[Federal Register Volume 77, Number 245 (Thursday, December 20, 2012)]
[Notices]
[Pages 75499-75501]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-30700]


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DEPARTMENT OF VETERANS AFFAIRS


Reasonable Charges for Medical Care or Services; V3.12, 2013 
Calendar Year Update and National Average Administrative Prescription 
Drug Charge Update

AGENCY: Department of Veterans Affairs.

ACTION: Notice.

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SUMMARY: This Department of Veterans Affairs (VA) notice informs the 
public of the updated data for calculating the ``Reasonable Charges'' 
collected or recovered by VA for medical care or services and of the 
updated ``National Average Administrative Costs'' for purposes of 
calculating VA's charges for prescription drugs that were not 
administered during treatment but

[[Page 75500]]

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 for care) under a health plan contract; 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 a nonservice-
connected disability incurred as a result of a motor vehicle accident 
in a State that requires automobile accident reparations insurance. The 
charge tables and supplemental tables that are applicable to this 
notice can be viewed on the Veterans Health Administration Chief 
Business Office's Internet Web site. These changes are effective 
January 1, 2013.

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: Section 17.101 of title 38, United States 
Code of Federal Regulations (CFR), sets forth VA's medical regulations 
concerning ``Reasonable Charges'' for medical care or services provided 
or furnished by VA to a veteran for: (1) A nonservice-connected 
disability for which the veteran is entitled to care (or the payment of 
expenses for care) under a health plan contract; (2) 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 (3) a 
nonservice-connected disability incurred as a result of a motor vehicle 
accident in a State that requires automobile accident reparations 
insurance.
    The regulation includes methodologies for establishing billed 
amounts for the following types of charges: Acute inpatient facility 
charges; skilled nursing facility and 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. In cases where 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 or regulations, the method for determining VA's charges is 
set forth at 38 CFR 17.101(a)(8).
    The regulation provides that the actual charge amounts at 
individual VA facilities based on these methodologies and the data 
sources used for calculating those actual charge amounts will either be 
published as a notice in the Federal Register or will be posted on the 
Internet site of the Veterans Health Administration Chief Business 
Office. Certain charges are hereby updated as described below, 
effective January 1, 2013.
    Based on the methodologies set forth in 38 CFR 17.101, this 
document provides an update to charges for 2013 HCPCS Level II and 
Current Procedural Technology codes. Charges are also being updated 
based on more recent versions of data sources 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. These 
updated charges are effective January 1, 2013. As of the date of this 
notice, the actual charge amounts at individual VA facilities based on 
the methodologies in the regulation will be posted at http://www1.va.gov/CBO/apps/rates/index.asp, under the heading ``Reasonable 
Charges Data Tables'' and identified as ``V3.12 Data Tables (Outpatient 
and Professional).''
    The list of data sources used for calculating the actual charge 
amounts listed above also will be posted at http://www1.va.gov/CBO/apps/rate/index.asp under the heading ``Reasonable Charges Data 
Sources'' and identified as ``Reasonable Charges V3.12 Data Sources 
(Outpatient and Professional)(PDF).''
    Acute inpatient facility charges and skilled nursing facility/sub-
acute inpatient facility charges remain the same as set forth in the 
notice published in the Federal Register on September 7, 2012 (77 FR 
55269). The effective date of those charges was October 1, 2012. The 
data tables containing those actual charges are posted at http://www1.va.gov/CBO/apps/rates/index.asp, under the heading ``Reasonable 
Charges Data Tables'' and identified as ``V3.11 Data Tables 
(Inpatient).'' The data sources used to calculate these charges are 
posted at http://www1.va.gov/CBO/apps/rate/index.asp under the heading 
``Reasonable Charges Data Sources'' and identified as ``Reasonable 
Charges V3.11 Data Sources (Inpatient) (PDF).'' VA's current inpatient 
charge structure utilizes the methodology set forth in 38 CFR 17.101 
and VA does not itemize inpatient bills.
    The list of VA medical facility locations has also been updated. 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. The updated VA medical facility locations will be 
posted on the Internet site of the Veterans Health Administration Chief 
Business Office, currently at http://www1.va.gov/CBO/apps/rate/index.asp under the heading ``VA Medical Facility Locations,'' and 
identified as ``VA Medical Facility Locations V3.12 (Jan13).''
    As provided in 38 CFR 17.101(m), when VA provides or furnishes 
prescription drugs not administered during treatment, ``charges billed 
separately for such prescription drugs will consist of the amount that 
equals the total of the actual cost to VA for the drugs and the 
national average of VA administrative costs associated with dispensing 
the drugs for each prescription.''
    Section 17.101(m) includes the methodology for calculating the 
national average administrative cost for prescription drug charges not 
administered during treatment. The administrative cost is determined 
annually using VA's managerial cost accounting system. Under this 
accounting system, the national average administrative cost is 
determined by adding the total VA national drug general overhead costs 
(such as costs of buildings and maintenance, utilities, billing, and 
collections) to the total VA national drug dispensing costs (such as 
costs of the labor of the pharmacy department, packaging, and mailing) 
with the sum divided by the actual number of VA prescriptions filled 
nationally. The labor cost also includes cost for the professional 
activity of reviewing and dispensing a prescription.
    Based on the accounting system, VA will determine the amount of the

[[Page 75501]]

national average administrative cost annually for the prior fiscal year 
(October through September) and then apply the charge at the start of 
the next calendar year. The national average administrative cost for 
the calendar year 2013 is $13.18. This change is effective on January 
1, 2013, and will be posted at http://www1.va.gov/CBO/payerinfo.asp and 
identified as ``CY 2013 Average Administrative Cost For 
Prescriptions.''
    Consistent with the regulations, the national average 
administrative cost, the updated data tables, and the supplementary 
tables containing the changes described in this notice will be posted 
online as indicated in this notice. This notice will be posted at 
http://www1.va.gov/CBO/apps/rates/index.asp under the heading ``Federal 
Registers, Rules, and Notices'' and identified as, ``V3.12 Federal 
Register Notice 01/01/13 (Outpatient and Professional), and National 
Administrative Cost (PDF).'' The national average administrative cost, 
updated data tables, and the supplementary tables containing the 
changes described will be effective until changed by a subsequent 
Federal Register notice.

    Approved: December 14, 2012.
John R. Gingrich,
Chief of Staff, Department of Veterans Affairs.
[FR Doc. 2012-30700 Filed 12-19-12; 8:45 am]
BILLING CODE 8320-01-P