[Federal Register Volume 76, Number 132 (Monday, July 11, 2011)]
[Notices]
[Pages 40749-40751]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-17263]


=======================================================================
-----------------------------------------------------------------------

OFFICE OF MANAGEMENT AND BUDGET

DEPARTMENT OF VETERANS AFFAIRS


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

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

ACTION: Notice.

-----------------------------------------------------------------------

SUMMARY: This document updates the Cost-Based and Inter-Agency billing 
rates for medical care or services provided by the Department of 
Veterans Affairs (VA) that apply in certain circumstances. This notice 
is issued jointly by the Office of Management and Budget and the 
Department of Veterans Affairs.

DATES: Effective Date: The rates set forth herein are effective July 
11, 2011 and until further notice.

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.)

[[Page 40750]]


SUPPLEMENTARY INFORMATION: VA's methodology for computing Cost-Based 
and Inter-Agency billing rates for medical care or services provided by 
VA is set forth in 38 CFR 17.102(h). These rates apply to medical care 
or services provided:
    (a) In error or based 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 (DoD) or other 
Federal agencies, when the care or service provided is not covered by 
an applicable sharing agreement. The rates contained in this notice do 
not apply to sharing agreements between VA and DoD unless otherwise 
stated.
    Two sets of rates are obtained via application of this methodology: 
Cost-Based rates, for use for purposes (a) through (d), above, and 
Inter-Agency rates, for use for purpose (e), above. The calculations 
for the Cost-Based and Inter-Agency rates are the same except that 
Inter-Agency rates are not broken down into three components 
(Physician; Ancillary; and Nursing, Room, and Board), and they do not 
include standard fringe benefit costs covering government employee 
retirement, disability costs, and return on fixed assets.
    When VA pays for medical care or service from a non-VA source under 
circumstances in which the Cost-Based or Inter-Agency Rates would apply 
if the care or service had been provided by VA, 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.
    The third party pharmacy rate will remain the same as set forth in 
the notice published in the Federal Register on November 3, 2005 (70 FR 
66866) until VA's final rule RIN 2900-AN15 for the ``Charges Billed to 
Third Parties for Prescription Drugs Furnished by VA to a Veteran for a 
Nonservice-Connected Disability'' is effective on March 18, 2011. VA's 
current third party pharmacy rate utilizes the cost-based methodology 
set forth in 38 CFR 17.102, which was only to be used until such time 
as charges for prescription drugs were implemented under the provisions 
of 38 CFR 17.101. Effective March 18, 2011, VA will use the new 
methodology set forth in 38 CFR 17.101(m).
    Current rates obtained via the above methodology are as follows:

------------------------------------------------------------------------
                                            Cost-based     Inter-agency
                                               rates           rates
------------------------------------------------------------------------
A. Hospital Care per inpatient day
General Medicine:
    All Inclusive Rate..................          $2,384          $2,232
    Physician...........................             285  ..............
    Ancillary...........................             621  ..............
    Nursing Room and Board..............           1,478  ..............
Neurology:
    All Inclusive Rate..................           3,899           3,648
    Physician...........................             571  ..............
    Ancillary...........................           1,029  ..............
    Nursing Room and Board..............           2,299  ..............
Rehabilitation Medicine:
    All Inclusive Rate..................           2,122           1,992
    Physician...........................             241  ..............
    Ancillary...........................             648  ..............
    Nursing Room and Board..............           1,233  ..............
Blind Rehabilitation:
    All Inclusive Rate..................           1,240           1,161
    Physician...........................             100  ..............
    Ancillary...........................             616  ..............
    Nursing Room and Board..............             524  ..............
Spinal Cord Injury:
    All Inclusive Rate..................           1,756           1,644
    Physician...........................             218  ..............
    Ancillary...........................             442  ..............
    Nursing Room and Board..............           1,096  ..............
Surgery:
    All Inclusive Rate..................           4,533           4,248
    Physician...........................             500  ..............
    Ancillary...........................           1,375  ..............
    Nursing Room and Board..............           2,658  ..............
General Psychiatry
    All Inclusive Rate..................             801             749
    Physician...........................              76  ..............
    Ancillary...........................             126  ..............
    Nursing Room and Board..............             599  ..............
Substance Abuse (Alcohol and Drug
 Treatment)
    All Inclusive Rate..................           1,154           1,081
    Physician...........................             110  ..............
    Ancillary...........................             267  ..............
    Nursing Room and Board..............             777  ..............
Psychosocial Residential Rehabilitation
 Program
    All Inclusive Rate..................             577             540
    Physician...........................              36  ..............
    Ancillary...........................              61  ..............
    Nursing Room and Board..............             480  ..............

[[Page 40751]]

 
Intermediate Medicine
    All Inclusive Rate..................           1,920           1,796
    Physician...........................              94  ..............
    Ancillary...........................             282  ..............
    Nursing Room and Board..............           1,544  ..............
Polytrauma Inpatient
    All Inclusive Rate..................           3,391           3,197
    Physician...........................             385  ..............
    Ancillary...........................           1,036  ..............
    Nursing Room and Board..............           1,970  ..............
B. Nursing Home Care, Per Day
    All Inclusive Rate..................             993             929
    Physician...........................              31  ..............
    Ancillary...........................             134  ..............
    Nursing Room and Board..............             828  ..............
C. Outpatient Medical and Emergency
 Dental Treatment
    Outpatient Visit (Other than                     231             214
     Emergency Dental)..................
    Emergency Dental Outpatient Visit...             487             416
    PM&RS Outpatient Visit..............             430             401
    Outpatient PolyTrauma/Traumatic                  573             535
     Brain Injury.......................
------------------------------------------------------------------------

    Beginning on the effective date indicated herein, these rates 
supersede those established by VA and by the Director of Office of 
Management and Budget on November 3, 2005 (70 FR 66866).

    Approved: August 9, 2010.
John R. Gingrich,
Chief of Staff, Department of Veterans Affairs.
    Approved: June 29, 2011.
Jacob J. Lew,
Director, Office of Management and Budget.
[FR Doc. 2011-17263 Filed 7-8-11; 8:45 am]
BILLING CODE 3110-01-P