[Federal Register Volume 68, Number 191 (Thursday, October 2, 2003)]
[Notices]
[Pages 56892-57302]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-24103]



  Federal Register / Vol. 68, No. 191 / Thursday, October 2, 2003 / 
Notices  

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DEPARTMENT OF VETERANS AFFAIRS


Reasonable Charges For Medical Care Or Services; 2003 Methodology 
Changes

AGENCY: Department of Veterans Affairs.

ACTION: Notice.

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SUMMARY: In a companion document published as a proposed rule in this 
issue of the Federal Register, we are proposing to amend VA's medical 
regulations concerning ``reasonable charges'' for medical care or 
services provided or furnished by VA to a veteran:
    --For a nonservice-connected disability for which the veteran is 
entitled to care (or the payment of expenses of care) under a health 
plan contract;
    --For a nonservice-connected disability incurred incident to the 
veteran's employment and covered under a worker's compensation law or 
plan that provides reimbursement or indemnification for such care and 
services; or
    --For a nonservice-connected disability incurred as a result of a 
motor vehicle accident in a State that requires automobile accident 
reparations insurance.
    If the methodology changes presented in the proposed rule are 
subsequently adopted as a final rule, then the information set forth in 
this document for calculating actual charge amounts at individual VA 
facilities will be used from the effective date of the final rule until 
changed by a subsequent Federal Register notice. Accordingly, 
interested parties may wish to retain this document for future 
reference.
    This document also identifies the editions of the data sources used 
to develop the accompanying charge tables, provides information on 
where the various data sources may be obtained, and provides a list of 
VA health care facilities.

FOR FURTHER INFORMATION CONTACT: David Cleaver, Chief Business Office 
(168), Veterans Health Administration, Department of Veterans Affairs, 
810 Vermont Avenue, NW., Washington, DC 20420, (202) 254-0361. (This is 
not a toll free number.)

SUPPLEMENTARY INFORMATION: A proposed rule published as a companion 
document in this issue of the Federal Register proposes to amend VA's 
``reasonable charges'' regulations for medical care and services (38 
CFR 17.101) to revise the methodology for establishing acute inpatient 
facility charges; skilled nursing facility/sub-acute inpatient facility 
charges; partial hospitalization facility charges; outpatient facility 
charges; physician and other professional charges, including 
professional charges for anesthesia services and dental services; 
pathology and laboratory charges; observation care facility charges; 
ambulance and other emergency transportation charges; and charges for 
durable medical equipment, drugs, injectables, and other medical 
services, items, and supplies identified by HCPCS Level II codes. If 
the changes presented in the proposed rule are subsequently adopted as 
a final rule, then information for calculating actual charge amounts at 
individual VA facilities using the amended methodologies will be as set 
forth in Tables A through S in this document and will be effective 
until changed by a subsequent Federal Register notice.
    The proposed rule also proposes to amend the existing regulations 
to provide authority to charge for medical care and services under 
specified circumstances when VA does not have an established charge.
    Previously, information on the editions of the data sources used to 
establish reasonable charges and where the various data sources could 
be obtained was included in the regulations. We are now proposing to 
present this information in the applicable Federal Register notice. 
Accordingly, Supplementary Table 1 lists the data sources and editions 
used for compiling the data in Tables A through S in this document. 
Supplementary Table 2 provides information on where the various data 
sources may be obtained.
    Previously, the tables of geographic area adjustment factors 
(GAAFs) listed VA facility locations by city and state. Consistent with 
the proposal to use three-digit ZIP Code areas as the geographic areas 
for all charge types, the GAAFs presented in this document are listed 
by three-digit ZIP Code. Supplementary Table 3 provides a list of VA 
facilities that links them to their three-digit ZIP Codes.

Anthony J. Principi,
Secretary of Veterans Affairs.
BILLING CODE 8320-01-P

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[FR Doc. 03-24103 Filed 10-1-03; 8:45 am]
BILLING CODE 8320-01-C