[Federal Register: September 17, 2009 (Volume 74, Number 179)]
[Notices]
[Page 47856-47858]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr17se09-92]
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DEPARTMENT OF VETERANS AFFAIRS
Reasonable Charges for Inpatient MS-DRGs and SNF Medical Services
for 2010; Fiscal Year Update
AGENCY: Department of Veterans Affairs.
ACTION: Notice.
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[[Page 47857]]
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 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 for the Veterans Health
Administration Chief Business Office, currently at http://www1.va.gov/
CBO/apps/rates/index.asp, under ``Charge Data.'' Certain charges are
hereby updated as described in the Supplementary Information section of
this notice. These changes are effective October 1, 2009.
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) 461-1595. (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
December 11, 2008 (73 FR 239).
Based on the methodologies set forth in 38 CFR 17.101(b), this
document provides an update to acute inpatient charges that were based
on 2009 Medicare severity diagnosis related groups (MS-DRGs). Acute
inpatient facility charges by MS-DRGs are set forth in Table A and are
posted on the Internet site of the Veterans Health Administration Chief
Business Office, currently at http://www1.va.gov/CBO/apps/rates/
index.asp, under ``Charge Data.'' This Table A corresponds to the Table
A referenced in the October 1, 2008, Federal Register Notice. Table A
referenced in this notice provides updated charges based on 2010 MS-
DRGs and will replace Table A posted on the Internet site of the
Veterans Health Administration Chief Business Office, which corresponds
to the Table A referenced in the October 1, 2008, Federal Register
notice.
Also, this document provides for an updated all-inclusive per diem
charge for skilled nursing facility/sub-acute inpatient facility charge
using the methodologies set forth in 38 CFR 17.101(c) and it 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 and is posted on the
Internet site of the Veterans Health Administration Chief Business
Office, currently at http://www1.va.gov/CBO/apps/rates/index.asp, under
``Charge Data.'' This Table B corresponds to the Table B referenced in
the October 1, 2008, Federal Register Notice. Table B referenced in
this notice provides updated all-inclusive nationwide skilled nursing
facility/sub-acute inpatient facility per diem charge and will replace
Table B posted on the Internet site of the Veterans Health
Administration Chief Business Office, which corresponds to the Table B
referenced in the October 1, 2008, Federal Register notice.
The charges in this update for acute inpatient facility and skilled
nursing facility/sub-acute inpatient facility services are effective
October 1, 2009.
In this update, we are retaining the table designations used for
acute inpatient facility charges by MS-DRGs which is posted on the
Internet site of the Veterans Health Administration Chief Business
Office, currently at http://www1.va.gov/CBO/apps/rates/index.asp, under
``Charge Data.'' We also are retaining the table designation used for
skilled nursing facility/sub-acute inpatient facility charges which is
posted on the Internet site of the Veterans Health Administration Chief
Business Office, currently at http://www1.va.gov/CBO/apps/rates/
index.asp, under ``Charge Data.'' Accordingly, the tables identified as
being updated by this notice correspond to the applicable tables
referenced in the October 1, 2008, notice beginning with Table A
through Table B.
We have updated the list of data sources presented in Supplementary
Table 1 posted on the Internet site of the Veterans Health
Administration Chief Business Office, currently at http://www1.va.gov/
CBO/apps/rates/index.asp 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 posted on the internet site of the
Veterans Health Administration Chief Business Office, currently at
http://www1.va.gov/CBO/apps/rates/index.asp, we set forth the list of
VA medical facility locations, which includes their three-digit zip
codes and provider-based/non-provider-based designations.
Consistent with VA's regulations, the updated data tables and
supplementary tables containing the changes described in this notice
will be posted on the Internet site of the Veterans Health
Administration Chief Business Office, currently at http://www1.va.gov/
CBO/apps/rates/index.asp, under ``Charge Data.''
[[Page 47858]]
Approved: September 3, 2009.
John R. Gingrich,
Chief of Staff, Department of Veterans Affairs.
[FR Doc. E9-22382 Filed 9-16-09; 8:45 am]
BILLING CODE 8320-01-P