[Federal Register Volume 78, Number 237 (Tuesday, December 10, 2013)]
[Notices]
[Pages 74121-74122]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-29438]
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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 2014 Mental Health
Rate Updates
AGENCY: Department of Defense.
ACTION: Notice of Updated Mental Health Rates for FY 2014.
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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 FY 2014.
DATES: Effective Date: The FY 2014 rates contained in this notice are
effective for services on or after October 1, 2013.
ADDRESSES: TRICARE Management Activity (TMA), Medical Benefits and
Reimbursement Branch, 16401 East Centretech Parkway, Aurora, CO 80011-
9066.
FOR FURTHER INFORMATION CONTACT: Elan Green, Medical Benefits and
Reimbursement Branch, TMA, telephone (303) 676-3907.
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 35400) 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 (i.e., this is the same update factor used for the
inpatient prospective payment system). For FY 2014, the market basket
rate is 2.5 percent. This year, Medicare applied two reductions to its
market basket amount: (1) A 0.5 percent reduction for economy-wide
productivity required by section 3401(a) of the Patient Protection and
Affordable Care Act (PPACA) which amended section 1886(b)(3)(B) of the
Social Security Act, and (2) a 0.3 percent point adjustment as required
by section 1886(b)(3)(B)(xii) of the Act as added and amended by
sections 3401 and 10319(a) of the PPACA. 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 FY 2014 updated by 2.5 percent.
Partial hospitalization rates for full-day programs also will be
updated by 2.5 percent for FY 2014. Partial hospitalization rates for
programs of less than 6 hours (with a minimum of three hours) will be
paid a per diem rate of 75 percent of the rate for a full-day program.
The cap amount for high-volume hospitals and units also will be
updated by the 2.5 percent for FY 2014.
The beneficiary cost share for low-volume hospitals and units also
will be updated by the 2.5 percent for FY 2014.
Per 32 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 69.6 percent for FY 2014. 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 62.0 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 2.5 percent for FY 2014.
Regional--Specific Rates for Psychiatric Hospitals and Units With Low
TRICARE Volume for FY 2014
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Regional
United States census region rate
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Northeast:
New England............................................ $827
Mid-Atlantic........................................... 797
Midwest:
East North Central..................................... 689
West North Central..................................... 650
South:
South Atlantic......................................... 820
East South Central..................................... 877
West South Central..................................... 747
[[Page 74122]]
West:
Mountain............................................... 746
Pacific................................................ 882
Puerto Rico............................................ 563
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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 $218 per day or 25 percent of
the hospital billed charges effective for services rendered on or after
October 1, 2013. Cap Amount: Updated cap amount for hospitals and units
with high TRICARE volume is $1,040 per day for services on or after
October 1, 2013.
The following reflects an update of 2.5 percent for FY 2014 for the
full day partial hospitalization rates. Partial hospitalization rates
for programs of less than 6 hours (with a minimum of three hours) will
be paid a per diem rate of 75 percent of the rate for a full-day
program.
Partial Hospitalization Rates for Full-Day and Half-Day Programs
[FY 2014]
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Full-day rate (6 Half-day rate (3-
United States census region hours or more) 5 hours)
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Northeast:
New England (Maine, N.H., Vt., Mass., R.I., Conn.)...................... $331 $248
Mid-Atlantic:
(N.Y., N.J., Penn.)..................................................... 361 271
Midwest:
East North Central (Ohio, Ind., Ill., Mich., Wis.)...................... 318 239
West North Central:
(Minn., Iowa, Mo., N.D., S.D., Neb., Kan.).............................. 318 239
South:
South Atlantic (Del., Md., DC, Va., W.Va., N.C., S.C., Ga., Fla.)....... 339 254
East South Central:
(Ky., Tenn., Ala., Miss.)............................................... 368 276
West South Central:
(Ark., La., Texas, Okla.)............................................... 368 276
West:
Mountain (Mon., Idaho, Wyo., Col., N.M., Ariz., Utah, Nev.)............. 371 278
Pacific (Wash., Ore., Calif., Alaska, Hawaii)........................... 365 274
Puerto Rico................................................................. 237 178
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The above rates are effective for services rendered on or after
October 1, 2013.
Dated: December 5, 2013.
Aaron Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2013-29438 Filed 12-9-13; 8:45 am]
BILLING CODE 5001-06-P