Reasonable Charges for Medical Care or Services; 2011 Calendar Year Update, 81335-81336 [2010-32426]

Download as PDF erowe on DSK5CLS3C1PROD with NOTICES Federal Register / Vol. 75, No. 247 / Monday, December 27, 2010 / Notices NAS discussed three new studies regarding neurobehavioral effects. Two of the studies found an increased reporting of neurobehavioral symptoms with self-reported pesticide exposure, but no associations specific to herbicide exposure. The third study found an increased incidence of abnormalities on neurobehavioral testing among persons chronically exposed to herbicides, but NAS found this study limited by the small sample size, the lack of information on methodology, and the possibility that many other environmental and age-related factors may have affected the results. Further, the data do not clearly relate the increased symptoms or abnormal test results to specific neurobehavioral diseases or diagnoses. NAS concluded that the overall evidence remained inadequate or insufficient to detect an association. NAS noted that several previously reviewed studies failed to support the hypothesis that herbicide exposure is associated with respiratory mortality from non-cancer diseases. In Update 2008, NAS identified one new study showing increased respiratory mortality, but determined that no conclusions could be drawn from the study due to lack of specificity regarding the health outcomes and due to other methodological concerns. In Update 2008, NAS also discussed new and previously reviewed studies relating to three specific categories of respiratory effects: chronic obstructive pulmonary disease (COPD), ‘‘wheeze’’ and asthma, and farmer’s lung. NAS concluded that most prevalence studies found no association between herbicide exposure and COPD, and the two that did find evidence of such association were limited by methodological concerns. NAS found that the relevant studies did not detect an association between herbicide exposure and ‘‘wheeze’’ or asthma after adjusting for known confounders, and that the sole relevant study on farmer’s lung was inconclusive. NAS discussed two new studies regarding immune system disorders. One study found no evidence of immune system disorders in persons highly exposed to dioxin. The other study found an increase in self-reported arthritis (thought to be an autoimmune disorder) among exposed women, but not men. NAS concluded that the positive finding was unsupported by experimental evidence and that the overall evidence remained inadequate or insufficient to determine whether an association exists. NAS identified one study finding evidence of an increased risk of VerDate Mar<15>2010 15:15 Dec 23, 2010 Jkt 223001 mortality from rheumatic heart disease in an exposed population, but concluded that the basis for the observed association was unclear and that the data were limited by the lack of control for significant confounders and other methodological concerns. NAS found that the overall evidence was inadequate or insufficient to determine whether herbicide exposure is associated with any circulatory disorders other than ischemic heart disease or hypertension. NAS discussed four new studies regarding thyroid homeostasis. It found that the new studies were generally consistent with previously reviewed studies suggesting that herbicides may exert some effect on thyroid function. However, NAS concluded that the significance of the observed effects is unclear because the body’s adaptive capacity should be sufficient to accommodate them. NAS concluded that there was inadequate or insufficient evidence to determine whether herbicide exposure is associated with clinical or overt adverse effects on thyroid homeostasis. NAS noted that previous Veterans and Agent Orange (VAO) committee findings did not find any significant association between the relevant exposure and several reproductive outcomes. In Update 2008, NAS determined that there is inadequate or insufficient evidence of an association between herbicide exposure and endometriosis; semen quality; infertility; spontaneous abortion; late fetal, neonatal, or infant death; low birth weight or preterm delivery; birth defects other than spina bifida; and childhood cancers (including acute myelogenous leukemia) in offspring of exposed people. Among three new studies on endometriosis, two found no significant evidence of association and the third found a decreased risk among the most highly exposed persons. NAS found that several new studies regarding the effects of herbicide exposure on semen quality and female infertility provided little evidence of any adverse impact. NAS found that two new studies regarding spontaneous abortion provided conflicting results and that the overall evidence indicates that paternal exposure is not associated with spontaneous abortion and that there is inadequate or insufficient evidence to determine whether maternal exposure is associated with such outcomes. NAS concluded that one new study regarding the effect of dioxin-like substances on stillbirth, neonatal, death, or spontaneous abortion, did not provide primary evidence for an association between dioxin and such outcomes. PO 00000 Frm 00132 Fmt 4703 Sfmt 4703 81335 NAS discussed four new studies concerning low birth weight or preterm delivery and found that the evidence overall suggests no association between herbicide exposure and those outcomes. NAS concluded that two new studies provided no evidence of an association between herbicide exposure and birth defects other than spina bifida. NAS concluded that the four new studies of childhood cancer in the offspring of exposed individuals contained conflicting findings, but that the positive findings in two studies were limited by broad exposure classifications. Conclusion: After careful review of the findings of the NAS Report, Veterans and Agent Orange Update 2008, the Secretary has determined that the scientific evidence presented in the 2008 NAS report and other information available to the Secretary indicates that no new presumption of service connection is warranted at this time for any disease other than HCL and other chronic b-cell leukemias, Parkinson’s disease, and ischemic heart disease. 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. John R. Gingrich, Chief of Staff, Department of Veterans Affairs, approved this document on December 20, 2010, for publication. Dated: December 20, 2010. Robert C. McFetridge, Director, Regulations Policy and Management, Department of Veterans Affairs. [FR Doc. 2010–32332 Filed 12–23–10; 8:45 am] BILLING CODE 8320–01–P DEPARTMENT OF VETERANS AFFAIRS Reasonable Charges for Medical Care or Services; 2011 Calendar Year Update Department of Veterans Affairs. Notice. AGENCY: ACTION: 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 non serviceconnected disability for which the veteran is entitled to care or the SUMMARY: E:\FR\FM\27DEN1.SGM 27DEN1 81336 Federal Register / Vol. 75, No. 247 / Monday, December 27, 2010 / Notices erowe on DSK5CLS3C1PROD with NOTICES payment of expenses for care under a health plan contract; (2) a non serviceconnected 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 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, 2011. 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, United States 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 non serviceconnected disability for which the veteran is entitled to care (or the payment of expenses for care) under a health plan contract; (2) a non serviceconnected 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 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 https:// www.va.gov/cbo, under ‘‘Charge Data.’’ VerDate Mar<15>2010 15:15 Dec 23, 2010 Jkt 223001 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, 2011. 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 27, 2010 (75 FR 59329). 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 27, 2010 (75 FR 59329). Based on the methodologies set forth in 38 CFR 17.101, this document provides an update to charges for 2011 HCPCS Level II and Current Procedural Technology (CPT) codes. Charges are also being updated based on more PO 00000 Frm 00133 Fmt 4703 Sfmt 9990 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, 2011. In this update, we are retaining the table designations used for HCPCS Level II and CPT Codes in the notice posted on the Internet site of the Veterans Health Administration Chief Business Office currently at https://www.va.gov/ cbo , under ‘‘Charge Data.’’ The effective date of this change was January 1, 2010, and the notice can be found in the Federal Register. 74 FR 68660 (Dec. 28, 2009). 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. 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 threedigits 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.’’ The updated data tables and supplementary tables containing the changes described will be effective until changed by a subsequent Federal Register notice. Approved: December 20, 2010. John R. Gingrich, Chief of Staff, Department of Veterans Affairs. [FR Doc. 2010–32426 Filed 12–23–10; 8:45 am] BILLING CODE 8320–01–P E:\FR\FM\27DEN1.SGM 27DEN1

Agencies

[Federal Register Volume 75, Number 247 (Monday, December 27, 2010)]
[Notices]
[Pages 81335-81336]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2010-32426]


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DEPARTMENT OF VETERANS AFFAIRS


Reasonable Charges for Medical Care or Services; 2011 Calendar 
Year Update

AGENCY: Department of Veterans Affairs.

ACTION: Notice.

-----------------------------------------------------------------------

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 non service-connected 
disability for which the veteran is entitled to care or the

[[Page 81336]]

payment of expenses for 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 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, 2011.

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, United States 
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 non service-connected disability for which the 
veteran is entitled to care (or the payment of expenses for 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 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 https://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, 2011.
    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 27, 2010 (75 
FR 59329). 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 27, 2010 (75 FR 59329).
    Based on the methodologies set forth in 38 CFR 17.101, this 
document provides an update to charges for 2011 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, 2011.
    In this update, we are retaining the table designations used for 
HCPCS Level II and CPT Codes in the notice posted on the Internet site 
of the Veterans Health Administration Chief Business Office currently 
at https://www.va.gov/cbo , under ``Charge Data.'' The effective date of 
this change was January 1, 2010, and the notice can be found in the 
Federal Register. 74 FR 68660 (Dec. 28, 2009). 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.
    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 https://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 20, 2010.
John R. Gingrich,
Chief of Staff, Department of Veterans Affairs.
[FR Doc. 2010-32426 Filed 12-23-10; 8:45 am]
BILLING CODE 8320-01-P
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