TRICARE, Formerly Known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); Fiscal Year 2015 Mental Health Rate Updates, 7846-7847 [2015-02900]
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Federal Register / Vol. 80, No. 29 / Thursday, February 12, 2015 / Notices
G. Indirect Medical Education (IDME)
Adjustment
Passage of the Medical Modernization
Act of 2003 modified the formula
multipliers to be used in the calculation
of IDME adjustment factor. Since the
IDME formula used by TRICARE does
not include disproportionate share
hospitals (DSHs), the variables in the
formula are different than Medicare’s,
however; the percentage reductions that
will be applied to Medicare’s formula
will also be applied to the TRICARE
IDME formula. The multiplier for the
IDME adjustment factor for TRICARE for
FY 2015 is 1.02.
I. Pricing of Claims
The final rule published on May 21,
2014, (79 FR 29085–29088) set forth all
final claims with discharge dates of
October 1, 2014, or later and reimbursed
under the TRICARE DRG-Based
payment system, are to be priced using
the rules, weights and rates in effect on
as of the date of discharge. Prior to this,
all final claims were priced using the
rules, weights and rates in effective as
of the date of admission.
J. Updated Rates and Weights
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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 2015 Mental Health Rate
Updates
Department of Defense.
Notice of updated mental health
rates for Fiscal Year 2015.
ACTION:
TRICARE uses a national Medicare
cost-to-charge ratio (CCR). For FY 2015,
the Medicare CCR used for the TRICARE
DRG-based payment system for acute
care hospitals and neonates will be
0.2726. This is based on a weighted
average of the hospital-specific
Medicare CCRs (weighted by the
number of Medicare discharges) after
excluding hospitals not subject to the
TRICARE DRG system (Sole Community
Hospitals, Indian Health Service
hospitals, and hospitals in Maryland).
The Medicare CCR is used to calculate
cost outlier payments, except for
children’s hospitals. The Medicare CCR
has been increased by a factor of 1.0065
to include an additional allowance for
bad debt. The 1.0065 factor reflects the
provisions of the Middle Class Tax
Relief and Job Creation Act of 2012. For
children’s hospital cost outliers, the
CCR used is 0.2939.
The updated rates and weights are
accessible through the Internet at
https://www.tricare.mil/drgrates. The
implementing regulations for the
TRICARE/CHAMPUS DRG-based
payment system are in 32 CFR part 199.
13:54 Feb 11, 2015
[FR Doc. 2015–02898 Filed 2–11–15; 8:45 am]
AGENCY:
H. Cost to Charge Ratio
VerDate Sep<11>2014
Dated: February 6, 2015.
Aaron Siegel,
Alternate OSD Federal Register Liaison
Officer, Department of Defense.
Jkt 235001
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 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
SUMMARY:
PO 00000
Frm 00020
Fmt 4703
Sfmt 4703
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 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 2015 updated by 2.9 percent.
Partial hospitalization rates for fullday 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 lowvolume 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 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 2.9
percent for Fiscal Year 2015.
E:\FR\FM\12FEN1.SGM
12FEN1
7847
Federal Register / Vol. 80, No. 29 / Thursday, February 12, 2015 / Notices
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 ..........................................................................................................................................................................
Mid-Atlantic .............................................................................................................................................................................
Midwest:
East North Central ..................................................................................................................................................................
West North Central .................................................................................................................................................................
South:
South Atlantic .........................................................................................................................................................................
East South Central .................................................................................................................................................................
West South Central ................................................................................................................................................................
West:
Mountain .................................................................................................................................................................................
Pacific .....................................................................................................................................................................................
Puerto Rico .............................................................................................................................................................................
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
$851
820
709
669
844
902
769
768
908
579
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 hours or more)
United States census region
Northeast:
New England (Maine, N.H., Vt., Mass., R.I., Conn.) ...........................................................................
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,
2014.
DEPARTMENT OF DEFENSE
Dated: February 6, 2015.
Aaron Siegel,
Alternate OSD Federal Register Liaison
Officer, Department of Defense.
Air University Board of Visitors Air
Force Institute of Technology
Subcommittee Meeting and Spring
Committee Meeting
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[FR Doc. 2015–02900 Filed 2–11–15; 8:45 am]
BILLING CODE 5001–06–P
Department of the Air Force
Notice of Meeting of the Air
University Board of Visitors Air Force
Institute of Technology Subcommittee
Meeting and Spring Committee Meeting.
ACTION:
Under the provisions of the
Federal Advisory Committee Act of
1972 (5 U.S.C., Appendix, as amended),
SUMMARY:
VerDate Sep<11>2014
13:54 Feb 11, 2015
Jkt 235001
PO 00000
Frm 00021
Fmt 4703
Sfmt 4703
Half-day rate
(3–5 hours)
$341
$256
371
278
327
245
327
245
349
262
379
284
379
284
382
376
244
287
282
183
the Government in the Sunshine Act of
1976 (5 U.S.C. 552b, as amended), and
41 CFR 102–3.150, the Department of
Defense announces that the Air
University Board of Visitors’ Air Force
Institute of Technology (AFIT)
Subcommittee annual meeting will take
place on Monday, March 9th, 2015,
from 8:00 a.m. to approximately 4:30
p.m. and Tuesday, March 10th, 2015,
from 8:00 a.m. to approximately 3:00
p.m. The meeting will be held at AFIT
on Wright-Patterson Air Force Base,
Area B, in Dayton, Ohio. The purpose of
this meeting is to provide independent
advice and recommendations on matters
E:\FR\FM\12FEN1.SGM
12FEN1
]]>Agencies
[Federal Register Volume 80, Number 29 (Thursday, February 12, 2015)]
[Notices]
[Pages 7846-7847]
From the Federal Register Online via the Government Printing 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
