[Federal Register Volume 85, Number 145 (Tuesday, July 28, 2020)]
[Notices]
[Pages 45471-45473]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2020-16323]


-----------------------------------------------------------------------

DEPARTMENT OF VETERANS AFFAIRS


Cost-Based and Inter-Agency Billing Rates for Medical Care or 
Services Provided by the Department of Veterans Affairs for Fiscal Year 
2021

AGENCY: U.S. Department of Veterans Affairs.

ACTION: Notice.

-----------------------------------------------------------------------

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

APPLICABLE DATE: The rates set forth herein are effective October 1, 
2020.

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; 
telephone: 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 section 17.102(h) of title 38 Code of Federal Regulations 
(CFR). 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 38 CFR 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

[[Page 45472]]

effective October 1, 2020, 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 September 30, 
2019, at 84 FR 51728.

------------------------------------------------------------------------
                                            Cost-based     Inter-agency
                                               rates           rates
------------------------------------------------------------------------
A. Hospital Care per inpatient day
    General Medicine:
        All Inclusive Rate..............          $4,626          $4,473
        Physician.......................             554  ..............
        Ancillary.......................           1,206  ..............
        Nursing Room and Board..........           2,866  ..............
    Neurology:
        All Inclusive Rate..............           4,433           4,280
        Physician.......................             649  ..............
        Ancillary.......................           1,170  ..............
        Nursing Room and Board..........           2,614  ..............
    Rehabilitation Medicine:
        All Inclusive Rate..............           3,090           2,979
        Physician.......................             351  ..............
        Ancillary.......................             944  ..............
        Nursing Room and Board..........           1,795  ..............
    Blind Rehabilitation:
        All Inclusive Rate..............           2,073           1,998
        Physician.......................             167  ..............
        Ancillary.......................           1,030  ..............
        Nursing Room and Board..........             876  ..............
    Spinal Cord Injury:
        All Inclusive Rate..............           3,032           2,924
        Physician.......................             376  ..............
        Ancillary.......................             763  ..............
        Nursing Room and Board..........           1,893  ..............
    Surgery:
        All Inclusive Rate..............           8,205           7,935
        Physician.......................             904  ..............
        Ancillary.......................           2,489  ..............
        Nursing Room and Board..........           4,812  ..............
    General Psychiatry:
        All Inclusive Rate..............           2,403           2,314
        Physician.......................             227  ..............
        Ancillary.......................             378  ..............
        Nursing Room and Board..........           1,798  ..............
    Substance Abuse (Alcohol and Drug
     Treatment):
        All Inclusive Rate..............           2,327           2,240
        Physician.......................             222  ..............
        Ancillary.......................             538  ..............
        Nursing Room and Board..........           1,567  ..............
    Psychosocial Residential
     Rehabilitation Program:
        All Inclusive Rate..............             306             297
        Physician.......................              19  ..............
        Ancillary.......................              32  ..............
        Nursing Room and Board..........             255  ..............
    Intermediate Medicine:
        All Inclusive Rate..............           3,029           2,928
        Physician.......................             149  ..............
        Ancillary.......................             444  ..............
        Nursing Room and Board..........           2,436  ..............
    Poly-trauma Inpatient:
        All Inclusive Rate..............           3,303           3,165
        Physician.......................             375  ..............
        Ancillary.......................           1,009  ..............
        Nursing Room and Board..........           1,919  ..............
B. Nursing Home Care, Per Day
    All Inclusive Rate..................           1,504           1,450
    Physician...........................              47  ..............
    Ancillary...........................             203  ..............
    Nursing Room and Board..............           1,254  ..............
C. Outpatient Medical Treatments
    Outpatient Visit (to include                     409             396
     Ineligible Emergency Dental Care)..
    Outpatient Physical Medicine &                   241             231
     Rehabilitation Service Visit.......
    Outpatient Poly-trauma/Traumatic                 643             622
     Brain Injury.......................
------------------------------------------------------------------------


[[Page 45473]]

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. Brooks D. 
Tucker, Acting Chief of Staff, Department of Veterans Affairs, approved 
this document on July 22, 2020 for publication.

Luvenia Potts,
Regulation Development Coordinator, Office of Regulation Policy & 
Management, Office of the Secretary, Department of Veterans Affairs.
[FR Doc. 2020-16323 Filed 7-27-20; 8:45 am]
BILLING CODE 8320-01-P