[Federal Register Volume 83, Number 234 (Thursday, December 6, 2018)]
[Notices]
[Pages 62959-62960]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-26459]
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DEPARTMENT OF VETERANS AFFAIRS
Reasonable Charges for Medical Care or Services; v3.25, 2019
Calendar Year Update and National Average Administrative Prescription
Drug Charge Update
AGENCY: Department of Veterans Affairs.
ACTION: Notice.
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SUMMARY: This Department of Veterans Affairs (VA) notice updates the
data for calculating the ``Reasonable Charges'' collected or recovered
by VA for medical care or services. This notice also updates the
``National Average Administrative Prescription Costs'' for purposes of
calculating VA's charges for prescription drugs that were not
administered during treatment, but provided or furnished by VA to a
veteran.
FOR FURTHER INFORMATION CONTACT: Romona Greene, Office of Community
Care, Revenue Operations, Payer Relations and Services, Rates and
Charges (10D1C1), Veterans Health Administration (VHA), Department of
Veterans Affairs, 810 Vermont Avenue NW, Washington, DC 20420, (202)
382-2521. (This is not a toll free number).
SUPPLEMENTARY INFORMATION: Section 17.101(a)(1) of 38 Code of Federal
Regulations (CFR) sets forth the ``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 for 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.'' Section 17.101 provides the
methodologies for establishing billed amounts for several types of
charges; however, this notice will only address 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
[[Page 62960]]
Healthcare Common Procedure Coding System (HCPCS) Level II codes.
Section 17.101(a)(2) provides that the actual charge amounts at
individual VA medical facilities based on these methodologies and the
data sources used for calculating those actual charge amounts will
either be published as a notice in the Federal Register or will be
posted on the internet site of the Veterans Health Administration
Office of Community Care's website at https://www.va.gov/communitycare/revenue_ops/payer_rates.asp.
Certain charges are hereby updated as stated in this notice and
will be effective on January 1, 2019.
In cases where VA has not established charges for medical care or
services provided or furnished at VA expense (by either VA or non-VA
providers) under other provisions or regulations, the method for
determining VA's charges is set forth at 38 CFR 17.101(a)(8).
Based on the methodologies set forth in Sec. 17.101, this notice
provides an update to charges for 2019 HCPCS Level II and Current
Procedural Terminology (CPT) codes. Charges are also being updated
based on more recent versions of data sources 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. As of
the date of this notice, the actual charge amounts at individual VA
medical facilities based on the methodologies in Sec. 17.101 will be
posted on the VHA Office of Community Care's website at https://www.va.gov/communitycare/revenue_ops/payer_rates.asp under the heading
``Reasonable Charges Data Tables'' and identified as ``v3.25 Data
Tables (Outpatient and Professional).''
The list of data sources used for calculating the actual charge
amounts listed above also will be posted on the VHA Office of Community
Care's website under the heading ``Reasonable Charges Data Sources''
and identified as ``Reasonable Charges v3.25 Data Sources (Outpatient
and Professional) (PDF).''
Acute inpatient facility charges and skilled nursing facility/sub-
acute inpatient facility charges remain the same as set forth in the
notice published in the Federal Register on September 19, 2018 (83 FR
47412).
We are also updating the list of VA medical facility locations. The
list of VA medical facility locations, including the first three digits
of their zip codes as well as provider-based/non-provider-based
designations, will be posted on the VHA Office of Community Care's
website under the heading ``VA Medical Facility Locations'' and
identified as ``v3.25 (Jan19).''
As indicated in 38 CFR 17.101(m), when VA provides or furnishes
prescription drugs not administered during treatment, ``charges billed
separately for such prescription drugs will consist of the amount that
equals the total of the actual cost to VA for the drugs and the
national average of VA administrative costs associated with dispensing
the drugs for each prescription.'' Section 17.101(m) includes the
methodology for calculating the national average administrative cost
for prescription drug charges not administered during treatment.
VA determines the amount of the national average administrative
cost annually for the prior fiscal year (October through September) and
then applies the charge at the start of the next calendar year. The
national average administrative drug cost for calendar year 2019 is
$17.66. This change will be posted on the VHA Office of Community
Care's website at https://www.va.gov/COMMUNITYCARE/revenue_ops/admin_costs.asp under the heading ``CY 2019 Average Administrative Cost
for Prescriptions.''
Consistent with Sec. 17.101, the national average administrative
cost, the updated data, and supplementary tables containing the changes
described in this notice will be posted online, as indicated in this
notice. This notice will be posted on the VHA Office of Community
Care's website at https://www.va.gov/communitycare/revenue_ops/payer_rates.asp under the heading ``Reasonable Charges Rules, Notices,
& Federal Register'' and identified as ``v3.25 Federal Register Notice
01/01/19 (Outpatient and Professional), and National Administrative
Cost (PDF).'' The national average administrative cost, updated data,
and supplementary tables containing the changes described will be
effective until changed by a subsequent Federal Register notice.
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 November 29, 2018, for publication.
Dated: November 29, 2018.
Jeffrey M. Martin,
Assistant Director, Office of Regulation Policy & Management, Office of
the Secretary, Department of Veterans Affairs.
[FR Doc. 2018-26459 Filed 12-4-18; 8:45 am]
BILLING CODE 8320-01-P