[Federal Register Volume 79, Number 213 (Tuesday, November 4, 2014)]
[Notices]
[Pages 65479-65480]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-26148]


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DEPARTMENT OF VETERANS AFFAIRS


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

AGENCY: Department of Veterans Affairs.

ACTION: Notice.

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SUMMARY: This document updates the Cost-Based and Inter-Agency billing 
rates for medical care or services provided by the U.S. Department of 
Veterans Affairs (VA).

DATES: Effective Date: The rates set forth in this notice are effective 
November 4, 2014 and until further notice.

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'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). Two sets of rates are obtained by 
applying this methodology, Cost-Based rates and Inter-Agency rates. 
Cost-Based rates apply to medical care and services that are provided 
by VA:
    (a) In error or based on tentative eligibility;
    (b) In a medical emergency;
    (c) To pensioners of allied nations; or
    (d) For research purposes in circumstances under which VA medical 
care appropriation is to be reimbursed by VA research appropriation.
    Inter-Agency rates apply to medical care and services that are 
provided by VA to beneficiaries of the Department of Defense (DoD) or 
other Federal agencies, when the care or services provided is not 
covered by an applicable sharing agreement. The Inter-Agency rates 
contained in this notice do not apply to sharing agreements between VA 
and DoD unless otherwise stated.
    The calculations for the Cost-Based and Inter-Agency rates are the 
same with two exceptions. Inter-Agency rates are all inclusive and are 
not broken down into three components (Physician; Ancillary; and 
Nursing, Room and Board), and Inter-Agency rates do not include 
standard fringe benefit costs that cover government employee 
retirement, disability costs, and return on fixed assets. When VA pays 
for medical care or services from a non-VA source under circumstances 
in which the Cost-Based or Inter-Agency Rates would apply if the care 
or services had been provided by VA, the charge for such care or 
services will be the actual amount paid by VA for the care or services. 
Inpatient charges will be at the per diem rates shown for the type of 
bed section or discrete treatment unit providing the care.
    The following table depicts the Cost Based and Inter-Agency Rates 
which are effective upon publication of this notice. These rates 
supersede those established by the Federal Register notice published on 
July 11, 2011 at 76 FR 40749.

------------------------------------------------------------------------
                                            Cost-based     Inter-agency
                                               rates           rates
------------------------------------------------------------------------
A. Hospital Care per inpatient day
    General Medicine:
        All Inclusive Rate..............          $3,313          $3,142
        Physician.......................             397  ..............
        Ancillary.......................             863  ..............
        Nursing Room and Board..........           2,053  ..............
    Neurology:
        All Inclusive Rate..............           3,152           2,993
        Physician.......................             461  ..............
        Ancillary.......................             832  ..............
        Nursing Room and Board..........           1,859  ..............
    Rehabilitation Medicine:
        All Inclusive Rate..............           2,480           2,353
        Physician.......................             282  ..............
        Ancillary.......................             758  ..............
        Nursing Room and Board..........           1,440  ..............
    Blind Rehabilitation:

[[Page 65480]]

 
        All Inclusive Rate..............           1,641           1,557
        Physician.......................             132  ..............
        Ancillary.......................             815  ..............
        Nursing Room and Board..........             694  ..............
    Spinal Cord Injury:
        All Inclusive Rate..............           2,201           2,089
    Physician...........................             273  ..............
        Ancillary.......................             554  ..............
        Nursing Room and Board..........           1,374  ..............
    Surgery:
        All Inclusive Rate..............           5,165           4,899
        Physician.......................             569  ..............
        Ancillary.......................           1,567  ..............
        Nursing Room and Board..........           3,029  ..............
    General Psychiatry:
        All Inclusive Rate..............           1,611           1,527
        Physician.......................             152  ..............
        Ancillary.......................             254  ..............
        Nursing Room and Board..........           1,205  ..............
    Substance Abuse (Alcohol and Drug
     Treatment):
        All Inclusive Rate..............           1,363           1,294
        Physician.......................             130  ..............
        Ancillary.......................             315  ..............
        Nursing Room and Board..........             918  ..............
    Psychosocial Residential
     Rehabilitation Program:
        All Inclusive Rate..............             650             616
        Physician.......................              41  ..............
        Ancillary.......................              68  ..............
        Nursing Room and Board..........             541  ..............
    Intermediate Medicine:
        All Inclusive Rate..............           2,249           2,135
        Physician.......................             111  ..............
        Ancillary.......................             330  ..............
        Nursing Room and Board..........           1,808  ..............
    Polytrauma Inpatient:
        All Inclusive Rate..............           3,217           3,058
        Physician.......................             365  ..............
        Ancillary.......................             983  ..............
        Nursing Room and Board..........           1,869  ..............
B. Nursing Home Care, Per Day
    All Inclusive Rate..................           1,082           1,025
    Physician...........................              34  ..............
    Ancillary...........................             146  ..............
    Nursing Room and Board..............             902  ..............
C. Outpatient Medical Treatments
    Outpatient Visit (to include                     236             222
     Ineligible Dental Care)............
    Physical Medicine & Rehabilitation               443             419
     Service Outpatient Visit...........
    Outpatient Polytrauma/Traumatic                  586             561
     Brain Injury.......................
------------------------------------------------------------------------


    Dated: October 30, 2014.
    By Direction of the Secretary.
William F. Russo,
Acting Director, Office of Regulation Policy and Management, Office of 
the General Counsel, U.S. Department of Veterans Affairs.
[FR Doc. 2014-26148 Filed 11-3-14; 8:45 am]
BILLING CODE 8320-01-P