29882 Federal Register / Vol. 86, No. 105 / Thursday, June 3, 2021 / Notices 

information collection by selecting 

‘‘Currently under 30-day Review—Open 

for Public Comments’’ or by using the 

search function. 

FOR FURTHER INFORMATION CONTACT: 

Copies of the submissions may be 

obtained from Spencer W. Clark by 

emailing PRA@treasury.gov, calling 

(202) 927–5331, or viewing the entire 

information collection request at 

www.reginfo.gov. 

SUPPLEMENTARY INFORMATION: 

Internal Revenue Service (IRS) 

Title: State Election of Qualified 

Health Insurance for Health Coverage 

Tax Credit (HCTC). 

OMB Control Number: 1545–1875. 

Type of Review: Extension without 

change of a currently approved 

collection. 

Description: Revenue Procedure 

2004–12 informs states how to elect a 

health program to be qualified health 

insurance for purposes of the health 

coverage tax credit (HCTC) under 

section 35 of the Internal Revenue Code. 

The collection of information is 

voluntary. However, if a state does not 

make an election, eligible residents of 

the state may be impeded in their efforts 

to claim the HCTC. 

Form: None. 

Affected Public: State governments. 

Estimated Number of Respondents: 

51. 

Frequency of Response: Once. 

Estimated Total Number of Annual 

Responses: 51. 

Estimated Time per Response: 30 

minutes. 

Estimated Total Annual Burden 

Hours: 26. 

(Authority: 44 U.S.C. 3501 et seq.) 

Dated: May 28, 2021. 

Spencer W. Clark, 

Treasury PRA Clearance Officer. 

[FR Doc. 2021–11696 Filed 6–2–21; 8:45 am] 

BILLING CODE 4830–01–P 

DEPARTMENT OF VETERANS 

AFFAIRS 

VA’s Indian Health Service/Tribal 

Health Program Reimbursement 

Agreements Program—Pharmacy 

Reimbursement Rate for the Lower 48 

States 

AGENCY: Department of Veterans Affairs. 

ACTION: Notice of Tribal Consultation 

Session. 

SUMMARY: VA, Veterans Health 

Administration (VHA) will facilitate a 

tribal consultation regarding VA’s 

Indian Health Service/Tribal Health 

Program (IHS/THP) Reimbursement 

Agreements Program. VA is seeking 

input on adopting a pharmacy 

reimbursement rate for the lower 48 

states. 

DATES: Comments must be received by 

VA on or before July 5, 2021. 

ADDRESSES: Comments may be 

submitted to tribalgovernment

consultation@va.gov or by mail at 

Department of Veterans Affairs, Suite 

915L, 810 Vermont Avenue NW, 

Washington, DC 20420. 

FOR FURTHER INFORMATION CONTACT: Kara 

Hawthorne, IHS/THP Program Manager, 

VA Office of Community Care, at 

Tribal.Agreements@va.gov, or by 

telephone at 303–780–4826. (This is not 

a toll-free number.) 

SUPPLEMENTARY INFORMATION: Utilizing 

the authorities found in 25 U.S.C. 

1645(c), Sharing Arrangements with 

Federal Agencies, and 38 U.S.C. 8153, 

Sharing of Health-Care Resources, VA, 

IHS and Tribal health care providers 

have created the IHS/THP 

Reimbursement Agreements Program. 

This program provides a means for IHS 

and THP health facilities to receive 

reimbursement from VA for direct care 

services, including pharmaceutics, 

provided to eligible American Indian/ 

Alaska Native (AI/AN) Veterans. 

Currently, reimbursement agreements 

under this program state that VA will 

reimburse ‘‘actual costs’’ for 

pharmaceuticals. In implementing this 

requirement, VA has realized that this 

term, ‘‘actual costs,’’ may be ambiguous 

and has led to difficulties in 

administering the agreements in 

compliance with applicable laws. VA is 

considering replacing the term ‘‘actual 

cost’’ with a more recognizable and 

easily calculated rate. Selecting an 

industry standard pharmaceutical rate 

structure would benefit IHS/THP sites 

by making it easier to understand and 

predict the reimbursement rate by 

eliminating the need to calculate actual 

cost. 

VA is proposing two distinct 

pharmacy payment rates for IHS and 

THP facilities. For IHS facilities, VA has 

collaborated with IHS to use the Federal 

Supply Schedule (FSS) or other 

established contract vehicles (i.e., joint 

national drug contracts) pharmaceutical 

pricing as the proposed reimbursement 

rate, as most of their pharmaceuticals 

are purchased using the FSS contract or 

other contract vehicles. The FSS 

contract and other contract vehicles are 

collectively referred to as the FSS rate. 

For those pharmaceuticals not available 

on FSS, or non-contracted drugs, claims 

will be paid based on the adopted rate 

that is agreed upon with THPs. 

For THP facilities, VA is suggesting 

using one of two industry-standard 

pharmacy reimbursement 

methodologies. These proposed 

methodologies are: (1) Wholesale 

Acquisition Cost (WAC) plus dispensing 

fee and (2) Average Wholesale Price 

(AWP), minus discount, plus dispensing 

fee. 

This written tribal consultation is 

seeking input on the preferred 

pharmacy reimbursement rate from the 

options above. VA suggests the 

following questions for response: 

(1) For the rates for THP facilities, 

what is your preferred methodology, 

WAC plus dispensing fee, or (2) AWP, 

minus discount, plus dispensing fee. 

(2) For the rates for THP facilities, if 

you identify AWP as the preferred 

method, what would you propose as the 

AWP discount percent rate for generic 

drugs and name brand/specialty drugs? 

How did you calculate or determine the 

proposed discount percent rate? 

(3) For THP dispensing fee, VA 

proposes to adopt an amount in line 

with industry standard, which is 

generally less than $1.00 per drug, to be 

applied to either selected rates (WAC or 

AWP). Do you agree with $1.00 per drug 

for a dispensing fee? If not, what do you 

propose the dispensing fee should be? 

How did you calculate or determine the 

proposed dispensing fee? 

(4) Do you have any comments on 

pharmacy reimbursement rates for IHS 

facilities and/or the related claims 

submission and reimbursement process? 

Signing Authority 

Denis McDonough, Secretary of 

Veterans Affairs, approved this 

document on May 26, 2021, 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. 

Luvenia Potts, 

Regulation Development Coordinator, Office 

of Regulation Policy & Management, Office 

of General Counsel, Department of Veterans 

Affairs. 

[FR Doc. 2021–11624 Filed 6–2–21; 8:45 am] 

BILLING CODE 8320–01–P 


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