[Federal Register Volume 65, Number 216 (Tuesday, November 7, 2000)]
[Rules and Regulations]
[Pages 66636-66637]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-28472]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 17

RIN 2900-AK57


VA Payment for Non-VA Public or Private Hospital Care and Non-VA 
Physician Services That Are Associated With Either Outpatient or 
Inpatient Care

AGENCY: Department of Veterans Affairs.

ACTION: Final rule.

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SUMMARY: This document amends our medical regulations concerning VA 
payment for non-VA public or private hospital care provided to eligible 
VA beneficiaries. This document also amends our medical regulations 
concerning VA payment for non-VA physician services that are associated 
with either outpatient or inpatient care provided to eligible VA 
beneficiaries at non-VA facilities. With certain exceptions, these 
payments have been based on Medicare methodology. Sometimes VA can 
negotiate contracts with hospitals or physicians or with their agents 
to reduce the payment amounts. This document amends these

[[Page 66637]]

regulations to allow VA to make lower payments based on such 
negotiations.

DATES: Effective Date: November 7, 2000.

FOR FURTHER INFORMATION CONTACT: Tony Guagliardo, Health Administration 
Service, (10C3), Veterans Health Administration, Department of Veterans 
Affairs, 810 Vermont Avenue, NW., Washington, DC 20420, (202) 273-8307. 
(This is not a toll-free number.)

SUPPLEMENTARY INFORMATION:

Administrative Procedure Act

    This document allows VA to pay hospitals and physicians the amount 
that they on their own or through agents have negotiated to receive 
from VA. Accordingly, this document reflects contract actions that are 
exempt from the prior notice-and-comment and delayed effective date 
provisions of 5 U.S.C. 553.

Unfunded Mandates

    The Unfunded Mandates Reform Act requires (in section 202) that 
agencies prepare an assessment of anticipated costs and benefits before 
developing any rule that may result in an expenditure by State, local, 
or tribal governments, in the aggregate, or by the private sector of 
$100 million or more in any given year. This rule would have no 
consequential effect on State, local, or tribal governments.

Regulatory Flexibility Act

    The Secretary hereby certifies that this rule will not have a 
significant economic impact on a substantial number of small entities 
as they are defined in the Regulatory Flexibility Act, 5 U.S.C. 601-
612. This rule would affect only a small portion of the business of the 
affected entities. Accordingly, pursuant to 5 U.S.C. 605(b), this rule 
is exempt from the initial and final regulatory flexibility analysis 
requirements of Secs. 603 and 604.

Catalog of Federal Domestic Assistance Numbers

    The Catalog of Federal domestic assistance numbers for the 
programs affected by this rule are 64.005, 64.007, 64.008, 64.009, 
64.010, 64.011, 64.012, 64.013, 64.014, 64.015, 64.016, 64.018, 
64.019, 64.022, and 64.025.

List of Subjects in 38 CFR Part 17

    Administrative practice and procedure, Alcohol abuse, Alcoholism, 
Claims, Day care, Dental health, Drug abuse, Foreign relations, 
Government contracts, Grant programs health, Grant programs-veterans, 
Health care, Health facilities, Health professions, Health records, 
Homeless, Medical and dental schools, Medical devices, Medical 
research, Mental health programs, Nursing homes, Philippines, Reporting 
and record-keeping requirements, Scholarships and fellowships, Travel 
and transportation expenses, Veterans.

    Approved: October 31, 2000.
Hershel W. Gober,
Acting Secretary of Veterans Affairs.

    For the reasons set out in the preamble, 38 CFR part 17 is amended 
as set forth below:

PART 17--MEDICAL

    1. The authority citation for part 17 continues to read as follows:

    Authority: 38 U.S.C. 501, 1721, unless otherwise noted.


    2. In Sec. 17.55, a new paragraph (k) is added; and the authority 
citation at the end of the section is revised, to read as follows:


Sec. 17.55  Payment for authorized public or private hospital care.

* * * * *
    (k) Notwithstanding other provisions of this section, VA, for 
public or private hospital care covered by this section, will pay the 
lesser of the amount determined under paragraphs (a) through (j) of 
this section or the amount negotiated with the hospital or its agent.

(Authority: 38 USC 513, 1703, 1728; Sec. 233 of P. L. 99-576)


    3. Remove the undesignated center heading immediately before 
Sec. 17.56.

    4. In Sec. 17.56, a new paragraph (e) is added to read as follows:


Sec. 17.56  Payment for non-VA physician services associated with 
outpatient and inpatient care provided at non-VA facilities.

* * * * *
    (e) Notwithstanding other provisions of this section, VA, for 
physician services covered by this section, will pay the lesser of the 
amount determined under paragraphs (a) through (d) of this section or 
the amount negotiated with the physician or the physician's agent.

    (Authority: 38 U.S.C. 513, 38 U.S.C. 1703, 38 U.S.C. 1728)


    5. Add an undesignated center heading immediately before Sec. 17.57 
to read as follows:
    Use of Community Nursing Home Care Facilities.

[FR Doc. 00-28472 Filed 11-06-00; 8:45 am]
BILLING CODE 8320-01-P