TRICARE Manuals - Display Chap 7 Addendum A (Baseline, Dec 5, 2022)

Mental Health

Chapter 7

Addendum A

Table Of Regional Specific Rates For Psychiatric Hospitals And Units With Low TRICARE Volume - FY 2019 - FY 2021

Revision:

United States Census Regions	FY 2019 Regional Rates 10/01/18 - 09/30/19	FY 2020 Regional Rates 10/01/19 - 09/30/20	FY 2021 Regional Rates 10/01/20 - 09/30/21
Northeast:
New England (ME, NH, VT, MA, RI, CT)	$946	$974	$997
Mid-Atlantic (NY, NJ, PA)	$912	$939	$962
Midwest:
East North Central (OH, IN, IL, MI, WI)	$788	$812	$831
West North Central (MN, IA, MO, ND, SD, NE, KS)	$743	$765	$783
South:
South Atlantic (DE, MD, DC, VA, WV, NC, SC, GA, FL)	$937	$965	$988
East South Central (KY, TN, AL, MS)	$1003	$1033	$1058
West South Central (AR, LA, TX, OK)	$854	$880	$901
West:
Mountain (MT, ID, WY, CO, NM, AZ, UT, NV)	$853	$879	$900
Pacific (WA, OR, CA, AK, HI)	$1009	$1039	$1064
Puerto Rico	$643	$662	$678

Note: This table reflects maximum rates.

For FYs 2019 through 2021: 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 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.

For FY 2020/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 $255 per day or 25% of the hospital billed charges effective for services rendered on or after October 1, 2019.

For FY 2021/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 $261 per day or 25% of the hospital billed charges effective for services rendered on or after October 1, 2020.

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