82_FR_59452 82 FR 59213 - Reasonable Charges for Medical Care or Services; v3.23, 2018 Calendar Year Update and National Average Administrative Prescription Drug Charge Update

82 FR 59213 - Reasonable Charges for Medical Care or Services; v3.23, 2018 Calendar Year Update and National Average Administrative Prescription Drug Charge Update

DEPARTMENT OF VETERANS AFFAIRS

Federal Register Volume 82, Issue 239 (December 14, 2017)

Page Range59213-59214
FR Document2017-26950

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.

Federal Register, Volume 82 Issue 239 (Thursday, December 14, 2017) 
[Federal Register Volume 82, Number 239 (Thursday, December 14, 2017)]
[Notices]
[Pages 59213-59214]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2017-26950]



[[Page 59213]]

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DEPARTMENT OF VETERANS AFFAIRS


Reasonable Charges for Medical Care or Services; v3.23, 2018 
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 of Title 38 of the Code of 
Federal Regulations 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 Healthcare Common Procedure Coding System (HCPCS) Level 
II codes.
    Section 17.101 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, 2018.
    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 2018 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 ``v3.23 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 v3.23 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 25, 2017 (82 FR 
44701).
    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 ``v3.23 (Jan18).''
    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 2018 is 
$16.64. 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 2018 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 under the heading ``Federal Registers, Rules, and 
Notices'' and identified as ``v3.23 Federal Register Notice 01/01/18 
(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, 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,

[[Page 59214]]

approved this document on November 24, 2017, for publication.

    Dated: November 24, 2017.
Jeffrey Martin,
Office Program Manager, Office of Regulation Policy & Management, 
Office of the Secretary, Department of Veterans Affairs.
[FR Doc. 2017-26950 Filed 12-13-17; 8:45 am]
 BILLING CODE 8320-01-P

Federal Register / Vol. 82, No. 239 / Thursday, December 14, 2017 / Notices 59213 DEPARTMENT OF VETERANS Healthcare Common Procedure Coding We are also updating the list of VA AFFAIRS System (HCPCS) Level II codes. medical facility locations. The list of VA Section 17.101 provides that the medical facility locations, including the Reasonable Charges for Medical Care actual charge amounts at individual VA first three digits of their zip codes as or Services; v3.23, 2018 Calendar Year medical facilities based on these well as provider-based/non-provider- Update and National Average methodologies and the data sources based designations, will be posted on Administrative Prescription Drug used for calculating those actual charge the VHA Office of Community Care’s Charge Update amounts will either be published as a website under the heading ‘‘VA Medical notice in the Federal Register or will be Facility Locations’’ and identified as AGENCY: Department of Veterans Affairs. posted on the internet site of the ‘‘v3.23 (Jan18).’’ ACTION: Notice. Veterans Health Administration Office As indicated in 38 CFR 17.101(m), of Community Care’s website at https:// when VA provides or furnishes SUMMARY: This Department of Veterans www.va.gov/communitycare/revenue_ prescription drugs not administered Affairs (VA) notice updates the data for ops/payer_rates.asp. during treatment, ‘‘charges billed calculating the ‘‘Reasonable Charges’’ Certain charges are hereby updated as separately for such prescription drugs collected or recovered by VA for stated in this notice and will be effective will consist of the amount that equals medical care or services. This notice on January 1, 2018. the total of the actual cost to VA for the also updates the ‘‘National Average In cases where VA has not established drugs and the national average of VA Administrative Prescription Costs’’ for charges for medical care or services administrative costs associated with purposes of calculating VA’s charges for provided or furnished at VA expense dispensing the drugs for each prescription drugs that were not (by either VA or non-VA providers) prescription.’’ Section 17.101(m) administered during treatment, but under other provisions or regulations, includes the methodology for provided or furnished by VA to a the method for determining VA’s calculating the national average veteran. charges is set forth at 38 CFR administrative cost for prescription drug FOR FURTHER INFORMATION CONTACT: 17.101(a)(8). charges not administered during Based on the methodologies set forth treatment. Romona Greene, Office of Community in § 17.101, this notice provides an VA determines the amount of the Care, Revenue Operations, Payer update to charges for 2018 HCPCS Level national average administrative cost Relations and Services, Rates and II and Current Procedural Terminology annually for the prior fiscal year Charges (10D1C1), Veterans Health (CPT) codes. Charges are also being (October through September) and then Administration (VHA), Department of updated based on more recent versions Veterans Affairs, 810 Vermont Avenue applies the charge at the start of the next of data sources for the following charge calendar year. The national average NW, Washington, DC 20420, (202) 382– types: partial hospitalization facility 2521. (This is not a toll free number). administrative drug cost for calendar charges; outpatient facility charges; year 2018 is $16.64. This change will be SUPPLEMENTARY INFORMATION: Section physician and other professional posted on the VHA Office of 17.101 of Title 38 of the Code of Federal charges, including professional charges Community Care’s website at https:// Regulations sets forth the ‘‘Reasonable for anesthesia services and dental www.va.gov/COMMUNITYCARE/ Charges’’ for medical care or services services; pathology and laboratory revenue_ops/admin_costs.asp under the provided or furnished by VA to a charges; observation care facility heading ‘‘CY 2018 Average veteran: ‘‘For a nonservice-connected charges; ambulance and other Administrative Cost for Prescriptions.’’ disability for which the veteran is emergency transportation charges; and Consistent with § 17.101, the national entitled to care (or the payment of charges for durable medical equipment, average administrative cost, the updated expenses for care) under a health plan drugs, injectables, and other medical data, and supplementary tables contract; For a nonservice-connected services, items, and supplies identified containing the changes described in this disability incurred incident to the by HCPCS Level II codes. As of the date notice will be posted online, as veteran’s employment and covered of this notice, the actual charge amounts indicated in this notice. This notice will under a worker’s compensation law or at individual VA medical facilities be posted on the VHA Office of plan that provides reimbursement or based on the methodologies in § 17.101 Community Care’s website under the indemnification for such care and will be posted on the VHA Office of heading ‘‘Federal Registers, Rules, and services; or For a nonservice-connected Community Care’s website at https:// Notices’’ and identified as ‘‘v3.23 disability incurred as a result of a motor www.va.gov/communitycare/revenue_ Federal Register Notice 01/01/18 vehicle accident in a State that requires ops/payer_rates.asp under the heading (Outpatient and Professional), and automobile accident reparations ‘‘Reasonable Charges Data Tables’’ and National Administrative Cost (PDF).’’ insurance.’’ Section 17.101 provides the identified as ‘‘v3.23 Data Tables The national average administrative methodologies for establishing billed (Outpatient and Professional).’’ cost, updated data, and supplementary amounts for several types of charges; The list of data sources used for tables containing the changes described however, this notice will only address calculating the actual charge amounts will be effective until changed by a partial hospitalization facility charges; listed above also will be posted on the subsequent Federal Register notice. outpatient facility charges; physician VHA Office of Community Care’s and other professional charges, website under the heading ‘‘Reasonable Signing Authority including professional charges for Charges Data Sources’’ and identified as The Secretary of Veterans Affairs, or anesthesia services and dental services; designee, approved this document and sradovich on DSK3GMQ082PROD with NOTICES ‘‘Reasonable Charges v3.23 Data Sources pathology and laboratory charges; (Outpatient and Professional) (PDF).’’ authorized the undersigned to sign and observation care facility charges; Acute inpatient facility charges and submit the document to the Office of the ambulance and other emergency skilled nursing facility/sub-acute Federal Register for publication transportation charges; and charges for inpatient facility charges remain the electronically as an official document of durable medical equipment, drugs, same as set forth in the notice published the Department of Veterans Affairs. Gina injectables, and other medical services, in the Federal Register on September S. Farrisee, Deputy Chief of Staff, items, and supplies identified by 25, 2017 (82 FR 44701). Department of Veterans Affairs, VerDate Sep<11>2014 21:28 Dec 13, 2017 Jkt 244001 PO 00000 Frm 00422 Fmt 4703 Sfmt 4703 E:\FR\FM\14DEN1.SGM 14DEN1

59214 Federal Register / Vol. 82, No. 239 / Thursday, December 14, 2017 / Notices approved this document on November Dated: November 24, 2017. 24, 2017, for publication. Jeffrey Martin, Office Program Manager, Office of Regulation Policy & Management, Office of the Secretary, Department of Veterans Affairs. [FR Doc. 2017–26950 Filed 12–13–17; 8:45 am] BILLING CODE 8320–01–P sradovich on DSK3GMQ082PROD with NOTICES VerDate Sep<11>2014 21:28 Dec 13, 2017 Jkt 244001 PO 00000 Frm 00423 Fmt 4703 Sfmt 9990 E:\FR\FM\14DEN1.SGM 14DEN1


Document Created: 2018-10-25 10:53:24
Document Modified: 2018-10-25 10:53:24
CategoryRegulatory Information
CollectionFederal Register
sudoc ClassAE 2.7:
GS 4.107:
AE 2.106:
PublisherOffice of the Federal Register, National Archives and Records Administration
SectionNotices
ActionNotice.
ContactRomona 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).
FR Citation82 FR 59213 
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