Department of Army Health Services Command CHAMPUS Catastrophic Case Limits Gateway Catchment Areas
Final rept. Oct-Nov 1991,
ARMY HEALTH CARE STUDIES AND CLINICAL INVESTIGATION ACTIVITY FORT SAM HOUSTON TX
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Consultant Report is the estimation of case total limits for catastrophic re-insurance payments to be made to Army Gateway sites beginning Fiscal Year FY 1992. Case totals included both institutional and professional services CHAMPUS payments. Calendar Year CY 1990 data were used to derive estimates to insure using only completed cases. Catastrophic case cutoffs are listed as part of the report Summary. These cutoffs when implemented by Health Services Command HSC will result in approximately 5 of each Gateway sites total CHAMPUS budget being paid through catastrophic re-insurance. An actual application of the model using two Gateway sites is also included. Appendix A lists the actual computation for each site and displays cutoffs associated with various percentages of the budget paid as re-insurance. Appendix B displays catastrophic cases for each Gateway site which satisfy the cutoff criteria during CY 1990.
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