[Federal Register Volume 59, Number 190 (Monday, October 3, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-24388]
[[Page Unknown]]
[Federal Register: October 3, 1994]
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DEPARTMENT OF DEFENSE
Office of the Secretary
Civilian Health and Medical Program of the Uniformed Services
(CHAMPUS); Fiscal Year 1995 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 to be used for FY 1995 under the CHAMPUS Mental Health Per
Diem Payment System; and the updated per diem rates for both full-day
and half-day CHAMPUS Partial Hospitalization Programs for fiscal year
1995.
EFFECTIVE DATE: The rates contained in this notice are effective for
services occurring on or after October 1, 1994.
ADDRESSES: Office of the Civilian Health and Medical Program of the
Uniformed Services (OCHAMPUS), Program Development Branch, Aurora, CO
80045-6900.
For copies of the Federal Register containing this notice,contact
the Superintendent of Documents, U.S. Government Printing Office,
Washington, DC 20402, (202) 783-3238.
The charge for the Federal Register is $1.50 for each issue payable
by check or money order to the Superintendent of Documents.
FOR FURTHER INFORMATION CONTACT:
Stan Regensberg, Program Development Branch, OCHAMPUS, telephone (303)
361-1342. To obtain copies of this document, see the ADDRESSES section
above. Questions regarding payment of specific claims under the CHAMPUS
Mental Health Per Diem Payment System should be addressed to the
appropriate CHAMPUS contractor.
SUPPLEMENTARY INFORMATION: The final rule published in the Federal
Register on September 6, 1988, (52 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. Medicare has recommended an update factor of 3.7
percent for federal fiscal year 1995 for hospitals and units excluded
from the prospective payment system. CHAMPUS will adopt this update
factor for FY 1995 as the final update factor. Hospitals and units with
hospital-specific rates (hospitals and units with high CHAMPUS volume)
will have their FY 1994 CHAMPUS per diem rates updated by 3.7 percent
for FY 1995.
The following reflect an update of 3.7 percent.
Regional Specific Rates for Psychiatric Hospitals and Units With Low
Champus Volume
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United States census region Rate\2\
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Northeast:
New England................................................. $515
Mid-Atlantic................................................ 492
Midwest:
East North Central.......................................... 426
West North Central.......................................... 402
South:
South Atlantic.............................................. 509
East South Central.......................................... 550
West South Central.......................................... 463
West:
Mountain.................................................... 462
Pacific..................................................... 545
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\2\The wage portion of the rate, subject to the area wage adjustment, is
71.40 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 $137 per day or 25 percent of the hospital
billed charges effective for services rendered on or after October 1,
1994.
Cap Amount: Cap amount for hospitals and units with high CHAMPUS volume
is $760 per day.
CHAMPUS Partial Hospitalization Programs will have their FY 1994
CHAMPUS per diem rates updated by 3.7 percent for FY 1995.
The following reflect an update of 3.7 percent.
Partial Hospitalization Rates for Full-Day and Half-Day Programs
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Full-day Half-day
rate (6 rate (3-
United States census regions hrs or 5 hours)
more)
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Northeast:
New England (ME, NH, VT, MA, RI, CT).............. $211 $159
Mid-Atlantic (NY, NJ, PA)......................... 230 173
Midwest:
East North Central (OH, IN, IL, MI, WI)........... 205 154
West North Central (MN, IA, MO, ND, SD, NE, KS)... 202 152
South:
South Atlantic (DE, MD, DC, VA, WV, NC, SC, GA,
FL).............................................. 218 164
East South Central (KY, TN, AL, MS)............... 237 178
West South Central (AR, LA, TX, OK)............... 234 176
West:
Mountain (MT, ID, WY, CO, NM, AZ, UT, NV)......... 243 183
Pacific (WA, OR, CA, AK, HI)...................... 239 180
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Dated: September 26, 1994.
L.M. Bynum,
Alternate OSD Federal Register Liaison Office, Department of Defense.
[FR Doc. 94-24388 Filed 9-30-94; 8:45 am]
BILLING CODE 5000-04-M
