[Federal Register: January 7, 2004 (Volume 69, Number 4)]
[Notices]
[Page 1062-1064]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr07ja04-93]
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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.
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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:
[[Page 1063]]
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Cost-based Interagency
rates rates
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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 300 282
Emergency Dental)..................
Emergency Dental Outpatient Visit... 185 167
D. Prescription Filled, Per Prescription 45 45
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[[Page 1064]]
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]
BILLING CODE 3110-01-P