[Federal Register Volume 80, Number 239 (Monday, December 14, 2015)]
[Notices]
[Pages 77417-77418]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-31385]



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DEPARTMENT OF VETERANS AFFAIRS


Reasonable Charges for Medical Care or Services; V3.18, 2016 
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 updates the 
data for calculating the ``Reasonable Charges'' collected or recovered 
by VA for medical care or services. This notice also updates the 
``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 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: Section 17.101 of 38 Code of Federal 
Regulations sets forth the ``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 for 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.'' Section 17.101 provides the methodologies for 
establishing billed amounts for several types of 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.
    Section 17.101 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://www.va.gov/CBO/apps/rates/index.asp. Certain charges 
are hereby updated as stated in this notice and will be effective on 
January 1, 2016.
    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).
    Based on the methodologies set forth in Sec.  17.101, this notice 
provides an update to charges for 2016 HCPCS Level II and Current 
Procedural Terminology (CPT) 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. As of 
the date of this notice, the actual charge amounts at individual VA 
facilities based on the methodologies in Sec.  17.101 will be posted at 
http://www.va.gov/CBO/apps/rates/index.asp under the heading 
``Reasonable Charges Data Tables'' and identified as ``V3.18 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://www.va.gov/CBO/apps/rates/index.asp under the heading ``Reasonable Charges Data Sources'' 
and identified as ``Reasonable Charges V3.18 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 21, 2015 (80 FR 
57051). The effective date of those charges is October 1, 2015. The 
data tables containing those actual charges are posted at http://www.va.gov/CBO/apps/rates/index.asp under the heading ``Reasonable 
Charges Data Tables'' and identified as ``V3.17 Data Tables 
(Inpatient).'' The data sources used to calculate these charges are 
posted at http://www.va.gov/CBO/apps/rates/index.asp under the heading 
``Reasonable Charges Data Sources and identified as ``Reasonable 
Charges Data Sources V3.17 (Inpatient) (PDF).
    We are also updating 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://www.va.gov/CBO/apps/rates/index.asp under the heading ``VA Medical 
Facility Locations,'' and identified as ``VA Medical Facility Locations 
V3.18 (Jan16).''
    As indicated 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.
    VA determines the amount of the national average administrative 
cost annually for the prior fiscal year (October through September) and 
then applies the charge at the start of the next calendar year. The 
national average administrative drug cost for calendar year 2016 is 
$14.29. This change will be posted at http://www.va.gov/CBO/payerinfo.asp and identified as ``CY 2016 Average Administrative Cost 
for Prescriptions.''
    Consistent with Sec.  17.101, 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://www.va.gov/CBO/apps/rates/index.asp under the heading ``Federal Registers, Rules, and 
Notices'' and identified as, ``V3.18 Federal Register Notice 01/01/16 
(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.

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Signing Authority

    The Secretary of Veterans Affairs, or designee, approved this 
document and authorized the undersigned to sign and submit the document 
to the Office of the Federal Register for publication electronically as 
an official document of the Department of Veterans Affairs. Robert L. 
Nabors II, Chief of Staff, Department of Veterans Affairs, approved 
this document on November 30, 2015, for publication.

    Dated: December 9, 2015.
William F. Russo,
Director, Office of Regulation Policy & Management, Office of the 
General Counsel, Department of Veterans Affairs.
[FR Doc. 2015-31385 Filed 12-11-15; 8:45 am]
 BILLING CODE 8320-01-P