2017-18219. Cost-Based and Inter-Agency Billing Rates for Medical Care or Services Provided by the Department of Veterans Affairs

AGENCY:

Department of Veterans Affairs.

ACTION:

Notice.

SUMMARY:

This document updates the Cost-Based and Inter-Agency billing rates for medical care or services provided by the Department of Veterans Affairs (VA) that apply in certain circumstances.

DATES:

The rates set forth herein are effective August 29, 2017 and until further notice.

FOR FURTHER INFORMATION CONTACT:

Romona Greene, Office of Community Care (10D1C1), Veterans Health Administration, Department of Veterans Affairs, 810 Vermont Avenue NW., Washington, DC 20420, [phone] (this is not a toll free number).

SUPPLEMENTARY INFORMATION:

VA's methodology for computing Cost-Based and Inter-Agency billing rates for medical care or services provided by VA is set forth in 38 CFR 17.102(h). Two sets of rates are obtained by applying this methodology, Cost-Based rates and Inter-Agency rates. Cost-Based rates apply in accordance with 38 CFR 17.102 to medical care and services that are provided by VA:

(a) In error or based on tentative eligibility;

(b) In a medical emergency;

(c) To pensioners of allied nations; and

(d) For research purposes in circumstances under which the medical care appropriation shall be reimbursed from the research appropriation.

Inter-Agency rates apply to medical care and services that are provided by VA to beneficiaries of the Department of Defense (DoD) or other Federal agencies, when the care or services provided is not covered by an applicable sharing agreement, unless otherwise stated. The calculations for the Cost-Based and Inter-Agency rates are the same with two exceptions. Inter-Agency rates are all-inclusive, and are not broken down into three components (Physician; Ancillary; and Nursing, Room and Board), and Inter-Agency rates do not include standard fringe benefit costs that cover government employee retirement, disability costs, and return on fixed assets. When VA pays for medical care or services from a non-VA source under circumstances in which the Cost-Based or Inter-Agency Rates would apply if the care or services had been provided by VA, the charge for such care or services will be the actual amount paid by VA for the care or services. Inpatient charges will be at the per diem rates shown for the type of bed section or discrete treatment unit providing the care.

The following table depicts the Cost-Based and Inter-Agency Rates that are effective upon publication of this notice and will remain in effect until the next Federal Register notice is published. These rates supersede those established by the Federal Register notice published on July 7, 2016, at 81 FR 44409.

	Cost-based rates	Inter-agency rates
A. Hospital Care per inpatient day:
General Medicine:
All Inclusive Rate	$3,805	$3,645
Physician	455
Ancillary	992
Nursing Room and Board	2,358
Neurology:
All Inclusive Rate	3,806	3,644
Physician	557
Ancillary	1005
Nursing Room and Board	2,244
Rehabilitation Medicine:
All Inclusive Rate	2,489	2,372
Physician	283
Ancillary	760
Nursing Room and Board	1,446
Blind Rehabilitation:
All Inclusive Rate	1,726	1,646
Physician	139
Ancillary	857
Nursing Room and Board	730
Spinal Cord Injury:
All Inclusive Rate	2,285	2,182
Physician	283
Ancillary	575
Nursing Room and Board	1,427
Surgery:
All Inclusive Rate	6,388	6,119
Physician	704
Ancillary	1,937
Nursing Room and Board	3,747
General Psychiatry:
All Inclusive Rate	1,849	1,761
Physician	175
Ancillary	291
Nursing Room and Board	1,383
Substance Abuse (Alcohol and Drug Treatment):
All Inclusive Rate	1,814	1,727
Physician	173
Ancillary	420
Nursing Room and Board	1,221
Psychosocial Residential Rehabilitation Program:
All Inclusive Rate	705	671
Physician	44
Ancillary	74
Nursing Room and Board	587
Intermediate Medicine:
All Inclusive Rate	2,123	2,025
Physician	104
Ancillary	311
Nursing Room and Board	1,708
Poly-trauma Inpatient:
All Inclusive Rate	3,070	2,927
Physician	349
Ancillary	938
Nursing Room and Board	1,783
B. Nursing Home Care, Per Day:
All Inclusive Rate	1,209	1,154
Physician	38
Ancillary	164
Nursing Room and Board	1007
C. Outpatient Medical Treatments:
Outpatient Visit (to include Ineligible Emergency Dental Care)	347	333
Outpatient Physical Medicine & Rehabilitation Service Visit	212	201
Outpatient Poly-trauma/Traumatic Brain Injury	546	522
Note: Outpatient Prescriptions will be billed at Drug Cost plus Administrative Fee.

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, approved this document on August 21, 2017, for publication.

Dated: August 22, 2017.

Jeffrey Martin,

Office Program Manager, Office of Regulation Policy & Management, Office of the Secretary, Department of Veterans Affairs.