07-4829. TRICARE, Formerly Known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); Fiscal Year (FY) 2008 Mental Health Rate Updates

AGENCY:

Department of Defense.

ACTION:

Notice of updated mental health per diem rates.

SUMMARY:

This notice provides for the updating of institution-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 2008 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 FY 2008.

DATES:

Effective Date: The FY 2008 rates contained in this notice are effective for services occurring on or after October 1.

FOR FURTHER INFORMATION CONTACT:

Christine Covie, Office of Medical Benefits and Reimbursement Systems, TRICARE Management Activity, telephone [phone].

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 FY. 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 2008, 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 2008 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 2007 updated by 3.4 percent for FY 2008. Partial hospitalization rates for full-day and half-day programs will also be updated by 3.4 percent for FY 2008. The cap amount for high-volume hospitals and units will also be updated by the 3.4 percent for FY 2008. The beneficiary cost share for low volume hospitals and units will also be updated by the 3.4 percent for FY 2008.

Consistent with Medicare, the wage portion of the regional rate subject to the area wage adjustment is 75.788 percent for FY 2008. The following reflect an update of 3.4 percent for FY 2008.

Regional Specific Rates for Psychiatric Hospitals and Units With Low TRICARE Volume

United States Census Region

	Rate @
Northeast:
New England	$707
Mid-Atlantic	681
Midwest:
East North Central	588
West North Central	555
South:
South Atlantic	701
East South Central	750
West South Central	639
West:
Mountain	638
Pacific	754
Puerto Rico	481
@ Wage portion of the rate, subject to the area wage adjustment—75.788.

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 $187 per day or 25 percent of the hospital billed charges effective for services rendered on or after October 1, 2007.

Cap Amount: Updated cap amount for hospitals and units with high TRICARE volume is $889 per day for FY 2008.

The following reflect an update of 3.4 percent for FY 2008.

Partial Hospitalization Rates for Full-Day and Half-Day Programs

[Fiscal year 2007]

United States Census Region	Full-day rate (6 hours or more)	Half-day rate (3-5 hours)
Northeast:
New England (Maine, N.H., Vt., Mass., R.I., Conn.)	$284	$214
Mid-Atlantic:
(N.Y., N.J., Penn.)	308	232
Midwest:
East North Central (Ohio, Ind., Ill., Mich., Wis.)	271	203
West North Central:
(Minn., Iowa, Mo., N.D., S.D., Neb., Kan.)	271	203
South:
South Atlantic (Del., Md., D.C., Va., W.Va., N.C., S.C., Ga., Fla.)	292	219
East South Central:
(Ky., Tenn., Aa., Miss.)	315	237
West South Central:
(Ark., La., Texas, Okla.)	315	237
West:
Mountain (Mon., Idaho, Wyo., Col., N.M., Ariz., Utah, Nev.)	318	240
Pacific (Wash., Ore., Calif., Alaska, Hawaii)	312	234
Puerto Rico	203	153

The above rates are effective for services rendered on or after October 1, 2007.

Dated: September 25, 2007.

L.M. Bynum,

Alternate OSD Federal Register Liaison Officer, Department of Defense.