[Federal Register Volume 73, Number 191 (Wednesday, October 1, 2008)]
[Notices]
[Pages 57219-57220]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E8-22787]


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DEPARTMENT OF VETERANS AFFAIRS


Reasonable Charges for Inpatient DRG and SNF Medical Services; 
2009; Fiscal Year Update

AGENCY: Department of Veterans Affairs.

ACTION: Notice.

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SUMMARY: Section 17.101 of Title 38 of the Code of Federal Regulations 
sets forth the Department of Veterans Affairs (VA) 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.

    The regulations include methodologies for establishing billed 
amounts for the following types of charges: Acute inpatient facility 
charges; skilled nursing facility/sub-acute inpatient facility (SNF) 
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 Healthcare Common Procedure 
Coding System (HCPCS) Level II codes. The regulations also provide that 
data for calculating actual charge amounts at individual VA facilities 
based on these methodologies will either be published in a notice in 
the Federal Register or will be posted on the Internet site of the 
Veterans Health Administration Chief Business Office, currently at 
http://www1.va.gov/CBO/apps/rates/index.asp, under ``Charge Data.'' 
Certain of these charges are hereby updated as described in the 
Supplementary Information section of this notice. These changes are 
effective October 1, 2008.
    When charges for medical care or services provided or furnished at 
VA expense by either VA or non-VA providers have not been established 
under other provisions of the regulations, the method for determining 
VA's charges is set forth at 38 CFR 17.101(a)(8).

FOR FURTHER INFORMATION CONTACT: Romona Greene, 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: Of the charge types listed in the Summary 
section of this notice, only the acute inpatient facility charges and 
skilled nursing facility/sub-acute inpatient facility charges are being 
changed. Charges for the following charge types: 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 are not being changed. 
These Outpatient facility charges and Professional charges remain the 
same as set forth in a notice published in the Federal Register on 
December 26, 2007 (72 FR 246).
    Based on the methodologies set forth in 38 CFR 17.101(b), this 
document provides an update to acute inpatient charges that were based 
on 2008 diagnosis related group (DRG). Acute inpatient facility charges 
by DRG are set forth in Table A in the September 28, 2007, Federal 
Register notice (72 FR 188). Table A in this notice provides updated 
charges based on 2009 DRGs and will replace Table A in the September 
28, 2007, notice.
    Also, this document provides for an updated all-inclusive per diem 
charge for skilled nursing facility/sub-acute inpatient facility charge 
using the methodologies set forth in 38 CFR 17.101(c) and it is 
adjusted by a geographic area factor based on the location where the 
care is provided. The skilled nursing facility/sub-acute inpatient 
facility per diem charge is set forth in Table B in the September 28, 
2007, Federal Register notice. Table B in this notice provides the 
updated all-inclusive nationwide skilled nursing facility/sub-acute 
inpatient facility per diem charge and will replace Table B in the 
September 28, 2007, notice.
    The charges in this update for acute inpatient facility and skilled 
nursing facility/sub-acute inpatient facility services are effective 
October 1, 2008.
    In this update, we are retaining the table designations used for 
acute inpatient facility charges by DRGs in the notice published in the 
Federal Register on September 28, 2007. We also are retaining the table 
designation used for skilled nursing facility/sub-acute inpatient 
facility charges in the notice published in the Federal Register on 
September 28, 2007. Accordingly, the tables identified as being updated 
by this notice correspond to the applicable tables published in the 
September 28, 2007, notice, beginning with Table A through Table B.
    We have updated the list of data sources presented in Supplementary 
Table 1 to reflect the updated data sources used to establish the 
updated charges described in this notice.
    We have also updated the list of VA medical facility locations. As 
a reminder, in Supplementary Table 3 posted on the internet site of the 
Veterans Health Administration Chief Business Office, currently at 
http://www1.va.gov/CBO/apps/rates/index.asp, we set forth the list of 
VA medical facility locations, which includes the first three-digits of 
their ZIP Codes and provider-based/non-provider-based designations.
    Consistent with VA's regulations, the updated data tables and 
supplementary tables containing the changes described in this notice 
will be posted on the Internet site of the Veterans Health 
Administration Chief Business Office, currently at http://www1.va.gov/CBO/apps/rates/index.asp, under ``Charge Data.''


[[Page 57220]]


    Approved: August 28, 2008.
Gordon H. Mansfield,
Deputy Secretary of Veterans Affairs.
 [FR Doc. E8-22787 Filed 9-30-08; 8:45 am]
BILLING CODE 8320-01-P