[Federal Register Volume 80, Number 29 (Thursday, February 12, 2015)]
[Notices]
[Pages 7846-7847]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-02900]
-----------------------------------------------------------------------
DEPARTMENT OF DEFENSE
Office of the Secretary
TRICARE, Formerly Known as the Civilian Health and Medical
Program of the Uniformed Services (CHAMPUS); Fiscal Year 2015 Mental
Health Rate Updates
AGENCY: Department of Defense.
ACTION: Notice of updated mental health rates for Fiscal Year 2015.
-----------------------------------------------------------------------
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 Fiscal Year 2015.
DATES: Effective Date: The Fiscal Year 2015 rates contained in this
notice are effective for services on or after October 1, 2014.
ADDRESSES: Defense Health Agency (DHA), Medical Benefits and
Reimbursement Branch, 16401 East Centretech Parkway, Aurora, CO 80011-
9066.
FOR FURTHER INFORMATION CONTACT: Elan Green, Medical Benefits and
Reimbursement Office, DHA, 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 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 (i.e., this is the same update factor used for the
inpatient prospective payment system). For Fiscal Year 2015, the market
basket rate is 2.9 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 0.2 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 Fiscal Year 2015 updated by 2.9 percent.
Partial hospitalization rates for full-day programs also will be
updated by 2.9 percent for Fiscal Year 2015. 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 2.9 percent for Fiscal Year 2015.
The beneficiary cost share for low-volume hospitals and units also
will be updated by the 2.9 percent for Fiscal Year 2015.
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 Fiscal Year 2015. 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 2.9 percent for Fiscal Year
2015.
[[Page 7847]]
Regional-Specific Rates for Psychiatric Hospitals and Units With Low
Tricare Volume for Fiscal Year 2015
------------------------------------------------------------------------
United States census region Regional rate
------------------------------------------------------------------------
Northeast:
New England...................................... $851
Mid-Atlantic..................................... 820
Midwest:
East North Central............................... 709
West North Central............................... 669
South:
South Atlantic................................... 844
East South Central............................... 902
West South Central............................... 769
West:
Mountain......................................... 768
Pacific.......................................... 908
Puerto Rico...................................... 579
------------------------------------------------------------------------
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 $224 per day or 25 percent of
the hospital billed charges effective for services rendered on or after
October 1, 2014. Cap Amount: Updated cap amount for hospitals and units
with high TRICARE volume is $1,070 per day for services on or after
October 1, 2014.
The following reflects an update of 2.9 percent for Fiscal Year
2015 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
[Fiscal year 2015]
------------------------------------------------------------------------
Full-day rate (6 Half-day rate (3-
United States census region hours or more) 5 hours)
------------------------------------------------------------------------
Northeast:
New England (Maine, N.H., Vt., $341 $256
Mass., R.I., Conn.)..........
Mid-Atlantic:
(N.Y., N.J., Penn.)........... 371 278
Midwest:
East North Central (Ohio, 327 245
Ind., Ill., Mich., Wis.).....
West North Central:
(Minn., Iowa, Mo., N.D., S.D., 327 245
Neb., Kan.)..................
South:
South Atlantic (Del., Md., DC, 349 262
Va., W.Va., N.C., S.C., Ga.,
Fla.)........................
East South Central:
(Ky., Tenn., Ala., Miss.)..... 379 284
West South Central:
(Ark., La., Texas, Okla.)..... 379 284
West:
Mountain (Mon., Idaho, Wyo., 382 287
Col., N.M., Ariz., Utah,
Nev.)........................
Pacific (Wash., Ore., Calif., 376 282
Alaska, Hawaii)..............
Puerto Rico....................... 244 183
------------------------------------------------------------------------
The above rates are effective for services rendered on or after
October 1, 2014.
Dated: February 6, 2015.
Aaron Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2015-02900 Filed 2-11-15; 8:45 am]
BILLING CODE 5001-06-P