[Federal Register Volume 84, Number 189 (Monday, September 30, 2019)]
[Notices]
[Pages 51728-51729]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-21330]
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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 for FY 2020
ADDRESSES: The 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 Department of
Veterans Affairs (VA) furnished in certain circumstances.
DATES: The rates set forth herein are effective October 1, 2019.
FOR FURTHER INFORMATION CONTACT: Romona Greene, Office of Community
Care, Revenue Operations, Payer Relations and Services, Rates and
Charges (10D1C1), 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: VA's methodology for computing Cost-Based
and Inter-Agency rates for medical care or services provided by VA is
set forth in 38 Code of Federal Regulations 17.102(h). Two sets of
rates are obtained by applying this methodology, Cost-Based and Inter-
Agency.
Cost-Based rates apply to medical care and services that are
provided by VA under Sec. 17.102(a), (b), (d) and (g), respectively,
in the following circumstances:
In error or based on tentative eligibility,
In a medical emergency,
To pensioners of allied nations, and
For research purposes in circumstances under which the
medical care appropriation shall be reimbursed from the research
appropriation.
Inter-Agency rates apply to medical care and services that are
provided by VA under Sec. 17.102(c) and (f), respectively, in the
following circumstances when the care or services provided are not
covered by any applicable sharing agreement in accordance with Sec.
17.102(e):
To beneficiaries of the Department of Defense or other
Federal agencies; and
To military retirees with chronic disability.
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 (i.e., Physician; Ancillary; and
Nursing, Room and Board), and 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 October 1, 2019 and will remain in effect until the
next fiscal year Federal Register update. These rates supersede those
established by the Federal Register notice published on August 28,
2018, at 83 FR 43958.
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Cost-based Inter-agency
rates rates
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A. Hospital Care per inpatient day:
General Medicine:
All Inclusive Rate.............. $4,301 $4,156
Physician....................... 515 ..............
Ancillary....................... 1,121 ..............
Nursing Room and Board.......... 2,665 ..............
Neurology:
All Inclusive Rate.............. 4,232 4,086
Physician....................... 620 ..............
Ancillary....................... 1,117 ..............
Nursing Room and Board.......... 2,495 ..............
Rehabilitation Medicine:
All Inclusive Rate.............. 2,910 2,803
Physician....................... 331 ..............
Ancillary....................... 889 ..............
Nursing Room and Board.......... 1,690 ..............
Blind Rehabilitation:
All Inclusive Rate.............. 1,995 1,920
Physician....................... 161 ..............
Ancillary....................... 991 ..............
Nursing Room and Board.......... 843 ..............
Spinal Cord Injury:
All Inclusive Rate.............. 2,636 2,540
Physician....................... 327 ..............
Ancillary....................... 663 ..............
Nursing Room and Board.......... 1,646 ..............
Surgery:
All Inclusive Rate.............. 7,526 7,272
Physician....................... 829 ..............
Ancillary....................... 2,283 ..............
Nursing Room and Board.......... 4,414 ..............
General Psychiatry:
All Inclusive Rate.............. 2,174 2,091
Physician....................... 205 ..............
[[Page 51729]]
Ancillary....................... 342 ..............
Nursing Room and Board.......... 1,627 ..............
Substance Abuse (Alcohol and Drug
Treatment):
All Inclusive Rate.............. 2,232 2,147
Physician....................... 213 ..............
Ancillary....................... 516 ..............
Nursing Room and Board.......... 1,503 ..............
Psychosocial Residential
Rehabilitation Program:
All Inclusive Rate.............. 826 797
Physician....................... 52 ..............
Ancillary....................... 87 ..............
Nursing Room and Board.......... 687 ..............
Intermediate Medicine:
All Inclusive Rate.............. 3,301 3,182
Physician....................... 162 ..............
Ancillary....................... 484 ..............
Nursing Room and Board.......... 2,655 ..............
Poly-trauma Inpatient:
All Inclusive Rate.............. 3,223 3,097
Physician....................... 366 ..............
Ancillary....................... 985 ..............
Nursing Room and Board.......... 1,872 ..............
B. Nursing Home Care, Per Day:
All Inclusive Rate.................. 1,361 1,311
Physician....................... 42 ..............
Ancillary....................... 184 ..............
Nursing Room and Board.......... 1135 ..............
C. Outpatient Medical Treatments:
Outpatient Visit (to include 389 376
Ineligible Emergency Dental Care)..
Outpatient Physical Medicine & 238 228
Rehabilitation Service Visit.......
Outpatient Poly-trauma/Traumatic 671 649
Brain Injury.......................
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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. Robert L.
Wilkie, Secretary, Department of Veterans Affairs, approved this
document on September 26, 2019, for publication.
Dated: September 26, 2019.
Jeffrey M. Martin,
Assistant Director, Office of Regulation Policy & Management, Office of
the Secretary, Department of Veterans Affairs.
[FR Doc. 2019-21330 Filed 9-27-19; 8:45 am]
BILLING CODE 8320-01-P