[Federal Register Volume 85, Number 184 (Tuesday, September 22, 2020)]
[Notices]
[Pages 59606-59607]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2020-20894]


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DEPARTMENT OF VETERANS AFFAIRS


Reasonable Charges for Inpatient Medical Severity-Diagnosis 
Related Groups (MS-DRG) and Skilled Nursing Facility (SNF) Medical 
Services; v4.21 Fiscal Year (FY) 2021 Update

AGENCY: Department of Veterans Affairs (VA).

ACTION: Notice.

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SUMMARY: This document updates the acute inpatient and SNF/sub-acute 
inpatient facility charges. The updated charges are based on MS-DRGs 
for fiscal year (FY) 2021.

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; email: 
[email protected]; telephone: 202-382-2521 (This is not a toll-free 
number.)

SUPPLEMENTARY INFORMATION: Section 17.101(a)(1) of title 38 CFR sets 
forth the 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 FY 2020 MS-DRGs. Acute inpatient facility charges by MS-DRGs are 
posted on the Veterans Health Administration (VHA) Office of Community 
Care's website, at the following link: www.va.gov/communitycare/revenue_ops/payer_rates.asp, under the ``Reasonable Charges Data 
Tables'' section, Inpatient Data Table, as Table A (v3.26). This Table 
A corresponds to the Table A referenced in a notice published in the 
Federal Register on September 30, 2019 (see 84 FR 51727). Table A 
(v4.21) referenced in this notice provides updated charges based on the 
FY 2021 MS-DRGs and will replace Table A (v3.26) 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). 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, title ``Acute Inpatient,'' and Table O, 
title ``SNF,'' on the VHA Office of Community Care's website under the 
v3.27 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 (v3.26). This Table B corresponds to the Table B referenced in 
a notice published in the Federal Register on September 30, 2019 (see 
84 FR 51727). Table B referenced in this notice is v4.21, which 
provides an update to the all-inclusive nationwide SNF/sub-acute 
inpatient facility per diem charge and will replace Table B

[[Page 59607]]

(v3.26) 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, 2020.
    This notice is retaining the table designations used for acute 
inpatient facility charges by MS-DRGs, which are 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 are 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 a notice published in the Federal Register on 
September 30, 2019 (see 84 FR 51727).
    The list of data sources presented in Supplementary Table 1 (v4.21) 
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, 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 September 16, 2020 for publication.

Luvenia Potts,
Regulation Development Coordinator, Office of Regulation Policy & 
Management, Office of the Secretary, Department of Veterans Affairs.
[FR Doc. 2020-20894 Filed 9-21-20; 8:45 am]
BILLING CODE 8320-01-P