[Federal Register Volume 81, Number 177 (Tuesday, September 13, 2016)]
[Notices]
[Pages 62977-62978]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-21959]


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DEPARTMENT OF VETERANS AFFAIRS


Reasonable Charges for Inpatient MS-DRGs and SNF Medical 
Services; v3.19, Fiscal Year 2017 Update

AGENCY: Department of Veterans Affairs.

ACTION: Notice.

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SUMMARY: This document updates the acute inpatient and the skilled 
nursing facility (SNF)/sub-acute inpatient facility charges. The 
updated charges are based on the 2017 Medicare severity diagnosis 
related groups (MS-DRG).

FOR FURTHER INFORMATION CONTACT: Romona Greene, Office of Community 
Care, Revenue Operations, Consolidated Patient Account Center (CPAC) 
Rates and Charges (10D1C), Veterans Health Administration (VHA), 
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 Title 38 of the Code of 
Federal Regulations (CFR) sets forth the Department of Veterans Affairs 
(VA) medical regulations concerning ``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 of 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. The methodologies for establishing 
billed amounts for several types of charges are found in 38 CFR 17.101; 
however, this notice will only address the acute inpatient and the SNF/
sub-acute inpatient facility charges.
    Based on the methodologies set forth in 38 CFR 17.101(b), this 
notice updates the acute inpatient facility charges that were based on 
the 2016 MS-DRGs. Acute inpatient facility charges by MS-

[[Page 62978]]

DRGs are posted on the VHA Internet site, at http://www.va.gov/CBO/apps/rates/index.asp, under the ``Reasonable Charges Data Tables'' 
section, Inpatient Data Table, as Table A (v3.17). This Table A 
corresponds to the Table A referenced in 80 FR 57051, September 21, 
2015. Table A referenced in this notice is v3.19, which provides 
updated charges based on the 2017 MS-DRGs, and it will replace Table A 
(v3.17) posted on the VHA Internet site.
    Also, this document updates the SNF/sub-acute inpatient facility 
all-inclusive per diem charge using the methodologies set forth in 38 
CFR 17.101(c) and this charge is adjusted by a geographic area factor 
that is based on the location where the care is provided. For the 
geographic area factors, see Table N, Acute Inpatient, and Table O, 
SNF, on the VHA Web site under the v3.18 link in the ``Reasonable 
Charges Data Tables'' section. Tables N and O are not being updated by 
this notice. The SNF/sub-acute inpatient facility per diem charge is 
posted on the VHA Internet site, at http://www.va.gov/CBO/apps/rates/index.asp, under the ``Reasonable Charges Data Tables'' section, Table 
B (v3.17). This Table B corresponds to the Table B referenced in 80 FR 
57051, September 21, 2015. Table B referenced in this notice is v3.19, 
which provides an update to the all-inclusive nationwide SNF/sub-acute 
inpatient facility per diem charge and will replace Table B posted on 
the VHA Internet site.
    The charges in this notice for acute inpatient and SNF/sub-acute 
inpatient facility services are effective October 1, 2016.
    This notice is retaining the table designations used for acute 
inpatient facility charges by MS-DRGs, which is posted on the VHA 
Internet site, currently at http://www.va.gov/CBO/apps/rates/index.asp, 
under ``Reasonable Charges Data Tables.'' This notice is also retaining 
the table designation used for SNF/sub-acute inpatient facility 
charges, which is also posted on the VHA Internet site. Accordingly, 
the tables identified as being updated by this notice correspond to the 
applicable tables referenced in 80 FR 57051, September 21, 2015.
    The list of data sources presented in Supplementary Table 1 (v3.19) 
reflects the updated data sources used to establish the updated charges 
described in this notice, and will be posted on the VHA Internet site, 
at http://www.va.gov/CBO/apps/rates/index.asp, under the ``Reasonable 
Charges Data Sources'' section.
    VHA has also updated the list of VA medical facility locations. As 
a reminder, in Supplementary Table 3, posted on the VHA Internet site, 
CPAC Rates and Charges and Billing, at http://www.va.gov/CBO/apps/rates/index.asp, under the VA Medical Facility Locations section, VHA 
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.
    Consistent with VA's regulations, the updated data tables and 
supplementary tables containing the changes described in this notice 
will be posted on the VHA Internet site, at http://www.va.gov/CBO/apps/rates/index.asp, under the ``CPAC Rates and Charges and Billing, 
Reasonable Charges Information'' section.
    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 September 6, 2016, for publication.

    Dated: September 6, 2016.
Jeffrey Martin,
Office Program Manager, Office of Regulation Policy & Management, 
Office of the Secretary, Department of Veterans Affairs.
[FR Doc. 2016-21959 Filed 9-12-16; 8:45 am]
 BILLING CODE 8320-01-P