TRICARE, Formerly Known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); Fiscal Year 2013 Mental Health Rate Updates, 71179-71180 [2012-28881]
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71179
Federal Register / Vol. 77, No. 230 / Thursday, November 29, 2012 / Notices
Dated: November 26, 2012.
Aaron Siegel,
Alternate OSD Federal Register Liaison
Officer, Department of Defense.
[FR Doc. 2012–28902 Filed 11–28–12; 8:45 am]
BILLING CODE 5001–06–P
DEPARTMENT OF DEFENSE
Office of the Secretary
TRICARE, Formerly Known as the
Civilian Health and Medical Program of
the Uniformed Services (CHAMPUS);
Fiscal Year 2013 Mental Health Rate
Updates
Department of Defense.
Notice of updated mental health
rates for Fiscal Year 2013.
AGENCY:
ACTION:
This notice provides the
updated regional per-diem rates for lowvolume mental health providers; the
update factor for hospital-specific perdiems; the updated cap per-diem for
high-volume providers; the beneficiary
per-diem cost-share amount for lowvolume providers; and, the updated perdiem rates for both full-day and half-day
TRICARE Partial Hospitalization
Programs for Fiscal Year 2013.
DATES: Effective Date: The Fiscal Year
2013 rates contained in this notice are
effective for services on or after October
1, 2012.
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 35–400)
set forth maximum per-diem rates for all
partial hospitalization admissions on or
after September 29, 1993. Included in
pmangrum on DSK3VPTVN1PROD with NOTICES
SUMMARY:
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 2013, the market basket
rate is 2.6 percent. This year, Medicare
applied two reductions to its market
basket amount: (1) A 0.7 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 0.1 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 hospitalspecific rates (hospitals and units with
high TRICARE volume) and regionalspecific rates for psychiatric hospitals
and units with low TRICARE volume
will have their TRICARE rates for Fiscal
Year 2013 updated by 2.6 percent
Partial hospitalization rates for fullday programs also will be updated by
2.6 percent for Fiscal Year 2013. 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 2.6 percent for Fiscal Year 2013.
The beneficiary cost share for lowvolume hospitals and units also will be
updated by the 2.6 percent for Fiscal
Year 2013.
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 68.8 percent for Fiscal
Year 2013. 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 perdiems 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 2013.
REGIONAL-SPECIFIC RATES FOR PSYCHIATRIC HOSPITALS AND UNITS
WITH LOW TRICARE VOLUME FOR
FISCAL YEAR 2013
United States Census region
Northeast:
New England .....................
Mid-Atlantic .......................
Midwest:
East North Central ............
West North Central ...........
South:
South Atlantic ....................
East South Central ............
West South Central ...........
West:
Mountain ...........................
Pacific ................................
Puerto Rico ...........................
Regional rate
$807
778
672
634
800
856
729
728
860
549
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 $213 per day or 25 percent
of the hospital billed charges effective
for services rendered on or after October
1, 2012. Cap Amount: Updated cap
amount for hospitals and units with
high TRICARE volume is $1,015 per day
for services on or after October 1, 2012.
The following reflects an update of
2.6 percent for Fiscal Year 2013 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 2013]
Full-day rate
(6 hours or
more)
United States Census region
Northeast:
New England (Maine, N.H., Vt., Mass., R.I., Conn.) .......................................................................................
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$323
Half-day rate
(3–5 hours)
$242
71180
Federal Register / Vol. 77, No. 230 / Thursday, November 29, 2012 / Notices
PARTIAL HOSPITALIZATION RATES FOR FULL-DAY AND HALF-DAY PROGRAMS—Continued
[Fiscal year 2013]
Full-day rate
(6 hours or
more)
United States Census region
Mid-Atlantic:
(N.Y., N.J., Penn.) ............................................................................................................................................
Midwest:
East North Central (Ohio, Ind., Ill., Mich., Wis.) ...............................................................................................
West North Central:
(Minn., Iowa, Mo., N.D., S.D., Neb., Kan.) .......................................................................................................
South:
South Atlantic (Del., Md., DC, Va., W.Va., N.C., S.C., Ga., Fla.) ...................................................................
East South Central:
(Ky., Tenn., Ala., Miss.) ....................................................................................................................................
West South Central:
(Ark., La., Texas, Okla.) ...................................................................................................................................
West:
Mountain (Mon., Idaho, Wyo., Col., N.M., Ariz., Utah, Nev.) ...........................................................................
Pacific (Wash., Ore., Calif., Alaska, Hawaii) ....................................................................................................
Puerto Rico ..............................................................................................................................................................
The above rates are effective for
services rendered on or after October 1,
2012.
FOR FURTHER INFORMATION CONTACT:
[FR Doc. 2012–28881 Filed 11–28–12; 8:45 am]
Amber L. Butterfield, Medical Benefits
and Reimbursement Branch, TMA,
telephone (303) 676–3565.
Questions regarding payment of
specific claims under the TRICARE
DRG-based payment system should be
addressed to the appropriate contractor.
BILLING CODE 5001–06–P
SUPPLEMENTARY INFORMATION:
Dated: November 26, 2012.
Aaron Siegel,
Alternate OSD Federal Register Liaison
Officer, Department of Defense.
DEPARTMENT OF DEFENSE
Office of the Secretary
TRICARE; Civilian Health and Medical
Program of the Uniformed Services
(CHAMPUS); Fiscal Year 2013
Diagnosis Related Group (DRG)
Updates
AGENCY:
ACTION:
Office of the Secretary, DoD.
Notice of DRG revised rates.
This notice describes the
changes made to the TRICARE DRGbased payment system in order to
conform to changes made to the
Medicare Prospective Payment System
(PPS). It also provides the updated fixed
loss cost outlier threshold, cost-tocharge ratios and the data necessary to
update the FY 2013 rates.
SUMMARY:
Effective Date: The rates,
weights, and Medicare PPS changes
which affect the TRICARE DRG-based
payment system contained in this notice
are effective for admissions occurring on
or after October 1, 2012.
pmangrum on DSK3VPTVN1PROD with NOTICES
DATES:
TRICARE Management
Activity (TMA), Medical Benefits and
Reimbursement Branch, 16401 East
Centretech Parkway, Aurora, CO 80011–
9066.
ADDRESSES:
VerDate Mar<15>2010
15:12 Nov 28, 2012
Jkt 229001
The final
rule published on September 1, 1987 (52
FR 32992) set forth the basic procedures
used under the CHAMPUS DRG-based
payment system. This was subsequently
amended by final rules published
August 31, 1988 (53 FR 33461), October
21, 1988 (53 FR 41331), December 16,
1988 (53 FR 50515), May 30, 1990 (55
FR 21863), October 22, 1990 (55 FR
42560), and September 10, 1998 (63 FR
48439).
An explicit tenet of these final rules,
and one based on the statute authorizing
the use of DRGs by TRICARE, is that the
TRICARE DRG-based payment system is
modeled on the Medicare PPS, and that,
whenever practicable, the TRICARE
system will follow the same rules that
apply to the Medicare PPS. The Centers
for Medicare and Medicaid Services
(CMS) publish these changes annually
in the Federal Register and discuss in
detail the impact of the changes.
In addition, this notice updates the
rates and weights in accordance with
our previous final rules. The actual
changes we are making, along with a
description of their relationship to the
Medicare PPS, are detailed below.
I. Medicare PPS Changes Which Affect
the TRICARE DRG-Based Payment
System
Following is a discussion of the
changes CMS has made to the Medicare
PO 00000
Frm 00014
Fmt 4703
Sfmt 4703
Half-day rate
(3–5 hours)
352
264
310
233
310
233
331
248
359
269
359
269
362
356
231
272
267
173
PPS that affect the TRICARE DRG-based
payment system.
A. DRG Classifications
Under both the Medicare PPS and the
TRICARE DRG-based payment system,
cases are classified into the appropriate
DRG by a Grouper program. The
Grouper classifies each case into a DRG
on the basis of the diagnosis and
procedure codes and demographic
information (that is, sex, age, and
discharge status). The Grouper used for
the TRICARE DRG-based payment
system is the same as the current
Medicare Grouper with two
modifications. The TRICARE system has
replaced Medicare DRG 435 with two
age-based DRGs (900 and 901), and has
implemented thirty-four (34) neonatal
DRGs in place of Medicare DRGs 385
through 390. For admissions occurring
on or after October 1, 2001, DRG 435 has
been replaced by DRG 523. The
TRICARE system has replaced DRG 523
with the two age-based DRGs (900 and
901). For admissions occurring on or
after October 1, 1995, the CHAMPUS
grouper hierarchy logic was changed so
the age split (age <29 days) and
assignments to Major Diagnostic
Category (MDC) 15 occur before
assignment of the PreMDC DRGs. This
resulted in all neonate tracheostomies
and organ transplants being grouped to
MDC 15 and not to DRGs 480–483 or
495. For admissions occurring on or
after October 1, 1998, the CHAMPUS
grouper hierarchy logic was changed to
move DRG 103 to the PreMDC DRGs and
to assign patients to PreMDC DRGs 480,
103 and 495 before assignment to MDC
15 DRGs and the neonatal DRGs. For
admissions occurring on or after
October 1, 2001, DRGs 512 and 513
E:\FR\FM\29NON1.SGM
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]]>Agencies
[Federal Register Volume 77, Number 230 (Thursday, November 29, 2012)]
[Notices]
[Pages 71179-71180]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-28881]
-----------------------------------------------------------------------
DEPARTMENT OF DEFENSE
Office of the Secretary
TRICARE, Formerly Known as the Civilian Health and Medical
Program of the Uniformed Services (CHAMPUS); Fiscal Year 2013 Mental
Health Rate Updates
AGENCY: Department of Defense.
ACTION: Notice of updated mental health rates for Fiscal Year 2013.
-----------------------------------------------------------------------
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 2013.
DATES: Effective Date: The Fiscal Year 2013 rates contained in this
notice are effective for services on or after October 1, 2012.
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 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 2013, the market
basket rate is 2.6 percent. This year, Medicare applied two reductions
to its market basket amount: (1) A 0.7 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 0.1 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 2013 updated by 2.6 percent
Partial hospitalization rates for full-day programs also will be
updated by 2.6 percent for Fiscal Year 2013. 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 2.6 percent for Fiscal Year 2013.
The beneficiary cost share for low-volume hospitals and units also
will be updated by the 2.6 percent for Fiscal Year 2013.
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 68.8 percent for Fiscal Year 2013. 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
2013.
Regional-Specific Rates for Psychiatric Hospitals and Units With Low
TRICARE Volume for Fiscal Year 2013
------------------------------------------------------------------------
United States Census region Regional rate
------------------------------------------------------------------------
Northeast:
New England........................................... $807
Mid-Atlantic.......................................... 778
Midwest:
East North Central.................................... 672
West North Central.................................... 634
South:
South Atlantic........................................ 800
East South Central.................................... 856
West South Central.................................... 729
West:
Mountain.............................................. 728
Pacific............................................... 860
Puerto Rico............................................. 549
------------------------------------------------------------------------
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 $213 per day or 25 percent of
the hospital billed charges effective for services rendered on or after
October 1, 2012. Cap Amount: Updated cap amount for hospitals and units
with high TRICARE volume is $1,015 per day for services on or after
October 1, 2012.
The following reflects an update of 2.6 percent for Fiscal Year
2013 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 2013]
------------------------------------------------------------------------
Full-day rate
United States Census region (6 hours or Half-day rate
more) (3-5 hours)
------------------------------------------------------------------------
Northeast:
New England (Maine, N.H., Vt., $323 $242
Mass., R.I., Conn.)................
[[Page 71180]]
Mid-Atlantic:
(N.Y., N.J., Penn.)................. 352 264
Midwest:
East North Central (Ohio, Ind., 310 233
Ill., Mich., Wis.).................
West North Central:
(Minn., Iowa, Mo., N.D., S.D., Neb., 310 233
Kan.)..............................
South:
South Atlantic (Del., Md., DC, Va., 331 248
W.Va., N.C., S.C., Ga., Fla.)......
East South Central:
(Ky., Tenn., Ala., Miss.)........... 359 269
West South Central:
(Ark., La., Texas, Okla.)........... 359 269
West:
Mountain (Mon., Idaho, Wyo., Col., 362 272
N.M., Ariz., Utah, Nev.)...........
Pacific (Wash., Ore., Calif., 356 267
Alaska, Hawaii)....................
Puerto Rico............................. 231 173
------------------------------------------------------------------------
The above rates are effective for services rendered on or after
October 1, 2012.
Dated: November 26, 2012.
Aaron Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2012-28881 Filed 11-28-12; 8:45 am]
BILLING CODE 5001-06-P
