[Federal Register Volume 69, Number 240 (Wednesday, December 15, 2004)]
[Notices]
[Pages 75111-75141]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-27385]


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DEPARTMENT OF VETERANS AFFAIRS


Reasonable Charges for Inpatient DRG and SNF Medical Services; 
2005 Calendar Year Update

AGENCY: Department of Veterans Affairs.

ACTION: Notice.

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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:
    <bullet> 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;
    <bullet> 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
    <bullet> 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

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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.''

    Approved: November 30, 2004.
Anthony J. Principi,
Secretary of Veterans Affairs.
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[FR Doc. 04-27385 Filed 12-14-04; 8:45 am]
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