Reasonable Charges For Medical Care Or Services

[Wings]

[Federal Register: December 28, 2009 (Volume 74, Number 247)]

[Notices]

[Page 68660]

From the Federal Register Online via GPO Access [wais.access.gpo.gov]

[DOCID:fr28de09-110]

[[Page 68660]]

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DEPARTMENT OF VETERANS AFFAIRS

Reasonable Charges for Medical Care or Services; 2010 Calendar

Year Update

AGENCY: Department of Veterans Affairs.

ACTION: Notice.

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SUMMARY: This Department of Veterans Affairs (VA) notice informs the

public of updated data for calculating the ``reasonable charges''

collected or recovered by VA for medical care or services provided or

furnished by VA to a veteran for: (1) A nonservice-connected disability

for which the veteran is entitled to care or the payment of expenses

for care under a health plan contract; (2) 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 (3) a nonservice-

connected disability incurred as a result of a motor vehicle accident

in a State that requires automobile accident reparations insurance. The

charge tables and supplemental tables that are applicable to this

notice can be viewed on the Veterans Health Administration Chief

Business Office's Intranet and Internet Web sites. These changes are

effective January 1, 2010.

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: Section 17.101 of title 38, U.S. Code of

Federal Regulations (CFR), 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:

(1) A nonservice-connected disability for which the veteran is entitled

to care (or the payment of expenses for care) under a health plan

contract; (2) 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 (3) a nonservice-connected disability incurred as a

result of a motor vehicle accident in a State that requires automobile

accident reparations insurance.

The regulation also provides that data for calculating actual

charge amounts at individual VA facilities based on these methodologies

will either be published as a notice in the Federal Register or will be

posted on the Internet site of the Veterans Health Administration Chief

Business Office, currently at http://www.va.gov/cbo, under ``Charge

Data.'' The charge tables and supplemental tables that are applicable

to this Federal Register notice can be viewed on the Veterans Health

Administration Chief Business Office's Intranet and Internet Web sites.

Certain charges are hereby updated as described below. These changes

are effective January 1, 2010.

We note that in cases where 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 or regulations, the

method for determining VA's charges is set forth at 38 CFR

17.101(a)(8).

The regulation includes methodologies for establishing billed

amounts for the following types of charges: Acute inpatient facility

charges; skilled nursing facility and 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. Each type of charge is addressed

below.

Acute inpatient facility charges remain the same as set forth in

the notice published in the Federal Register on September 17, 2009 (74

FR 47856). VA's current inpatient charge structure utilizes the

methodology set forth in 38 CFR 17.101 and does not itemize inpatient

bills.

Skilled nursing facility/sub-acute inpatient facility charges also

remain the same as set forth in a notice published in the Federal

Register on September 17, 2009 (74 FR 47856).

Based on the methodologies set forth in 38 CFR 17.101, this

document provides an update to charges for 2010 HCPCS Level II and

Current Procedural Technology (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. These

updated charges are effective January 1, 2010.

In this update, we are retaining the table designations used for

HCPCS Level II and Current Procedural Technology (CPT) Codes in the

notice posted on the Internet site of the Veterans Health

Administration Chief Business Office currently at http://www.va.gov/

cbo, under ``Charge Data.'' The effective date of this change was

January 1, 2009, and the notice can be found in the Federal Register.

73 FR 75495 (Dec. 11, 2008). Accordingly, the tables identified as

being updated by this notice correspond to the applicable tables posted

on the Internet with the notice, beginning with Table C.

VA has updated the list of data sources presented in Supplementary

Table 1 to reflect the updated charges described in this notice.

The list of VA medical facility locations has also been updated. As

a reminder, in Supplementary Table 3 we set forth the list of VA

medical facility locations, which includes the first three digits of

their 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://www.va.gov/

cbo, under ``Charge Data.'' The updated data tables and supplementary

tables containing the changes described will be effective until changed

by a subsequent Federal Register notice.

Approved: December 18, 2009.

John R. Gingrich,

Chief of Staff, Department of Veterans Affairs.

[FR Doc. E9-30641 Filed 12-24-09; 8:45 am]

BILLING CODE 8320-01-P

[Stretch]

Good find Wings.

This needs to be saved. A few years down the road the VA will act as if this change has always been in force, rather starting in than calendar year 2010.

The effective date of this change was

January 1, 2009, and the notice can be found in the Federal Register.

73 FR 75495 (Dec. 11, 2008).

Edited January 5, 2010 by Stretch