80 FR 65716 - TRICARE, Formerly Known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); Fiscal Year 2016 Mental Health Rate Updates
DEPARTMENT OF DEFENSE
Office of the Secretary Federal Register Volume 80, Issue 207 (October 27, 2015)
Office of the Secretary
Federal Register Volume 80, Issue 207 (October 27, 2015)
| Page Range | 65716-65717 | |
| FR Document | 2015-27234 |
[Federal Register Volume 80, Number 207 (Tuesday, October 27, 2015)] [Notices] [Pages 65716-65717] From the Federal Register Online [www.thefederalregister.org] [FR Doc No: 2015-27234] ----------------------------------------------------------------------- DEPARTMENT OF DEFENSE Office of the Secretary TRICARE, Formerly Known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); Fiscal Year 2016 Mental Health Rate Updates AGENCY: Department of Defense. ACTION: Notice of Updated Mental Health Rates for Fiscal Year 2016. ----------------------------------------------------------------------- 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 2016. DATES: Effective Date: The Fiscal Year 2016 rates contained in this notice are effective for services on or after October 1, 2015. ADDRESSES: Defense Health Agency (DHA), Medical Benefits and Reimbursement Section, 16401 East Centretech Parkway, Aurora, CO 80011- 9066. FOR FURTHER INFORMATION CONTACT: Elan Green, Medical Benefits and Reimbursement Section, 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 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 2016, the market basket rate is 2.4 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 2016 updated by 2.4 percent. Partial hospitalization rates for full-day programs also will be updated by 2.4 percent for Fiscal Year 2016. 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 2.4 percent for Fiscal Year 2016. The beneficiary cost share for low-volume hospitals and units also will be updated by the 2.4 percent for Fiscal Year 2016. Per Title 32 Code of Federal Regulations (CFR), Part 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 2016. 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 part 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 2.4 percent for Fiscal Year 2016. Regional-Specific Rates for Psychiatric Hospitals and Units With Low Tricare Volume for Fiscal Year 2016 ------------------------------------------------------------------------ Regional United States census region rate ------------------------------------------------------------------------ Northeast: New England.............................................. $871 Mid-Atlantic............................................. 840 Midwest: East North Central....................................... 726 West North Central....................................... 685 [[Page 65717]] South: South Atlantic........................................... 864 East South Central....................................... 924 West South Central....................................... 787 West: Mountain................................................. 786 Pacific.................................................. 930 Puerto Rico.............................................. 593 ------------------------------------------------------------------------ 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 $229 per day or 25 percent of the hospital billed charges effective for services rendered on or after October 1, 2015. Cap Amount: Updated cap amount for hospitals and units with high TRICARE volume is $1,096 per day for services on or after October 1, 2015. The following reflects an update of 2.4 percent for Fiscal Year 2016 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 2016] ------------------------------------------------------------------------ Full-day rate (6 Half-day rate United States census region hours or more) (3-5 hours) ------------------------------------------------------------------------ Northeast: New England (Maine, N.H., Vt., $349 $262 Mass., R.I., Conn.)........... Mid-Atlantic: (N.Y., N.J., Penn.)............ 380 285 Midwest: East North Central (Ohio, Ind., 335 251 Ill., Mich., Wis.)............ West North Central: (Minn., Iowa, Mo., N.D., S.D., 335 251 Neb., Kan.)................... South: South Atlantic (Del., Md., DC, 357 268 Va., W.Va., N.C., S.C., Ga., Fla.)......................... East South Central: (Ky., Tenn., Ala., Miss.)...... 388 291 West South Central: (Ark., La., Texas, Okla.)...... 388 291 West: Mountain (Mon., Idaho, Wyo., 391 293 Col., N.M., Ariz., Utah, Nev.) Pacific (Wash., Ore., Calif., 385 289 Alaska, Hawaii)............... Puerto Rico........................ 250 188 ------------------------------------------------------------------------ The above rates are effective for services rendered on or after October 1, 2015. Dated: October 21, 2015. Aaron Siegel, Alternate OSD Federal Register Liaison Officer, Department of Defense. [FR Doc. 2015-27234 Filed 10-26-15; 8:45 am] BILLING CODE 5001-06-P
![65716 Federal Register / Vol. 80, No. 207 / Tuesday, October 27, 2015 / Notices
Administration and Management DEPARTMENT OF DEFENSE Security Act, and (2) a 0.2 percent point
Directorate, 16401 East Centretech adjustment as required by section
Parkway, Aurora, CO 80011–9066.’’ Office of the Secretary 1886(b)(3)(B)(xii) of the Act as added
and amended by sections 3401 and
NOTIFICATION PROCEDURE: TRICARE, Formerly Known as the 10319(a) of the PPACA. These two
Delete entry and replace with Civilian Health and Medical Program of reductions do not apply to TRICARE.
‘‘Individuals seeking to determine the Uniformed Services (CHAMPUS); Hospitals and units with hospital-
whether information about themselves Fiscal Year 2016 Mental Health Rate specific rates (hospitals and units with
is contained in this system of records Updates high TRICARE volume) and regional-
should address written inquiries to AGENCY: Department of Defense. specific rates for psychiatric hospitals
Chief, Freedom of Information Act and units with low TRICARE volume
ACTION: Notice of Updated Mental
(FOIA) Service Center, Defense Health will have their TRICARE rates for Fiscal
Health Rates for Fiscal Year 2016.
Agency Privacy and Civil Liberties Year 2016 updated by 2.4 percent.
Office, 7700 Arlington Boulevard, Suite SUMMARY: This notice provides the Partial hospitalization rates for full-
5101, Falls Church, VA 22042–5101. updated regional per-diem rates for low- day programs also will be updated by
Requests should contain the full name volume mental health providers; the 2.4 percent for Fiscal Year 2016. Partial
and signature of the sponsor or update factor for hospital-specific per- hospitalization rates for programs of less
beneficiary. diems; the updated cap per-diem for than 6 hours (with a minimum of three
If requesting information about a high-volume providers; the beneficiary hours) will be paid a per diem rate of
minor or legally incompetent person, per-diem cost-share amount for low- 75 percent of the rate for a full-day
the request must be made by the volume providers; and, the updated per- program.
custodial parent, legal guardian, or party diem rates for both full-day and half-day The cap amount for high-volume
acting in loco parentis of such TRICARE Partial Hospitalization hospitals and units also will be updated
individual. Written proof of that status Programs for Fiscal Year 2016. by the 2.4 percent for Fiscal Year 2016.
may be required before the existence of DATES: Effective Date: The Fiscal Year The beneficiary cost share for low-
any information will be confirmed.’’ 2016 rates contained in this notice are volume hospitals and units also will be
RECORD ACCESS PROCEDURES:
effective for services on or after October updated by the 2.4 percent for Fiscal
1, 2015. Year 2016.
Delete entry and replace with
ADDRESSES: Defense Health Agency Per Title 32 Code of Federal
‘‘Individuals seeking access to records
(DHA), Medical Benefits and Regulations (CFR), Part 199.14, the same
about themselves contained in this
Reimbursement Section, 16401 East area wage indexes used for the
system of records should address
Centretech Parkway, Aurora, CO 80011– CHAMPUS Diagnosis-Related Group
written inquiries to the Chief, FOIA
9066. (DRG)-based payment system shall be
Service Center, Defense Health Agency
FOR FURTHER INFORMATION CONTACT: Elan applied to the wage portion of the
Privacy and Civil Liberties Office, 7700
Green, Medical Benefits and applicable regional per-diem for each
Arlington Boulevard, Suite 5101, Falls
Reimbursement Section, DHA, day of the admission. The wage portion
Church, VA 22042–5101.
telephone (303) 676–3907. shall be the same as that used for the
Written requests for information
SUPPLEMENTARY INFORMATION: The final CHAMPUS DRG-based payment system.
should include the full name and
rule published in the Federal Register For wage index values greater than 1.0,
signature of the sponsor or beneficiary.
(FR) on September 6, 1988 (53 FR the wage portion of the regional rate
If requesting records about a minor or
34285) set forth reimbursement changes subject to the area wage adjustment is
legally incompetent person, the request
that were effective for all inpatient 69.6 percent for Fiscal Year 2016. For
must be made by the custodial parent,
hospital admissions in psychiatric wage index values less than or equal to
legal guardian, or party acting in loco
hospitals and exempt psychiatric units 1.0, the wage portion of the regional rate
parentis of such individual. Written
occurring on or after January 1, 1989. subject to the area wage adjustment is
proof of that status may be required
The final rule published in the Federal 62.0 percent.
before any records will be provided.’’
Register on July 1, 1993 (58 FR 35–400) Additionally, 32 CFR part 199.14
CONTESTING RECORD PROCEDURES: set forth maximum per-diem rates for all requires that hospital specific and
Delete entry and replace with ‘‘The partial hospitalization admissions on or regional per-diems shall be updated by
Office of the Secretary of Defense (OSD) after September 29, 1993. Included in the Medicare update factor for hospitals
rules for accessing records, for these final rules were provisions for and units exempt from the Medicare
contesting contents and appealing updating reimbursement rates for each prospective payment system.
initial agency determinations are federal Fiscal Year. As stated in the final The following reflect an update of 2.4
published in OSD Administrative rules, each per-diem shall be updated by percent for Fiscal Year 2016.
Instruction 81, 32 CFR part 311, or may the Medicare update factor for hospitals
be obtained from the system manager.’’ and units exempt from the Medicare REGIONAL-SPECIFIC RATES FOR PSY-
Prospective Payment System (i.e., this is CHIATRIC HOSPITALS AND UNITS
RECORD SOURCE CATEGORIES: WITH LOW TRICARE VOLUME FOR
the same update factor used for the
Delete entry and replace with inpatient prospective payment system). FISCAL YEAR 2016
‘‘Contractors, Congressional offices, For Fiscal Year 2016, the market basket
Beneficiary Counseling and Assistance rate is 2.4 percent. This year, Medicare Regional
United States census region
Coordinators, all branches of the rate
tkelley on DSK3SPTVN1PROD with NOTICES
applied two reductions to its market
Uniformed Services, providers of care, basket amount: (1) A 0.5 percent
consultants, sponsor and/or Northeast:
reduction for economy-wide New England ......................... $871
beneficiary.’’ productivity required by section 3401(a) Mid-Atlantic ........................... 840
* * * * * of the Patient Protection and Affordable Midwest:
[FR Doc. 2015–27229 Filed 10–26–15; 8:45 am] Care Act (PPACA) which amended East North Central ................ 726
BILLING CODE 5001–06–P section 1886(b)(3)(B) of the Social West North Central ............... 685
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![Federal Register / Vol. 80, No. 207 / Tuesday, October 27, 2015 / Notices 65717
REGIONAL-SPECIFIC RATES FOR PSY- REGIONAL-SPECIFIC RATES FOR PSY- of the hospital billed charges effective
CHIATRIC HOSPITALS AND UNITS CHIATRIC HOSPITALS AND UNITS for services rendered on or after October
WITH LOW TRICARE VOLUME FOR WITH LOW TRICARE VOLUME FOR 1, 2015. Cap Amount: Updated cap
FISCAL YEAR 2016—Continued FISCAL YEAR 2016—Continued amount for hospitals and units with
high TRICARE volume is $1,096 per day
Regional Regional for services on or after October 1, 2015.
United States census region United States census region
rate rate
The following reflects an update of
South: Puerto Rico ........................... 593 2.4 percent for Fiscal Year 2016 for the
South Atlantic ........................ 864 full day partial hospitalization rates.
East South Central ................ 924 Beneficiary cost-share: Beneficiary Partial hospitalization rates for
West South Central ............... 787 cost-share (other than dependents of programs of less than 6 hours (with a
West: Active Duty members) for care paid on minimum of three hours) will be paid a
Mountain ............................... 786 the basis of a regional per-diem rate is per diem rate of 75 percent of the rate
Pacific .................................... 930 the lower of $229 per day or 25 percent for a full-day program.
PARTIAL HOSPITALIZATION RATES FOR FULL-DAY AND HALF-DAY PROGRAMS
[Fiscal year 2016]
Full-day rate Half-day rate
United States census region (6 hours or more) (3–5 hours)
Northeast:
New England (Maine, N.H., Vt., Mass., R.I., Conn.) ............................................................................. $349 $262
Mid-Atlantic:
(N.Y., N.J., Penn.) .................................................................................................................................. 380 285
Midwest:
East North Central (Ohio, Ind., Ill., Mich., Wis.) ..................................................................................... 335 251
West North Central:
(Minn., Iowa, Mo., N.D., S.D., Neb., Kan.) ............................................................................................. 335 251
South:
South Atlantic (Del., Md., DC, Va., W.Va., N.C., S.C., Ga., Fla.) ......................................................... 357 268
East South Central:
(Ky., Tenn., Ala., Miss.) .......................................................................................................................... 388 291
West South Central:
(Ark., La., Texas, Okla.) ......................................................................................................................... 388 291
West:
Mountain (Mon., Idaho, Wyo., Col., N.M., Ariz., Utah, Nev.) ................................................................. 391 293
Pacific (Wash., Ore., Calif., Alaska, Hawaii) .......................................................................................... 385 289
Puerto Rico .................................................................................................................................................... 250 188
The above rates are effective for mass transportation program for DFAS members of the public is to make these
services rendered on or after October 1, civilian and DFAS NAF employees submissions available for public
2015. applying for and in receipt of mass viewing on the Internet at http://
Dated: October 21, 2015. transit subsidies. www.regulations.gov as they are
Aaron Siegel, DATES: Comments will be accepted on or received without change, including any
Alternate OSD Federal Register Liaison before November 27, 2015. This personal identifiers or contact
Officer, Department of Defense. proposed action will be effective the day information.
[FR Doc. 2015–27234 Filed 10–26–15; 8:45 am] following the end of the comment FOR FURTHER INFORMATION CONTACT: Mr.
BILLING CODE 5001–06–P
period unless comments are received Gregory Outlaw, Defense Finance and
which result in a contrary Accounting Service, Freedom of
determination. Information/Privacy Act Program
DEPARTMENT OF DEFENSE ADDRESSES: You may submit comments, Manager, Corporate Communications,
identified by docket number and title, DFAS–ZCF/IN, 8899 E. 56th Street,
Office of the Secretary Indianapolis, IN 46249–0150 or at (317)
by any of the following methods:
[Docket ID: DoD–2015–OS–0104] * Federal Rulemaking Portal: http:// 212–4591.
www.regulations.gov. Follow the SUPPLEMENTARY INFORMATION: The
Privacy Act of 1974; System of instructions for submitting comments. Defense Finance and Accounting
Records * Mail: Department of Defense, Office Service notices for systems of records
AGENCY: Defense Finance and of the Deputy Chief Management subject to the Privacy Act of 1974 (5
Accounting Service, DoD. Officer, Directorate of Oversight and U.S.C. 552a), as amended, have been
ACTION: Notice to add a new System of
Compliance, Regulatory and Audit published in the Federal Register and
tkelley on DSK3SPTVN1PROD with NOTICES
Records. Matters Office, 9010 Defense Pentagon, are available from the address in the FOR
Washington, DC 20301–9010. FURTHER INFORMATION CONTACT or from
SUMMARY: The Defense Finance and Instructions: All submissions received the Defense Privacy and Civil Liberties
Accounting Service proposes to add a must include the agency name and Division at http://dpcld.defense.gov/.
new system of records, T4500c, entitled docket number for this Federal Register The proposed system report, as
‘‘DFAS Transportation Incentive document. The general policy for required by 5 U.S.C. 552a(r) of the
Program System (TIPS)’’ to manage the comments and other submissions from Privacy Act of 1974, as amended, was
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Document Created: 2015-12-14 15:35:32
Document Modified: 2015-12-14 15:35:32
| Category | Regulatory Information | |
| Collection | Federal Register | |
| sudoc Class | AE 2.7: GS 4.107: AE 2.106: | |
| Publisher | Office of the Federal Register, National Archives and Records Administration | |
| Section | Notices | |
| Action | Notice of Updated Mental Health Rates for Fiscal Year 2016. | |
| Contact | Elan Green, Medical Benefits and Reimbursement Section, DHA, telephone (303) 676-3907. | |
| FR Citation | 80 FR 65716 |
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