[Federal Register Volume 69, Number 4 (Wednesday, January 7, 2004)]
[Notices]
[Pages 1062-1064]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-318]


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OFFICE OF MANAGEMENT AND BUDGET

DEPARTMENT OF VETERANS AFFAIRS


Cost-Based and Interagency Billing Rates for Medical Care or 
Services Provided by the Department of Veterans Affairs

AGENCIES: Office of Management and Budget, Executive Office of the 
President and the Department of Veterans Affairs.

ACTION: Notice.

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SUMMARY: This document provides cost-based and interagency billing 
rates for medical care or services provided by the Department of 
Veterans Affairs (VA):
    (a) In error or on tentative eligibility;
    (b) In a medical emergency;
    (c) To pensioners of allied nations;
    (d) For research purposes in circumstances under which VA medical 
care appropriation is to be reimbursed by VA research appropriation; 
and
    (e) To beneficiaries of the Department of Defense or other Federal 
agencies, when the care or service provided is not covered by an 
applicable sharing agreement.
    In addition, until such time as charges for outpatient dental care 
and prescription drugs are implemented under the provisions of 38 CFR 
17.101, the applicable cost-based billing rates provided in this notice 
will be used for collection or recovery by VA for outpatient dental 
care and prescription drugs provided under circumstances covered by 
that section. This notice is issued jointly by the Office of Management 
and Budget and the Department of Veterans Affairs.

EFFECTIVE DATE: The rates set forth herein are effective January 7, 
2004, and until further notice.

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: VA's medical regulations at 38 CFR 17.102(h) 
set forth a methodology for computing rates for medical care or 
services provided by VA:
    (a) In error or on tentative eligibility;
    (b) In a medical emergency;
    (c) To pensioners of allied nations;
    (d) For research purposes in circumstances under which VA medical 
care appropriation is to be reimbursed by VA research appropriation; 
and
    (e) To beneficiaries of the Department of Defense or other Federal 
agencies, when the care or service provided is not covered by an 
applicable sharing agreement.
    Two sets of rates are obtained via application of this methodology: 
Cost-Based Rates, for use for purposes (a) through (d), above, and 
Interagency Rates, for use for purpose (e), above. Government employee 
retirement benefits and return on fixed assets are not included in the 
Interagency Rates, and the Interagency Rates are not broken down into 
three components (Physician; Ancillary; and Nursing, Room, and Board), 
but in all other respects the Interagency Rates are the same as the 
Cost-Based Rates.
    When medical care or service is obtained at the expense of the 
Department of Veterans Affairs from a non-VA source under circumstances 
in which the Cost-Based or Interagency Rates would apply if the care or 
service had been provided by VA, then the charge for such care or 
service will be the actual amount paid by VA for that care or service.
    Inpatient charges will be at the per diem rates shown for the type 
of bed section or discrete treatment unit providing the care. 
Prescription Filled charge in lieu of the Outpatient Visit rate will be 
charged when the patient receives no service other than the Pharmacy 
outpatient service. This charge applies whether the patient receives 
the prescription in person or by mail.
    Current rates obtained via the above methodology are as follows:

[[Page 1063]]



------------------------------------------------------------------------
                                            Cost-based      Interagency
                                               rates           rates
------------------------------------------------------------------------
A. Hospital Care, Rates Per Inpatient
 Day
 
General Medicine:
    All Inclusive Rate..................          $1,815          $1,668
    Physician...........................             217  ..............
    Ancillary...........................             473  ..............
    Nursing, Room, and Board............           1,125  ..............
Neurology:
    All Inclusive Rate..................           2,289           2,098
    Physician...........................             335  ..............
    Ancillary...........................             604  ..............
    Nursing, Room, and Board............           1,350  ..............
Rehabilitation Medicine:
    All Inclusive Rate..................           1,723           1,574
    Physician...........................             196  ..............
    Ancillary...........................             526  ..............
    Nursing, Room, and Board............           1,001  ..............
Blind Rehabilitation:
    All Inclusive Rate..................           1,254           1,162
    Physician...........................             101  ..............
    Ancillary...........................             623  ..............
    Nursing, Room, and Board............             530  ..............
Spinal Cord Injury:
    All Inclusive Rate..................           1,237           1,136
    Physician...........................             153  ..............
    Ancillary...........................             311  ..............
    Nursing, Room, and Board............             773  ..............
Surgery:
    All Inclusive Rate..................           3,513           3,255
    Physician...........................             387  ..............
    Ancillary...........................           1,065  ..............
    Nursing, Room, and Board............           2,061  ..............
General Psychiatry:
    All Inclusive Rate..................             971             888
    Physician...........................              92  ..............
    Ancillary...........................             153  ..............
    Nursing, Room, and Board............             726  ..............
Substance Abuse (Alcohol and Drug
 Treatment):
    All Inclusive Rate..................           1,206           1,106
    Physician...........................             115  ..............
    Ancillary...........................             279  ..............
    Nursing, Room, and Board............             812  ..............
Psychosocial Residential Rehabilitation
 Treatment Programs:
    All Inclusive Rate..................             276             252
    Physician...........................              17  ..............
    Ancillary...........................              29  ..............
    Nursing, Room, and Board............             230  ..............
Intermediate Medicine:
    All Inclusive Rate..................             801             733
    Physician...........................              39  ..............
    Ancillary...........................             118  ..............
    Nursing, Room, and Board............             644  ..............
 
B. Nursing Home Care, Rates Per Day
    All Inclusive Rate..................             451             411
    Physician...........................              14  ..............
    Ancillary...........................              61  ..............
    Nursing, Room, and Board............             376  ..............
 
C. Outpatient Medical and Dental
 Treatment
    Outpatient Visit (other than                     300             282
     Emergency Dental)..................
    Emergency Dental Outpatient Visit...             185             167
 
D. Prescription Filled, Per Prescription              45              45
------------------------------------------------------------------------


[[Page 1064]]

    Beginning on the effective date indicated herein, these rates 
supercede those established for the Department of Veterans Affairs by 
the Director of the Office of Management and Budget on November 1, 1999 
(64 FR 58862).

    Approved: September 17, 2003.
Anthony J. Principi,
Secretary, Department of Veterans Affairs.
    Approved: December 30, 2003.
Joshua B. Bolten,
Director, Office of Management and Budget.
[FR Doc. 04-318 Filed 1-6-04; 8:45 am]
BILLING CODE 3110-01-P