[Federal Register Volume 76, Number 43 (Friday, March 4, 2011)]
[Notices]
[Pages 12074-12075]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-4866]
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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 2011 Mental
Health Rate Updates
AGENCY: Department of Defense.
ACTION: Notice of Updated Mental Health Rates for Fiscal Year 2011.
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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 2011.
DATES: Effective Date: The Fiscal Year 2011 rates contained in this
notice are effective for services on or after October 1, 2010.
ADDRESSES: TRICARE Management Activity (TMA), Medical Benefits and
Reimbursement Branch, 16401 East Centretech Parkway, Aurora, CO 80011-
9066.
FOR FURTHER INFORMATION CONTACT: Ann N. Fazzini, Medical Benefits and
Reimbursement Branch, TMA, telephone (303) 676-3803.
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 2011, the market
basket rate is 2.6 percent. This year, Medicare applied two reductions
to their market basket amount: (1) a 0.25 percent reduction due to
provisions found in the Patient Protection and Affordable Care Act, and
(2) a 2.9 percent reduction for documentation and coding adjustments
found in Public Law 110-90. 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 2011 updated by 2.6 percent.
Partial hospitalization rates for full-day and half-day programs
will also be updated by 2.6 percent for Fiscal Year 2011.
The cap amount for high-volume hospitals and units will also be
updated by the 2.6 percent for Fiscal Year 2011.
The beneficiary cost share for low volume hospitals and units will
also be updated by the 2.6 percent for Fiscal Year 2011.
Per 32 Code of Federal Regulations (CFR) 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 68.8 percent for Fiscal
Year 2011. 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, 32 CFR 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 2.6 percent for Fiscal Year
2011.
Regional Specific Rates for Psychiatric Hospitals and Units With Low
Tricare Volume for Fiscal Year 2011
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Regional
United States census region rate
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Northeast:
New England............................................ $764
Mid-Atlantic........................................... 736
Midwest:
East North Central..................................... 636
West North Central..................................... 600
South:
South Atlantic......................................... 757
East South Central..................................... 810
West South Central..................................... 690
West:
Mountain............................................... 689
Pacific................................................ 814
Puerto Rico............................................ 519
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Beneficiary cost-share: Beneficiary cost-share (other than
dependents of
[[Page 12075]]
Active Duty members) for care paid on the basis of a regional per-diem
rate is the lower of $202 per day or 25 percent of the hospital billed
charges effective for services rendered on or after October 1, 2010.
Cap Amount: Updated cap amount for hospitals and units with high
TRICARE volume is $960 per day for services on or after October 1,
2010.
The following reflect an update of 2.6 percent for Fiscal Year 2011
for the partial hospitalization rates.
Partial Hospitalization Rates for Full-Day and Half-Day Programs
[Fiscal year 2011]
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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 (Maine, N.H., Vt., Mass., $306 $227
R.I., Conn.).............................
Mid-Atlantic:
(N.Y., N.J., Penn.)....................... 333 250
Midwest:
East North Central (Ohio, Ind., Ill., 293 218
Mich., Wis.).............................
West North Central:
(Minn., Iowa, Mo., N.D., S.D., Neb., Kan.) 293 218
South:
South Atlantic (Del., Md., D.C., Va., 314 237
W.Va., N.C., S.C., Ga., Fla.)............
East South Central:
(Ky., Tenn., Ala., Miss.)................. 340 256
West South Central:
(Ark., La., Texas, Okla.)................. $340 256
West:
Mountain (Mon., Idaho, Wyo., Col., N.M., 343 259
Ariz., Utah, Nev.).......................
Pacific (Wash., Ore., Calif., Alaska, 337 252
Hawaii)..................................
Puerto Rico................................... 218 165
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The above rates are effective for services rendered on or after
October 1, 2010.
Dated: March 1, 2011.
Morgan F. Park,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2011-4866 Filed 3-3-11; 8:45 am]
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