Reasonable Charges for Inpatient DRG and SNF Medical Services; 2008 Fiscal Year Update, 55276-55277 [E7-19279]

Agencies

• DEPARTMENT OF VETERANS AFFAIRS

[Federal Register Volume 72, Number 188 (Friday, September 28, 2007)]
[Notices]
[Pages 55276-55277]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E7-19279]


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DEPARTMENT OF VETERANS AFFAIRS


Reasonable Charges for Inpatient DRG and SNF Medical Services; 
2008 Fiscal Year Update

AGENCY: Department of Veterans Affairs.

ACTION: Notice.

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SUMMARY: Title 38 of the Code of Federal Regulations (CFR), section 
17.01 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 non-
service-connected disability for which the veteran is entitled to care 
or the payment of expenses of care under a health plan contract; (2) a 
non-service-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 non-service-connected disability incurred as a result of a 
motor vehicle accident in a State that requires automobile accident 
reparations insurance.
    The regulations include 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. The regulations also provide 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 
https://www.va.gov/cbo, under ``Charge Data.'' Certain charges are 
hereby updated as described in the SUPPLEMENTARY INFORMATION Section of 
this notice. These changes are effective October 1, 2007.
    In circumstances when 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).

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) 254-0361. (This is 
not a toll free number.)

SUPPLEMENTARY INFORMATION: Of the charge types listed in the summary 
section of this notice, only the acute inpatient facility charges and 
skilled nursing facility and sub-acute inpatient facility charges are 
being changed. Charges for the following: 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 are not being changed. These 
outpatient facility charges and professional charges remain the same as 
set forth in a notice published in the Federal Register on December 22, 
2006 (71 FR 77096).
    Based on the methodologies set forth in 38 CFR 17.101(b), this 
document provides an update to acute inpatient charges that were based 
on 2007 diagnosis related group (DRG). Acute inpatient facility charges 
by DRG are set forth in Table A in the September 28, 2006, Federal 
Register Notice. VA is adopting the Medicare Severity DRG (MS-DRG) 
classification system as established by the Department of Health and 
Human Services, Centers for Medicare and Medicaid Services (CMS) (see 
Final Rule with Comment Period as published in the Federal Register on 
August 22, 2007, Vol. 72, No.162 FR 47130). Table A in this notice 
provides updated charges based on Fiscal Year 2008 MS-DRGs and will 
replace Table A in the September 28, 2006, Federal Register Notice.
    Also, this document provides for an updated all-inclusive per diem 
charge for skilled nursing facility/sub-acute inpatient facility charge 
using the methodologies set forth in 38 CFR 17.101(c) and it is 
adjusted by a geographic area factor based on the location where the 
care is provided. The skilled nursing facility/sub-acute inpatient 
facility per diem charge is set forth in Table B in the September 28, 
2006, Federal Register Notice. Table B in this Notice provides the 
updated all-inclusive nationwide skilled nursing facility/sub-acute 
inpatient facility per diem charge and will replace Table B in the 
September 28, 2006 Notice. The charges in this update for acute 
inpatient facility and skilled nursing facility/sub-acute inpatient 
facility services are effective October 1, 2007.
    In this update, VA is retaining the table designations used for 
acute inpatient facility charges by DRGs in the notice published in the 
Federal Register on September 28, 2006 (71 FR 57028). VA is retaining 
the table designation used for skilled nursing facility/sub-acute 
inpatient facility charges in the notice published in the Federal 
Register on September 28, 2006. Accordingly, the tables identified as 
being updated by this Notice correspond to the applicable tables 
published in the September 28, 2006, Federal Register Notice, beginning 
with Table A through Table B.
    VA has updated the list of data sources presented in Supplementary 
Table 1 to reflect the updated data sources used to establish 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 published in the Federal Register, 
dated December 22, 2006 (71 FR 77096), 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 https://www.va.gov/
cbo, under ``Charge Data.''


[[Page 55277]]


    Approved: September 25, 2007.
R. James Nicholson,
Secretary of Veterans Affairs.
 [FR Doc. E7-19279 Filed 9-27-07; 8:45 am]
BILLING CODE 8320-01-P