[Federal Register Volume 78, Number 242 (Tuesday, December 17, 2013)]
[Notices]
[Pages 76413-76414]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-29997]


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

DEPARTMENT OF VETERANS AFFAIRS


Reasonable Charges for Medical Care or Services; V3.14, 2014 
Calendar Year Update and National Average Administrative Prescription 
Drug Charge Update

AGENCY: Department of Veterans Affairs.

ACTION: Notice.

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

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 the 
updated ``National Average Administrative Costs'' for purposes of 
calculating VA's charges for prescription drugs that were not 
administered during treatment but 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 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 http://www1.va.gov/CBO/apps/rates/index.asp. These 
changes are effective January 1, 2014.

FOR FURTHER INFORMATION CONTACT: Romona Greene, Chief Business Office 
10NB, Veterans Health Administration, Department of Veterans Affairs, 
810 Vermont Avenue NW., Washington, DC 20420, (202) 382-2521. This is 
not a toll free number.

SUPPLEMENTARY INFORMATION: VA has published regulations at 38 CFR 
17.101 addressing ``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 at 38 CFR 17.101 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 VA has 
not established charges for medical care or services provided or 
furnished at VA expense (by either VA or non-VA providers) 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 at http://www1.va.gov/CBO/apps/rates/index.asp. Certain charges 
are hereby updated as described below, effective January 1, 2014.
    Based on the methodologies set forth in 38 CFR 17.101, this 
document provides an update to charges for 2014 HCPCS Level II and 
Current Procedural Technology (CPT) codes. Charges are also being 
updated based on more

[[Page 76414]]

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, 2014. 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 ``V3.14 Data Tables (Outpatient and Professional).''
    The list of data sources used for calculating the actual charge 
amounts 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 V3.14 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 26, 2013 (78 FR 
59427). The effective date of those charges was October 1, 2013. 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 ``V3.13 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 V3.13 Data Sources (Inpatient) (PDF).''
    We have also updated the list of VA medical facility locations. The 
list of VA medical facility locations, including the first three digits 
of their zip codes as well as provider based/non-provider based 
designations, 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 
V3.14 (Jan14).''
    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 
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 drug cost 
for the calendar year (CY) 2014 is $13.07. This change is effective on 
January 1, 2014, and will be posted at http://www1.va.gov/CBO/payerinfo.asp and identified as ``CY 2014 Average Administrative Cost 
for Prescriptions.''
    Consistent with the regulations, the national average 
administrative cost, the updated data tables, and 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, ``V3.14 Federal 
Register Notice 01/01/14 (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 9, 2013.
Jose D. Riojas,
Chief of Staff, Department of Veterans Affairs.
[FR Doc. 2013-29997 Filed 12-16-13; 8:45 am]
BILLING CODE 8320-01-P