[Federal Register: July 27, 2005 (Volume 70, Number 143)]
[Notices]
[Page 43400]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr27jy05-57]
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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 2005 Puerto Rico
Region Specific Mental Health Rates
AGENCY: Office of the Secretary, DoD.
ACTION: Notice of rate setting; establishment of region specific Puerto
Rico Mental Health rates.
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SUMMARY: This notice provides for the establishment of a Puerto Rico
region specific per diem rates for low volume providers; the
establishment of region specific per diem rates for both full-day and
half-day TRICARE Partial Hospitalization Programs under the TRICARE
Mental Health Per Diem Payment System for fiscal year 2005.
EFFECTIVE DATE: The fiscal year 2005 rates contained in this notice are
effective for services occurring on or after September 1, 2005.
FOR FURTHER INFORMATION CONTACT: Christine Gavlick, Office of Medical
Benefits and Reimbursement Systems, TRICARE Management Activity,
telephone (303) 676-3841.
SUPPLEMENTARY INFORMATION: The final rule published in the Federal
Register on September 6, 1988, (53 FR 34285) set forth reimbursement
methodologies that were effective for all inpatient hospital admissions
in psychiatric hospitals and exempt psychiatric units occurring on or
after January 1, 1989. This final rule uses regionally established per
diems to pay hospitals that do not have enough CHAMPUS discharges upon
which to base a valid hospital-specific rate. Regional rates
incorporate adjustments for area wage differences, indirect medical
educations costs and pass through payments for direct medical education
costs. Mental Health partial hospitalization programs are also
reimbursed according to regional per diems. The Mental Health regional
per diems are applied utilizing the designated Federal Census regions.
By 32 CFR 199.14(a)(2)(viii)(E), the commonwealth of Puerto Rico is
subject to TRICARE's mental halth reimbursement methodologies. Since
Puerto Rico is not incorporated in a Federal Census Region, this notice
establishes a Puerto Rico region specific per diem as well as region
specific rates for partial hospitalization programs, both full day and
half-day programs. TRICARE additionally published in the Federal
Register on July 1, 1993, (58 FR 35-400) final rules that 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 2005, Medicare has
recommended a rate of increase of 3.3 percent for hospitals and units
excluded from the prospective payment system. TRICARE has incorporated
this update factor for FY 2005 in the determinaion of the region
specific Puerto Rico rates. Consistent with Medicare, the wage portion
of the regional rate subject to the area wage adjustment is 71.56
percent for FY 2005.
The following reflects the Puerto Rico region specific rates:
Region Specific Rates for Psychiatric Hospitals and Units With Low
Tricare Volume
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United States region Rate1
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Puerto Rico.................................................. $434.00
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\1\ Wage portion of the rate, subject to the area wage adjustment--71.56
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 $169 per day or 25 percent of
the hospital billed charges effective for services rendered on or after
October 1, 2004.
Puerto Rico Region Specific Partial Hospitalization Rates For Full-Time
Day and Half-Day Programs FY 2005
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Full-day rate (6 (Half-day rate
United States region hours or more) (3-5 hours)
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Puerto Rico................... $183.................. $138
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The above rates are effective for services rendered on or after
September 1, 2005.
Dated: July 22, 2005.
L.M. Bynum,
Alternate OSD Federal Register, Liaison Officer, Department of Defense.
[FR Doc. 05-14844 Filed 7-26-05; 8:45 am]
BILLING CODE 5001-06-M