[Federal Register Volume 63, Number 187 (Monday, September 28, 1998)]
[Notices]
[Pages 51564-51566]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-25780]
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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 1999 Mental Health
Rate 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 for FY 1999 under the
[[Page 51565]]
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 1999.
EFFECTIVE DATE: The rates contained in this notice are effective for
services occurring on or after October 1, 1998.
FOR FURTHER INFORMATION CONTACT: Stan Regensberg, Office of Medical
Benefits and Reimbursement Systems, TRICARE Management Activity,
telephone (303) 676-3742.
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. The final rule published in the Federal
Register March 7, 1995, (60 FR 12419) set forth retaining all per diems
in effect at the end of fiscal year 1995 with no additional updates for
fiscal years 1996 and 1997. Medicare recommended a rate of increase of
0 percent for federal fiscal year 1998 for hospitals and units excluded
from the prospective payment system. For fiscal year 1999, Medicare has
recommended a rate of increase of 2.4 percent for hospitals and units
excluded from the prospective payment system. TRICARE will adopt this
update factor for FY 1999 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
1998 updated by 2.4 percent for FY 1999. Partial hospitalization rates
for full day and half day programs will also be 2 updated by 2.4
percent for FY 1999. The cap amount for high volume hospitals and units
will also be updated by the 2.4 percent for FY 1999. The beneficiary
cost-share of low volume hospitals and units will also be updated by
the 2.4 percent for FY 1999. Consistent with Medicare, the wage portion
of the regional rate subject to the area wage adjustment will remain at
71.1 percent for FY 1999.
The following reflect an update of 2.4 percent.
Regional Specific Rates for Psychiatric Hospitals and Units With Low
CHAMPUS Volume
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United States census region Rate \1\
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Northeast:
New England......................................... $527
Mid-Atlantic........................................ 504
Midwest:
East North Central.................................. 436
West North Central.................................. 412
South:
South Atlantic...................................... 521
East South Central.................................. 563
West South Central.................................. 474
West:
Mountain............................................ 473
Pacific............................................. 558
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\1\ Wage portion of the rate, subject to the area wage adjustment--71.1
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 $140 per day or 25 percent of
the hospital billed charges effective for services rendered on or after
October 1, 1998.
Cap Amount: Updated cap amount for hospitals and units with high
CHAMPUS volume is $660 per day for FY 1999.
The following reflect an update of 2.4 percent.
Partial Hospitalization Rates for Full-Day and Half-Day Programs
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Full-day rate
United States census region (6 hours or Half-day rate
more) (3-5 hours)
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Northeast:
New England (ME, NH, VT, MA, RI, CT) $216 $163
Mid-Atlantic (NY, NJ, PA)........... 236 177
Midwest:
East North Central (OH, IN, IL, MI,
WI)................................ 210 158
West North Central (MN, IA, MO, ND,
SD, NE, KS)........................ 207 156
South:
South Atlantic (DE, MD, DC, VA, WV,
NC, SC, GA, FL).................... 223 168
East South Central (KY, TN, AL, MS). 243 182
West South Central (AR, LA, TX, OK). 240 180
West:
Mountain (MT, ID, WY, CO, NM, AZ,
UT, NV)............................ 249 187
Pacific (WA, OR, CA, AK, HI)........ 245 184
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[[Page 51566]]
Dated: September 21, 1998.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 98-25780 Filed 9-25-98; 8:45 am]
BILLING CODE 5000-04-p
