[Federal Register Volume 83, Number 182 (Wednesday, September 19, 2018)]
[Notices]
[Pages 47412-47413]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-20331]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF VETERANS AFFAIRS
Reasonable Charges for Inpatient MS-DRGs and SNF Medical
Services; v3.24, Fiscal Year 2019 Update
AGENCY: Department of Veterans Affairs.
ACTION: Notice.
-----------------------------------------------------------------------
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 2019 Medicare severity diagnosis
related groups (MS-DRG).
FOR FURTHER INFORMATION CONTACT: Romona Greene, Office of Community
Care, Revenue Operations, Payer Relations and Services, Rates and
Charges (10D1C1), 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(a)(1) 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 2018 MS-DRGs. Acute inpatient facility charges by MS-DRGs are
posted on the Veterans Health Administration (VHA) Office of Community
Care's website, at www.va.gov/communitycare/revenue_ops/payer_rates.asp, under the ``Reasonable Charges Data Tables'' section,
Inpatient Data Table, as Table A (v3.22). This Table A corresponds to
the Table A referenced in 82 FR 44701, September 25, 2017. Table A
referenced in this notice is v3.24, which provides updated charges
based on the 2019 MS-DRGs, will replace Table A (v3.22) posted on the
VHA Office of Community Care's website.
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.
[[Page 47413]]
For the geographic area factors, see Table N, Acute Inpatient, and
Table O, SNF, on the VHA Office of Community Care's website under the
v3.23 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 Office of Community
Care's website under the ``Reasonable Charges Data Tables'' section,
Table B (v3.22). This Table B corresponds to the Table B referenced in
82 FR 44701, September 25, 2017. Table B referenced in this notice is
v3.24, 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 Office of Community Care's website.
The charges in this notice for acute inpatient and SNF/sub-acute
inpatient facility services are effective October 1, 2018.
This notice is retaining the table designations used for acute
inpatient facility charges by MS-DRGs, which is posted on the VHA
Office of Community Care's website 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 Office of Community Care's website. Accordingly, the tables
identified as being updated by this notice correspond to the applicable
tables referenced in 82 FR 44701, September 25, 2017.
The list of data sources presented in Supplementary Table 1 (v3.24)
reflects the updated data sources used to establish the updated charges
described in this notice, and will be posted on the VHA Office of
Community Care's website under the ``Reasonable Charges Data Sources''
section.
The list of VA medical facility locations is also updated. In
Supplementary Table 3, posted on the VHA Office of Community Care's
website under the VA Medical Facility Locations section, VA 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 Office of Community Care's website, under the
``Payer Rates and Charges'' information section.
Signing Authority
The Secretary of Veterans Affairs 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.
Wilkie, Secretary, Department of Veterans Affairs, approved this
document on September 13, 2018 for publication.
Dated: September 14, 2018.
Luvenia Potts,
Program Specialist, Office of Regulation Policy & Management, Office of
the Secretary, Department of Veterans Affairs.
[FR Doc. 2018-20331 Filed 9-18-18; 8:45 am]
BILLING CODE 8320-01-P