitals and units
will also be updated by 3.2 percent for FY 2009.
Per Title 32, Code of Federal Regulations (CFR), Part 199.14, the
same area wage indexes used for the CHAMPUS 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 69.7 percent for FY 2009. 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, Title
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 3.2 percent for FY 2009.
Regional Specific Rates for Psychiatric Hospitals and Units With Low
TRICARE Volume for Fiscal Year 2009
------------------------------------------------------------------------
Regional
United States Census Region rate
------------------------------------------------------------------------
Northeast:
New England............................................... $730
Mid-Atlantic.............................................. 703
Midwest:
East North Central........................................ 607
West North Central........................................ 573
South:
South Atlantic............................................ 723
East South Central........................................ 774
West South Central........................................ 659
West:
Mountain.................................................. 658
Pacific................................................... 778
Puerto Rico............................................... 496
------------------------------------------------------------------------
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 $193 per day or 25 percent of
the hospital billed charges effective for services rendered on or after
October 1, 2008.
Cap Amount: Updated cap amount for hospitals and units with high
TRICARE volume is $917 per day for FY 2009.
The following reflect an update of 3.2 percent for FY 2009.
Partial Hospitalization Rates for Full-Day and Half-Day Programs
[Fiscal year 2009]
------------------------------------------------------------------------
Full-day rate
United States Census Region (6 hours or Half-day rate
more) (3-5 hours)
------------------------------------------------------------------------
Northeast:
New England (Maine, N.H., Vt., $293 $221
Mass., R.I., Conn.)................
Mid-Atlantic:
(N.Y., N.J., Penn.)................. 318 239
Midwest:
East North Central (Ohio, Ind., 280 209
Ill., Mich., Wis.).................
West North Central:
(Minn., Iowa, Mo., N.D., S.D., Neb., 280 209
Kan.)..............................
South:
South Atlantic (Del., Md., D.C., 301 226
Va., W.Va., N.C., S.C., Ga., Fla.).
East South Central:
(Ky., Tenn., Al., Miss.)............ 325 245
West South Central:
(Ark., La., Texas, Okla.)........... 325 245
West:
Mountain (Mon., Idaho, Wyo., Col., 328 248
N.M., Ariz., Utah, Nev.)...........
Pacific (Wash., Ore., Calif., 322 241
Alaska, Hawaii)....................
Puerto Rico............................. 209 158
------------------------------------------------------------------------
The above rates are effective for services rendered on or after
October 1, 2008.
Dated: November 4, 2008.
Patricia L. Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. E8-26759 Filed 11-10-08; 8:45 am]
BILLING CODE 5001-06-P