[Federal Register Volume 81, Number 130 (Thursday, July 7, 2016)]
[Notices]
[Pages 44409-44411]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-15956]


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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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[[Page 44410]]

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

DATES: The rates set forth herein are effective July 7, 2016 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; and
    (d) For research purposes in circumstances under which the VA 
Medical Services appropriation is to be reimbursed by the 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 
that are effective upon publication of this notice and will remain in 
effect until the next Federal Register notice is published. These rates 
supersede those established by the Federal Register notice published on 
November 4, 2014, at 79 FR 65479.

------------------------------------------------------------------------
                                            Cost-based     Inter-agency
                                               rates           rates
------------------------------------------------------------------------
A. Hospital Care per inpatient day:
General Medicine:
    All Inclusive Rate..................          $3,720          $3,553
    Physician...........................             445  ..............
    Ancillary...........................             969  ..............
    Nursing Room and Board..............           2,306  ..............
Neurology:
    All Inclusive Rate..................           3,564           3,401
    Physician...........................             522  ..............
    Ancillary...........................             941  ..............
    Nursing Room and Board..............           2,101  ..............
Rehabilitation Medicine:
    All Inclusive Rate..................           2,477           2,354
    Physician...........................             281  ..............
    Ancillary...........................             757  ..............
    Nursing Room and Board..............           1,439  ..............
Blind Rehabilitation:
    All Inclusive Rate..................           1,741           1,653
    Physician...........................             140  ..............
    Ancillary...........................             865  ..............
    Nursing Room and Board..............             736  ..............
Spinal Cord Injury:
    All Inclusive Rate..................           2,631           2,502
    Physician...........................             326  ..............
    Ancillary...........................             662  ..............
    Nursing Room and Board..............           1,643  ..............
Surgery:
    All Inclusive Rate..................           5,910           5,642
    Physician...........................             651  ..............
    Ancillary...........................           1,793  ..............
    Nursing Room and Board..............           3,466  ..............
General Psychiatry:
    All Inclusive Rate..................           1,771           1,679
    Physician...........................             167  ..............
    Ancillary...........................             279  ..............
    Nursing Room and Board..............           1,325  ..............
Substance Abuse (Alcohol and Drug
 Treatment):
    All Inclusive Rate..................           1,861           1,765
    Physician...........................             178  ..............
    Ancillary...........................             431  ..............
    Nursing Room and Board..............           1,252  ..............
Psychosocial Residential Rehabilitation
 Program:
    All Inclusive Rate..................             695             662

[[Page 44411]]

 
    Physician...........................              44  ..............
    Ancillary...........................              73  ..............
    Nursing Room and Board..............             578  ..............
Intermediate Medicine:
    All Inclusive Rate..................           2,233           2,126
    Physician...........................             110  ..............
    Ancillary...........................             328  ..............
    Nursing Room and Board..............           1,795  ..............
Poly-trauma Inpatient:
    All Inclusive Rate..................           3,227           3,057
    Physician...........................             367  ..............
    Ancillary...........................             986  ..............
    Nursing Room and Board..............           1,874  ..............
B. Nursing Home Care, Per Day:
    All Inclusive Rate..................           1,197           1,138
    Physician...........................              37  ..............
    Ancillary...........................             162  ..............
    Nursing Room and Board..............             998  ..............
C. Outpatient Medical Treatments:
    Outpatient Visit (to include                     335             319
     Ineligible Dental Care)............
    Outpatient Physical Medicine &                   212             199
     Rehabilitation Service Visit.......
    Outpatient Poly-trauma/Traumatic                 537             510
     Brain Injury.......................
------------------------------------------------------------------------
Note: Outpatient Prescriptions will be billed at Drug Cost plus
  Administrative Fee.

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. Gina S. 
Farrisee, Deputy Chief of Staff, Department of Veterans Affairs, 
approved this document on June 30, 2016, for publication.

    Dated: June 30, 2016.
Jeffrey Martin,
Office Program Manager, Office of Regulation Policy & Management, 
Office of the Secretary, Department of Veterans Affairs.
[FR Doc. 2016-15956 Filed 7-6-16; 8:45 am]
BILLING CODE 8320-01-P