[Federal Register Volume 75, Number 186 (Monday, September 27, 2010)]
[Notices]
[Pages 59329-59330]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-24116]


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DEPARTMENT OF VETERANS AFFAIRS


Reasonable Charges for Inpatient MS-DRGs and SNF Medical 
Services; 2011 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 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 (VHA) Chief Business Office, currently at http://www1.va.gov/CBO/apps/rates/index.asp, under ``Charge Data.'' Certain 
charges are hereby updated as described in the Supplementary 
Information section of this notice. These changes are effective October 
1, 2010.
    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) 461-1595. (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 28, 2009 (74 FR 247).
    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 2010 Medicare severity diagnosis related groups (MS-DRGs). Acute 
inpatient facility charges by MS-DRGs are set forth in Table A and are 
posted on the Internet site of the VHA Chief Business Office, currently 
at http://www1.va.gov/CBO/apps/rates/index.asp, under ``Charge Data.'' 
This Table A corresponds to the Table A referenced in the September 17, 
2009, Federal Register Notice. Table A referenced in this notice 
provides updated charges based on 2011 MS-DRGs and will replace Table A 
posted on the Internet site of the VHA Chief Business Office, which 
corresponds to the Table A referenced in the September 17, 2009, 
Federal Register 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 and is posted on the 
Internet site of the VHA Chief Business Office, currently at http://www1.va.gov/CBO/apps/rates/index.asp, under ``Charge Data.'' This Table 
B corresponds to the Table B referenced in the September 17, 2009, 
Federal Register Notice. Table B referenced in this notice provides 
updated all-inclusive nationwide skilled nursing facility/sub-acute 
inpatient facility per diem charge and will replace Table B posted on 
the Internet site of the VHA Chief Business Office, which corresponds 
to the Table B referenced in the September 17, 2009, Federal Register 
notice.
    The charges in this update for acute inpatient facility and skilled 
nursing facility/sub-acute inpatient facility services are effective 
October 1, 2010.
    In this update, we are retaining the table designations used for 
acute inpatient facility charges by MS-DRGs which is posted on the 
Internet site of the VHA Chief Business Office, currently at http://www1.va.gov/CBO/apps/rates/index.asp, under ``Charge Data.'' We also 
are retaining the table designation used for skilled nursing facility/
sub-acute inpatient facility charges which is posted on the Internet 
site of the VHA Chief Business Office, currently at http://www1.va.gov/CBO/apps/rates/index.asp, under ``Charge Data.'' Accordingly, the 
tables identified as being updated by this notice correspond to the 
applicable tables

[[Page 59330]]

referenced in the September 17, 2009, notice, beginning with Table A 
through Table B.
    We have updated the list of data sources presented in Supplementary 
Table 1 posted on the Internet site of the VHA Chief Business Office, 
currently at http://www1.va.gov/CBO/apps/rates/index.asp 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 
VHA 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 their three-digit 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 VHA Chief Business Office, 
currently at http://www1.va.gov/CBO/apps/rates/index.asp, under 
``Charge Data.''

    Approved: August 25, 2010.
John R. Gingrich,
Chief of Staff, Department of Veterans Affairs.
[FR Doc. 2010-24116 Filed 9-24-10; 8:45 am]
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