Notices. Notice
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/register/2004/01/07/04-318·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
BILLING CODE 3110-01-P OFFICE OF MANAGEMENT AND BUDGET DEPARTMENT OF VETERANS AFFAIRS Cost-Based and Interagency Billing Rates for Medical Care or Services Provided by the Department of Veterans Affairs AGENCIES: Office of Management and Budget, Executive Office of the President and the Department of Veterans Affairs. ACTION: Notice. SUMMARY: This document provides cost-based and interagency billing rates for medical care or services provided by the Department of Veterans Affairs (VA):
(a)In error or on tentative eligibility;
(b)In a medical emergency;
(c)To pensioners of allied nations;
(d)For research purposes in circumstances under which VA medical care appropriation is to be reimbursed by VA research appropriation; and
(e)To beneficiaries of the Department of Defense or other Federal agencies, when the care or service provided is not covered by an applicable sharing agreement. In addition, until such time as charges for outpatient dental care and prescription drugs are implemented under the provisions of 38 CFR 17.101, the applicable cost-based billing rates provided in this notice will be used for collection or recovery by VA for outpatient dental care and prescription drugs provided under circumstances covered by that section. This notice is issued jointly by the Office of Management and Budget and the Department of Veterans Affairs. EFFECTIVE DATE: The rates set forth herein are effective January 7, 2004, and until further notice. FOR FURTHER INFORMATION CONTACT: David Cleaver, 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: VA's medical regulations at 38 CFR 17.102(h) set forth a methodology for computing rates for medical care or services provided by VA:
(a)In error or on tentative eligibility;
(b)In a medical emergency;
(c)To pensioners of allied nations;
(d)For research purposes in circumstances under which VA medical care appropriation is to be reimbursed by VA research appropriation; and
(e)To beneficiaries of the Department of Defense or other Federal agencies, when the care or service provided is not covered by an applicable sharing agreement. Two sets of rates are obtained via application of this methodology: Cost-Based Rates, for use for purposes
(a)through (d), above, and Interagency Rates, for use for purpose (e), above. Government employee retirement benefits and return on fixed assets are not included in the Interagency Rates, and the Interagency Rates are not broken down into three components (Physician; Ancillary; and Nursing, Room, and Board), but in all other respects the Interagency Rates are the same as the Cost-Based Rates. When medical care or service is obtained at the expense of the Department of Veterans Affairs from a non-VA source under circumstances in which the Cost-Based or Interagency Rates would apply if the care or service had been provided by VA, then the charge for such care or service will be the actual amount paid by VA for that care or service. Inpatient charges will be at the per diem rates shown for the type of bed section or discrete treatment unit providing the care. Prescription Filled charge in lieu of the Outpatient Visit rate will be charged when the patient receives no service other than the Pharmacy outpatient service. This charge applies whether the patient receives the prescription in person or by mail. Current rates obtained via the above methodology are as follows: Cost-based rates Interagency rates A. Hospital Care, Rates Per Inpatient Day General Medicine: All Inclusive Rate $1,815 $1,668 Physician 217 Ancillary 473 Nursing, Room, and Board 1,125 Neurology: All Inclusive Rate 2,289 2,098 Physician 335 Ancillary 604 Nursing, Room, and Board 1,350 Rehabilitation Medicine: All Inclusive Rate 1,723 1,574 Physician 196 Ancillary 526 Nursing, Room, and Board 1,001 Blind Rehabilitation: All Inclusive Rate 1,254 1,162 Physician 101 Ancillary 623 Nursing, Room, and Board 530 Spinal Cord Injury: All Inclusive Rate 1,237 1,136 Physician 153 Ancillary 311 Nursing, Room, and Board 773 Surgery: All Inclusive Rate 3,513 3,255 Physician 387 Ancillary 1,065 Nursing, Room, and Board 2,061 General Psychiatry: All Inclusive Rate 971 888 Physician 92 Ancillary 153 Nursing, Room, and Board 726 Substance Abuse (Alcohol and Drug Treatment): All Inclusive Rate 1,206 1,106 Physician 115 Ancillary 279 Nursing, Room, and Board 812 Psychosocial Residential Rehabilitation Treatment Programs: All Inclusive Rate 276 252 Physician 17 Ancillary 29 Nursing, Room, and Board 230 Intermediate Medicine: All Inclusive Rate 801 733 Physician 39 Ancillary 118 Nursing, Room, and Board 644 B. Nursing Home Care, Rates Per Day All Inclusive Rate 451 411 Physician 14 Ancillary 61 Nursing, Room, and Board 376 C. Outpatient Medical and Dental Treatment Outpatient Visit (other than Emergency Dental) 300 282 Emergency Dental Outpatient Visit 185 167 D. Prescription Filled, Per Prescription 45 45 Beginning on the effective date indicated herein, these rates supercede those established for the Department of Veterans Affairs by the Director of the Office of Management and Budget on November 1, 1999 (64 FR 58862). Approved: September 17, 2003. Anthony J. Principi, Secretary, Department of Veterans Affairs. Approved: December 30, 2003. Joshua B. Bolten, Director, Office of Management and Budget. [FR Doc. 04-318 Filed 1-6-04; 8:45 am]
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