[Federal Register Volume 77, Number 174 (Friday, September 7, 2012)]
[Notices]
[Pages 55269-55270]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-22049]


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DEPARTMENT OF VETERANS AFFAIRS


Reasonable Charges for Inpatient MS-DRGs and SNF Medical 
Services; V3.11, 2013; 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 ``Reasonable Charges Data 
Sources.'' Certain charges are hereby updated as described in the 
SUPPLEMENTARY INFORMATION section of this notice. These changes are 
effective October 1, 2012.
    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 
(10NB6), 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 are not being changed for: 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. These outpatient facility charges 
and professional charges remain the same as set forth in a notice 
published in the Federal Register on December 12, 2011 (76 FR 77328).

[[Page 55270]]

    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 2012 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 ``Reasonable 
Charges Data Tables.'' This Table A corresponds to the Table A 
referenced in the September 28, 2011, Federal Register Notice. Table A 
referenced in this notice provides updated charges based on 2013 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 28, 2011, 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 (See Table ``N'' Acute Inpatient and Table ``O'' SNF 
geographic factors found on the Web site under ``Reasonable Charges 
Data Tables''). 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 ``Reasonable Charges Data 
Tables.'' This Table B corresponds to the Table B referenced in the 
September 28, 2011, 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 28, 2011, 
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, 2012.
    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 ``Reasonable Charges Data 
Tables.'' 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 ``Reasonable Charges 
Data Tables.'' Accordingly, the tables identified as being updated by 
this notice correspond to the applicable tables referenced in the 
September 28, 2011, notice, beginning with Table A through Table B.
    The list of data sources presented in Supplementary Table 1 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 ``Reasonable 
Charges Data Sources'' 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, under ``VA Medical Facility Locations,'' 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 VHA Chief Business Office, 
``Reasonable Charges (Rates) Information'' page currently at http://www1.va.gov/CBO/apps/rates/index.asp.

    Approved: August 30, 2012.
John R. Gingrich,
Chief of Staff, Department of Veterans Affairs.
[FR Doc. 2012-22049 Filed 9-6-12; 8:45 am]
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