[Federal Register Volume 83, Number 167 (Tuesday, August 28, 2018)]
[Notices]
[Pages 43958-43959]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-18555]


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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

AGENCY: 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 August 28, 2018 and 
until further notice.

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, (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 CFR 17.102(h). Two sets of rates are obtained by 
applying this methodology, Cost-Based and Inter-Agency.
    In accordance with 38 CFR 17.102(a), (b), (d), and (g) 
respectively, Cost-Based rates apply to medical care and services that 
are provided by VA:
    <bullet> In error or based on tentative eligibility,
    <bullet> In a medical emergency,
    <bullet> To pensioners of allied nations; and
    <bullet> For research purposes in circumstances under which the 
medical care appropriation shall be reimbursed from the research 
appropriation.
    In accordance with 38 CFR 17.102(c) and (f), Inter-Agency rates 
apply to medical care and services that are provided by VA to 
beneficiaries of the Department of Defense or other Federal agencies, 
when the care or services provided is not covered by an applicable 
sharing agreement, unless otherwise stated.
    The calculations for the Cost-Based and Inter-Agency rates are the 
same with two exceptions. Inter-Agency rates are all-inclusive, are not 
broken down into three components (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 upon publication of this notice and will remain in 
effect until the next Federal Register notice is published. These rates 
supersede those established by the Federal Register notice published on 
August, 29 2017, at 82 FR 41093.

------------------------------------------------------------------------
                                                          Inter-Agency
                                      Cost-Based rates        rates
------------------------------------------------------------------------
A. Hospital Care per inpatient day:
    General Medicine:
        All Inclusive Rate..........            $4,025            $3,882
        Physician...................               482
        Ancillary...................             1,049
        Nursing Room and Board......             2,494
    Neurology:
        All Inclusive Rate..........             3,805             3,664
        Physician...................               557
        Ancillary...................             1,005
        Nursing Room and Board......             2,243
    Rehabilitation Medicine:
        All Inclusive Rate..........             2,749             2,641
        Physician...................               312
        Ancillary...................               840
        Nursing Room and Board......             1,597

[[Page 43959]]

 
    Blind Rehabilitation:
        All Inclusive Rate..........             1,843             1,770
        Physician...................               148
        Ancillary...................               916
        Nursing Room and Board......               779
    Spinal Cord Injury:
        All Inclusive Rate..........             2,431             2,338
        Physician...................               301
        Ancillary...................               612
        Nursing Room and Board......             1,518
    Surgery:
        All Inclusive Rate..........             6,832             6,590
        Physician...................               753
        Ancillary...................             2,072
        Nursing Room and Board......             4,007
    General Psychiatry:
        All Inclusive Rate..........             1,993             1,913
        Physician...................               188
        Ancillary...................               314
        Nursing Room and Board......             1,491
    Substance Abuse (Alcohol and
     Drug Treatment):
        All Inclusive Rate..........             1,963             1,884
        Physician...................               187
        Ancillary...................               454
        Nursing Room and Board......             1,322
    Psychosocial Residential
     Rehabilitation Program:
        All Inclusive Rate..........               768               740
        Physician...................                48
        Ancillary...................                81
        Nursing Room and Board......               639
    Intermediate Medicine:
        All Inclusive Rate..........             2,483             2,388
        Physician...................               122
        Ancillary...................               364
        Nursing Room and Board......             1,997
    Poly-trauma Inpatient:
        All Inclusive Rate..........             3,113             2,981
        Physician...................               354
        Ancillary...................               951
        Nursing Room and Board......             1,808
B. Nursing Home Care, Per Day:
    All Inclusive Rate..............             1,268             1,218
    Physician.......................                39
    Ancillary.......................               172
    Nursing Room and Board..........              1057
C. Outpatient Medical Treatments:
    Outpatient Visit (to include                   362               350
     Ineligible Emergency Dental
     Care)..........................
    Outpatient Physical Medicine &                 223               213
     Rehabilitation Service Visit...
    Outpatient Poly-trauma/Traumatic               602               580
     Brain Injury...................
------------------------------------------------------------------------
Note: Outpatient Prescriptions will be billed at Drug Cost plus
  Administrative Fee.

Signing Authority

    The Secretary of Veterans Affairs 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 August 22, 2018, for publication.

    Dated: August 22, 2018.
Jeffrey M. Martin,
Impact Analyst, Office of Regulation Policy & Management, Office of the 
Secretary, Department of Veterans Affairs.
[FR Doc. 2018-18555 Filed 8-27-18; 8:45 am]
 BILLING CODE 8320-01-P