[Federal Register Volume 76, Number 43 (Friday, March 4, 2011)]
[Notices]
[Pages 12074-12075]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-4866]


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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 2011 Mental 
Health Rate Updates

AGENCY: Department of Defense.

ACTION: Notice of Updated Mental Health Rates for Fiscal Year 2011.

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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 Fiscal Year 2011.

DATES: Effective Date: The Fiscal Year 2011 rates contained in this 
notice are effective for services on or after October 1, 2010.

ADDRESSES: TRICARE Management Activity (TMA), Medical Benefits and 
Reimbursement Branch, 16401 East Centretech Parkway, Aurora, CO 80011-
9066.

FOR FURTHER INFORMATION CONTACT: Ann N. Fazzini, Medical Benefits and 
Reimbursement Branch, TMA, telephone (303) 676-3803.

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 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 (i.e., this is the same update factor used for the 
inpatient prospective payment system). For Fiscal Year 2011, the market 
basket rate is 2.6 percent. This year, Medicare applied two reductions 
to their market basket amount: (1) a 0.25 percent reduction due to 
provisions found in the Patient Protection and Affordable Care Act, and 
(2) a 2.9 percent reduction for documentation and coding adjustments 
found in Public Law 110-90. 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 2011 updated by 2.6 percent.
    Partial hospitalization rates for full-day and half-day programs 
will also be updated by 2.6 percent for Fiscal Year 2011.
    The cap amount for high-volume hospitals and units will also be 
updated by the 2.6 percent for Fiscal Year 2011.
    The beneficiary cost share for low volume hospitals and units will 
also be updated by the 2.6 percent for Fiscal Year 2011.
    Per 32 Code of Federal Regulations (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 68.8 percent for Fiscal 
Year 2011. 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 
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 2.6 percent for Fiscal Year 
2011.

  Regional Specific Rates for Psychiatric Hospitals and Units With Low
                   Tricare Volume for Fiscal Year 2011
------------------------------------------------------------------------
                                                               Regional
                United States census region                      rate
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Northeast:
    New England............................................         $764
    Mid-Atlantic...........................................          736
Midwest:
    East North Central.....................................          636
    West North Central.....................................          600
South:
    South Atlantic.........................................          757
    East South Central.....................................          810
    West South Central.....................................          690
West:
    Mountain...............................................          689
    Pacific................................................          814
    Puerto Rico............................................          519
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    Beneficiary cost-share: Beneficiary cost-share (other than 
dependents of

[[Page 12075]]

Active Duty members) for care paid on the basis of a regional per-diem 
rate is the lower of $202 per day or 25 percent of the hospital billed 
charges effective for services rendered on or after October 1, 2010. 
Cap Amount: Updated cap amount for hospitals and units with high 
TRICARE volume is $960 per day for services on or after October 1, 
2010.
    The following reflect an update of 2.6 percent for Fiscal Year 2011 
for the partial hospitalization rates.

    Partial Hospitalization Rates for Full-Day and Half-Day Programs
                           [Fiscal year 2011]
------------------------------------------------------------------------
                                                  Full-day
                                                  rate  (6     Half-day
          United States census region             hours or    rate  (3-5
                                                   more)        hours)
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Northeast:
    New England (Maine, N.H., Vt., Mass.,              $306         $227
     R.I., Conn.).............................
Mid-Atlantic:
    (N.Y., N.J., Penn.).......................          333          250
Midwest:
    East North Central (Ohio, Ind., Ill.,               293          218
     Mich., Wis.).............................
West North Central:
    (Minn., Iowa, Mo., N.D., S.D., Neb., Kan.)          293          218
South:
    South Atlantic (Del., Md., D.C., Va.,               314          237
     W.Va., N.C., S.C., Ga., Fla.)............
East South Central:
    (Ky., Tenn., Ala., Miss.).................          340          256
West South Central:
    (Ark., La., Texas, Okla.).................         $340          256
West:
    Mountain (Mon., Idaho, Wyo., Col., N.M.,            343          259
     Ariz., Utah, Nev.).......................
    Pacific (Wash., Ore., Calif., Alaska,               337          252
     Hawaii)..................................
Puerto Rico...................................          218          165
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    The above rates are effective for services rendered on or after 
October 1, 2010.

    Dated: March 1, 2011.
Morgan F. Park,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2011-4866 Filed 3-3-11; 8:45 am]
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