[Federal Register Volume 77, Number 245 (Thursday, December 20, 2012)]
[Notices]
[Pages 75499-75501]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-30700]
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DEPARTMENT OF VETERANS AFFAIRS
Reasonable Charges for Medical Care or Services; V3.12, 2013
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 informs the
public of the updated data for calculating the ``Reasonable Charges''
collected or recovered by VA for medical care or services and of the
updated ``National Average Administrative Costs'' for purposes of
calculating VA's charges for prescription drugs that were not
administered during treatment but
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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; 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 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 Internet Web site. These changes are effective
January 1, 2013.
FOR FURTHER INFORMATION CONTACT: Romona Greene, Chief Business Office
(10NB6), 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, United States
Code of Federal Regulations (CFR), sets forth VA's 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 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. 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 provides that the actual charge amounts at
individual VA 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 Chief Business
Office. Certain charges are hereby updated as described below,
effective January 1, 2013.
Based on the methodologies set forth in 38 CFR 17.101, this
document provides an update to charges for 2013 HCPCS Level II and
Current Procedural Technology 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, 2013. As of the date of this
notice, the actual charge amounts at individual VA facilities based on
the methodologies in the regulation will be posted at http://www1.va.gov/CBO/apps/rates/index.asp, under the heading ``Reasonable
Charges Data Tables'' and identified as ``V3.12 Data Tables (Outpatient
and Professional).''
The list of data sources used for calculating the actual charge
amounts listed above also will be posted at http://www1.va.gov/CBO/apps/rate/index.asp under the heading ``Reasonable Charges Data
Sources'' and identified as ``Reasonable Charges V3.12 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 7, 2012 (77 FR
55269). The effective date of those charges was October 1, 2012. The
data tables containing those actual charges are posted at http://www1.va.gov/CBO/apps/rates/index.asp, under the heading ``Reasonable
Charges Data Tables'' and identified as ``V3.11 Data Tables
(Inpatient).'' The data sources used to calculate these charges are
posted at http://www1.va.gov/CBO/apps/rate/index.asp under the heading
``Reasonable Charges Data Sources'' and identified as ``Reasonable
Charges V3.11 Data Sources (Inpatient) (PDF).'' VA's current inpatient
charge structure utilizes the methodology set forth in 38 CFR 17.101
and VA does not itemize inpatient bills.
The list of VA medical facility locations has also been updated. 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. The updated VA medical facility locations will be
posted on the Internet site of the Veterans Health Administration Chief
Business Office, currently at http://www1.va.gov/CBO/apps/rate/index.asp under the heading ``VA Medical Facility Locations,'' and
identified as ``VA Medical Facility Locations V3.12 (Jan13).''
As provided 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. The administrative cost is determined
annually using VA's managerial cost accounting system. Under this
accounting system, the national average administrative cost is
determined by adding the total VA national drug general overhead costs
(such as costs of buildings and maintenance, utilities, billing, and
collections) to the total VA national drug dispensing costs (such as
costs of the labor of the pharmacy department, packaging, and mailing)
with the sum divided by the actual number of VA prescriptions filled
nationally. The labor cost also includes cost for the professional
activity of reviewing and dispensing a prescription.
Based on the accounting system, VA will determine the amount of the
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national average administrative cost annually for the prior fiscal year
(October through September) and then apply the charge at the start of
the next calendar year. The national average administrative cost for
the calendar year 2013 is $13.18. This change is effective on January
1, 2013, and will be posted at http://www1.va.gov/CBO/payerinfo.asp and
identified as ``CY 2013 Average Administrative Cost For
Prescriptions.''
Consistent with the regulations, the national average
administrative cost, the updated data tables, and the supplementary
tables containing the changes described in this notice will be posted
online as indicated in this notice. This notice will be posted at
http://www1.va.gov/CBO/apps/rates/index.asp under the heading ``Federal
Registers, Rules, and Notices'' and identified as, ``V3.12 Federal
Register Notice 01/01/13 (Outpatient and Professional), and National
Administrative Cost (PDF).'' The national average administrative cost,
updated data tables, and the supplementary tables containing the
changes described will be effective until changed by a subsequent
Federal Register notice.
Approved: December 14, 2012.
John R. Gingrich,
Chief of Staff, Department of Veterans Affairs.
[FR Doc. 2012-30700 Filed 12-19-12; 8:45 am]
BILLING CODE 8320-01-P