Document Headings

                    Document headings vary by document type but may contain                    the following:                  
                -                       the agency or agencies that issued and signed a document                    
                -                       the number of the CFR title and the number of each part                      the document amends, proposes to amend, or is directly                      related to                    
                -                       the agency docket number / agency internal file number                    
                -                       the RIN which identifies each regulatory action listed in                      the Unified Agenda of Federal Regulatory and Deregulatory                      Actions                    

                    See the                                          Document Drafting Handbook                                        for more details.                  

###### Department of Veterans Affairs

# AGENCY:

Department of Veterans Affairs. 

# ACTION:

Notice. 

# SUMMARY:

Section 17.101 of Title 38 of the Code of Federal Regulations 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 regulations include methodologies for establishing billed amounts for the following types of charges: Acute inpatient facility charges; skilled nursing facility/sub-acute inpatient facility charges; partial hospitalization facility charges; outpatient facility charges; physician and other professional charges, including professional charges for anesthesia services and dental services; pathology and laboratory charges; observation care facility charges; ambulance and other emergency transportation charges; and charges for durable medical equipment, drugs, injectables, and other medical services, items, and supplies identified by Healthcare Common Procedure Coding System (HCPCS) Level II codes. The regulations also provide that data for calculating actual charge amounts at individual VA facilities based on these methodologies will either be published in a notice in the                         **Federal Register**                         or will be posted on the Internet site of the Veterans Health Administration Chief Business Office, currently at                         *http://www.va.gov/​cbo,*                         under “Charge Data.” Certain of these charges are hereby updated as described in the                         **SUPPLEMENTARY INFORMATION**                         section of this notice. These changes are effective on January 1, 2005.                     

                        When charges for medical care or services provided or furnished at VA                               ( print page 75112)                            expense by either VA or non-VA providers have not been established under other provisions of the regulations, the method for determining VA's charges is set forth at 38 CFR 17.101(a)(8).                     

# FOR FURTHER INFORMATION CONTACT:

Romona Greene, Chief Business Office (168), Veterans Health Administration, Department of Veterans Affairs, 810 Vermont Avenue, NW., Washington, DC 20420, (202) 254-0361. (This is not a toll free number.) 

# SUPPLEMENTARY INFORMATION:

                    Of the charge types listed in the Summary section of this notice, only the acute inpatient facility charges and skilled nursing facility/sub-acute inpatient facility charges are being changed. Charges for the following charge types: Partial hospitalization facility charges; outpatient facility charges; physician and other professional charges, including professional charges for anesthesia services and dental services; pathology and laboratory charges; observation care facility charges; ambulance and other emergency transportation charges; and charges for durable medical equipment, drugs, injectables, and other medical services, items, and supplies identified by HCPCS Level II codes are not being changed. These Outpatient facility charges and Professional charges remain the same as set forth in a notice published in the                     **Federal Register**                     on April 15, 2004 (69 FR 20118).                 

                    Based on the methodologies set forth in 38 CFR 17.101, this document provides an update to acute inpatient charges based on 2005 DRGs. Acute inpatient facility charges by diagnosis related group (DRG) are set forth in Table A in the December 19, 2003,                     **Federal Register**                     notice. Table A in the December 19 notice document is being replaced by Table A in this notice, which provides updated charges based on 2005 DRGs.                 

                    Also, this document provides for an updated skilled nursing facility/sub-acute inpatient facility all-inclusive                     *per diem*                     charge that, using the methodologies set forth in 38 CFR 17.101, is adjusted by a geographic area factor based on the location where the care is provided. The skilled nursing facility/sub-acute inpatient facility                     *per diem*                     charge is set forth in Table B in the October 2, 2003,                     **Federal Register**                     notice. Table B in the October 2 notice document is being replaced by Table B in this notice, which provides the updated all-inclusive nationwide skilled nursing facility/sub-acute inpatient facility                     *per diem*                     charge.                 

The charges in this update for acute inpatient facility and skilled nursing facility/sub-acute inpatient facility services are effective on January 1, 2005. 

                    In this update, we are retaining the table designations used for acute inpatient facility charges by DRGs in the notice published in the                     **Federal Register**                     on December 19, 2003 (68 FR 70867). We also are retaining the table designation used for skilled nursing facility/sub-acute inpatient facility charges in the notice published in the                     **Federal Register**                     on October 2, 2003 (68 FR 56892). Accordingly, the tables identified as being updated by this notice correspond to the applicable tables published in the December 19 and October 2 notices, beginning with Table A through Table B.                 

We have updated the list of data sources presented in Supplementary Table 1 to reflect the updated data sources used to establish the updated charges described in this notice. 

                    We have also updated the list of VA medical facility locations. As a reminder, in Supplementary Table 3 published in the                     **Federal Register**                     dated April 15, 2004, we set forth the list of VA medical facility locations, which includes their three-digit ZIP Codes and provider-based/non-provider-based designations. In accordance with the final rule, subsequent updates to Supplementary Table 3 will be posted on the Internet site of the Veterans Health Administration Chief Business Office.                 

                    Consistent with the regulations, the updated data tables and supplementary tables containing the changes described in this notice are published with this notice and will be posted on the Internet site of the Veterans Health Administration Chief Business Office, currently at                     *http://www.va.gov/​cbo,*                     under “Charge Data.”                 

Anthony J. Principi, 

Secretary of Veterans Affairs. 

      ( print page 75113)          ( print page 75114)          ( print page 75115)          ( print page 75116)          ( print page 75117)          ( print page 75118)          ( print page 75119)          ( print page 75120)          ( print page 75121)          ( print page 75122)          ( print page 75123)          ( print page 75124)          ( print page 75125)          ( print page 75126)          ( print page 75127)          ( print page 75128)          ( print page 75129)          ( print page 75130)          ( print page 75131)          ( print page 75132)          ( print page 75133)          ( print page 75134)          ( print page 75135)          ( print page 75136)          ( print page 75137)          ( print page 75138)          ( print page 75139)          ( print page 75140)          ( print page 75141)    

BILLING CODE 8320-01-P

[FR Doc. 04-27385 Filed 12-14-04; 8:45 am]

BILLING CODE 8320-01-C