[Federal Register Volume 82, Number 166 (Tuesday, August 29, 2017)]
[Notices]
[Pages 41093-41094]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-18219]


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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) that apply in certain circumstances.

DATES: The rates set forth herein are effective August 29, 2017 and 
until further notice.

FOR FURTHER INFORMATION CONTACT: Romona Greene, Office of Community 
Care (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 billing 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 rates and Inter-Agency rates. 
Cost-Based rates apply in accordance with 38 CFR 17.102 to medical care 
and services that are provided by VA:
    (a) In error or based on tentative eligibility;
    (b) In a medical emergency;
    (c) To pensioners of allied nations; and
    (d) For research purposes in circumstances under which the medical 
care appropriation shall be reimbursed from the research appropriation.
    Inter-Agency rates apply to medical care and services that are 
provided by VA to beneficiaries of the Department of Defense (DoD) 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, and are not 
broken down into three components (Physician; Ancillary; and Nursing, 
Room and Board), and Inter-Agency rates 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 
July 7, 2016, at 81 FR 44409.

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                                            Cost-based     Inter-agency
                                               rates           rates
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A. Hospital Care per inpatient day:
General Medicine:
    All Inclusive Rate..................          $3,805          $3,645
    Physician...........................             455  ..............
    Ancillary...........................             992  ..............
    Nursing Room and Board..............           2,358  ..............
Neurology:
    All Inclusive Rate..................           3,806           3,644

[[Page 41094]]

 
    Physician...........................             557  ..............
    Ancillary...........................            1005  ..............
    Nursing Room and Board..............           2,244  ..............
Rehabilitation Medicine:
    All Inclusive Rate..................           2,489           2,372
    Physician...........................             283  ..............
    Ancillary...........................             760  ..............
    Nursing Room and Board..............           1,446  ..............
Blind Rehabilitation:
    All Inclusive Rate..................           1,726           1,646
    Physician...........................             139  ..............
    Ancillary...........................             857  ..............
    Nursing Room and Board..............             730  ..............
Spinal Cord Injury:
    All Inclusive Rate..................           2,285           2,182
    Physician...........................             283  ..............
    Ancillary...........................             575  ..............
    Nursing Room and Board..............           1,427  ..............
Surgery:
    All Inclusive Rate..................           6,388           6,119
    Physician...........................             704  ..............
    Ancillary...........................           1,937  ..............
    Nursing Room and Board..............           3,747  ..............
General Psychiatry:
    All Inclusive Rate..................           1,849           1,761
    Physician...........................             175  ..............
    Ancillary...........................             291  ..............
    Nursing Room and Board..............           1,383  ..............
Substance Abuse (Alcohol and Drug
 Treatment):
    All Inclusive Rate..................           1,814           1,727
    Physician...........................             173  ..............
    Ancillary...........................             420  ..............
    Nursing Room and Board..............           1,221  ..............
Psychosocial Residential Rehabilitation
 Program:
    All Inclusive Rate..................             705             671
    Physician...........................              44  ..............
    Ancillary...........................              74  ..............
    Nursing Room and Board..............             587  ..............
Intermediate Medicine:
    All Inclusive Rate..................           2,123           2,025
    Physician...........................             104  ..............
    Ancillary...........................             311  ..............
    Nursing Room and Board..............           1,708  ..............
Poly-trauma Inpatient:
    All Inclusive Rate..................           3,070           2,927
    Physician...........................             349  ..............
    Ancillary...........................             938  ..............
    Nursing Room and Board..............           1,783  ..............
B. Nursing Home Care, Per Day:
    All Inclusive Rate..................           1,209           1,154
    Physician...........................              38  ..............
    Ancillary...........................             164  ..............
    Nursing Room and Board..............            1007  ..............
C. Outpatient Medical Treatments:
    Outpatient Visit (to include                     347             333
     Ineligible Emergency Dental Care)..
    Outpatient Physical Medicine &                   212             201
     Rehabilitation Service Visit.......
    Outpatient Poly-trauma/Traumatic                 546             522
     Brain Injury.......................
------------------------------------------------------------------------
Note: Outpatient Prescriptions will be billed at Drug Cost plus
  Administrative Fee.

Signing Authority

    The Secretary of Veterans Affairs, or designee, 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. Gina S. 
Farrisee, Deputy Chief of Staff, Department of Veterans Affairs, 
approved this document on August 21, 2017, for publication.

    Dated: August 22, 2017.
Jeffrey Martin,
Office Program Manager, Office of Regulation Policy & Management, 
Office of the Secretary, Department of Veterans Affairs.
[FR Doc. 2017-18219 Filed 8-28-17; 8:45 am]
 BILLING CODE 8320-01-P