05-23766. 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.

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 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 [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 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

United States census region	Rate 1
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
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

United States census region	Full-day rate (6 hours or more)	Half-day rate (3-5 hours)
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

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.