[Federal Register Volume 70, Number 187 (Wednesday, September 28, 2005)]
[Notices]
[Pages 56772-56803]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-19283]


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DEPARTMENT OF VETERANS AFFAIRS


Reasonable Charges for Inpatient DRG and SNF Medical Services; 
2006 Fiscal 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:

--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

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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 October 1, 2005.
    When charges for medical care or services provided or furnished at 
VA 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 11, 2005 (70 FR 18466).
    Based on the methodologies set forth in 38 CFR 17.101, this 
document provides an update to acute inpatient charges based on 2006 
DRGs. Acute inpatient facility charges by diagnosis related group (DRG) 
are set forth in Table A in the December 15, 2004 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 2006 
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 December 15, 2004 Federal 
Register notice. Table B in the December 15 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 
October 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 15, 2004 (69 FR 75111). 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 December 15, 2004 (69 FR 75111). Accordingly, the tables 
identified as being updated by this notice correspond to the applicable 
tables published in the December 15 notice, 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 11, 2005, 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: August 26, 2005.
Gordon H. Mansfield,
Deputy Secretary of Veterans Affairs.
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[FR Doc. 05-19283 Filed 9-27-05; 8:45 am]
BILLING CODE 8320-01-C