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TRICARE Reimbursement Manual 6010.61-M, April 1, 2015
Mental Health
Chapter 7
Addendum A
Table Of Regional Specific Rates For Psychiatric Hospitals And Units With Low TRICARE Volume - FY 2017 - FY 2019
Revision:  C-37, June 18, 2019
United States Census Regions
FY 2017
Regional Rates
10/01/16 - 09/30/17
FY 2018
Regional Rates
10/01/17 - 09/30/18
FY 2019
Regional Rates
10/01/18 - 09/30/19
Northeast:
New England
(ME, NH, VT, MA, RI, CT)
$895
$919
$946
Mid-Atlantic
(NY, NJ, PA)
$863
$886
$912
Midwest:
East North Central
(OH, IN, IL, MI, WI)
$746
$766
$788
West North Central
(MN, IA, MO, ND, SD, NE, KS)
$703
$722
$743
South:
South Atlantic
(DE, MD, DC, VA, WV, NC, SC, GA, FL)
$887
$911
$937
East South Central
(KY, TN, AL, MS)
$949
$975
$1003
West South Central
(AR, LA, TX, OK)
$808
$830
$854
West:
Mountain
(MT, ID, WY, CO, NM, AZ, UT, NV)
$807
$829
$853
Pacific
(WA, OR, CA, AK, HI)
$955
$981
$1009
Puerto Rico
$609
$625
$643
Note:  This table reflects maximum rates.
For FY 2017: For wage index values greater than 1.0, the wage portion or labor related share subject to the area wage adjustment is 69.6%. The non-labor related share is 30.4%. For wage index values less than or equal to 1.0, the wage portion or labor related share subject to the area wage adjustment is 62%. The non-labor related share is 38%. Utilize the appropriate year DRG wage index file for area wage adjustment calculations.
For FYs 2018 through 2019: For wage index values greater than 1.0, the wage portion or labor related share subject to the area wage adjustment is 68.3%. The non-labor related share is 31.7%. For wage index values less than or equal to 1.0, the wage portion or labor related share subject to the area wage adjustment is 62%. The non-labor related share is 38%. Utilize the appropriate year DRG wage index file for area wage adjustment calculations.
For FY 2017/Beneficiary Cost-Share: Beneficiary cost-share (other than active duty members) for care paid on a basis of a regional per diem rate is the lower of $235 per day or 25% of the hospital billed charges effective for services rendered on or after October 1, 2016.
For FY 2018/Beneficiary Cost-Share: Beneficiary cost-share (other than active duty members) for care paid on a basis of a regional per diem rate is the lower of $241 per day or 25% of the hospital billed charges effective for services rendered on or after October 1, 2017.
For FY 2019/Beneficiary Cost-Share: Beneficiary cost-share (other than active duty members) for care paid on a basis of a regional per diem rate is the lower of $248 per day or 25% of the hospital billed charges effective for services rendered on or after October 1, 2018.
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