Reasonable Charges for Medical Care or Services; V3.12, 2013 Calendar Year Update and National Average Administrative Prescription Drug Charge Update, 75499-75501 [2012-30700]

Download as PDF tkelley on DSK3SPTVN1PROD with Federal Register / Vol. 77, No. 245 / Thursday, December 20, 2012 / Notices sample size, the expected response rate, methods for assessing potential nonresponse bias, the protocols for data collection, and any testing procedures that were or will be undertaken prior to fielding the study. Depending on the degree of influence the results are likely to have, such collections may still be eligible for submission for other generic mechanisms that are designed to yield quantitative results. As a general matter, information collections will not result in any new system of records containing privacy information and will not ask questions of a sensitive nature, such as sexual behavior and attitudes, religious beliefs, and other matters that are commonly considered private. Description of Respondents: Individuals and Households, Businesses and Organizations, State, Local or Tribal Government. Average Expected Annual Number of Activities: 15. Average Number of Respondents per Activities: 713. Annual Responses: 10,700. Frequency of Response: Once per Request. Average Minutes per Response: 20. Annual Burden: 3,032. Comments: Comments should refer to the docket number that appears at the top of this document. Written comments may be submitted to the Docket Clerk, U.S. DOT Dockets, Room W12–140, 1200 New Jersey Avenue SE., Washington, DC 20590. Comments also may be submitted by electronic means via the Internet at https://regulation.gov. Specifically address whether this information collection is necessary for proper performance of the functions of the agency and will have practical utility, accuracy of the burden estimates, ways to minimize this burden, and ways to enhance the quality, utility, and clarity of the information to be collected. All comments received will be available for examination at the above address between 10 a.m. and 5 p.m. EDT (or EST), Monday through Friday, except Federal Holidays. An electronic version of this document is available on the World Wide Web at https:// regulations.gov. Privacy Act: Anyone is able to search the electronic form of all comments received into any of our dockets by the name of the individual submitting the comment (or signing the comment, if submitted on behalf of an association, business, labor union, etc.). You may review DOT’s complete Privacy Act Statement in the Federal Register published on April 11, 2000 (Volume 65, Number 70; Pages 19477–78) or you may visit https://regulations.gov. VerDate Mar<15>2010 16:07 Dec 19, 2012 Jkt 229001 Authority: 49 CFR 1.66. By Order of the Maritime Administrator. Dated: December 6, 2012. Julie P. Agarwal, Secretary, Maritime Administration. [FR Doc. 2012–30354 Filed 12–19–12; 8:45 am] BILLING CODE 4910–81–P DEPARTMENT OF VETERANS AFFAIRS Privacy Act of 1974: Computer Matching Program Department of Veterans Affairs. Notice of Computer Matching Program. AGENCY: ACTION: Notice is hereby given that the Department of Veterans Affairs (VA) intends to conduct a recurring computer matching program. This will match personnel records of the Department of Defense (DoD) with VA records of benefit recipients under the Montgomery GI Bill and Post-9/11 GI Bill. The goal of these matches is to identify the eligibility status of veterans, servicemembers, and reservists who have applied for or who are receiving education benefit payments under the Montgomery GI Bill and Post-9/11 GI Bill. The purpose of the match is to enable VA to verify that individuals meet the conditions of military service and eligibility criteria for payment of benefits determined by VA under the Montgomery GI Bill and Post-9/11 GI Bill. The authority to conduct this match is found in 38 U.S.C. 3684A(a)(1). The records covered include eligibility records extracted from DoD personnel files and benefit records that VA establishes for all individuals who have applied for and/or are receiving, or have received education benefit payments under the Montgomery GI Bill and Post9/11 GI Bill. These benefit records are contained in a VA system of records identified as 58VA21/22/28 entitled: Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records—VA, first published in the Federal Register at 74 FR 9294 (March 3, 1976), and last amended at 74 FR 29275 (June 19, 2009), with other amendments as cited therein. DATES: Effective Date: This match will commence on or about January 22, 2013 or 40 days after the Office of Management and Budget (OMB) review period, whichever is later, and continue in effect for 18 months. At the expiration of 18 months after the SUMMARY: PO 00000 Frm 00094 Fmt 4703 Sfmt 4703 75499 commencing date, the Departments may renew the agreement for another 12 months. ADDRESSES: Written comments may be submitted through www.Regulations.gov; by mail or handdelivery to the Director, Regulations Management (02REG), Department of Veterans Affairs, 810 Vermont Avenue NW., Room 1068, Washington, DC 20420; or fax to (202) 273–9026. Copies of comments received will be available for public inspection in the Office of Regulation Policy and Management, Room 1063B, between the hours of 8:00 a.m. and 4:30 p.m., Monday through Friday (except holidays). Please call (202) 461–4902 for an appointment. In addition, during the comment period, comments may be viewed online through the Federal Docket Management System (FDMS) at www.regulations.gov. FOR FURTHER INFORMATION CONTACT: Eric Patterson, Strategy and Legislative Development Team Leader, Education Service (225B), Veterans Benefits Administration, Department of Veterans Affairs, 810 Vermont Avenue NW., Washington, DC 20420, (202) 461–9830. SUPPLEMENTARY INFORMATION: This information is required by paragraph 6c of the ‘‘Guidelines on the Conduct of Matching Programs’’ issued by OMB (54 FR 25818), as amended by OMB Circular A–130, 65 FR 77677 (2000). A copy of the notice has been provided to both Houses of Congress and OMB. The matching program is subject to their review. Approved: December 3, 2012. John R. Gingrich, Chief of Staff, Department of Veterans Affairs. [FR Doc. 2012–30572 Filed 12–19–12; 8:45 am] BILLING CODE 8320–01–P 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 Department of Veterans Affairs. Notice. AGENCY: ACTION: 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 SUMMARY: E:\FR\FM\20DEN1.SGM 20DEN1 tkelley on DSK3SPTVN1PROD with 75500 Federal Register / Vol. 77, No. 245 / Thursday, December 20, 2012 / Notices 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 nonserviceconnected disability for which the veteran is entitled to care (or the payment of expenses for care) under a health plan contract; (2) a nonserviceconnected 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, VerDate Mar<15>2010 16:07 Dec 19, 2012 Jkt 229001 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 https:// 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 https://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 PO 00000 Frm 00095 Fmt 4703 Sfmt 4703 of those charges was October 1, 2012. The data tables containing those actual charges are posted at https:// 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 https://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 threedigits 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 https://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 E:\FR\FM\20DEN1.SGM 20DEN1 Federal Register / Vol. 77, No. 245 / Thursday, December 20, 2012 / Notices tkelley on DSK3SPTVN1PROD with 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 https://www1.va.gov/CBO/ payerinfo.asp and identified as ‘‘CY 2013 Average Administrative Cost For Prescriptions.’’ VerDate Mar<15>2010 16:07 Dec 19, 2012 Jkt 229001 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 https://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 PO 00000 Frm 00096 Fmt 4703 Sfmt 9990 75501 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 E:\FR\FM\20DEN1.SGM 20DEN1

Agencies

[Federal Register Volume 77, Number 245 (Thursday, December 20, 2012)]
[Notices]
[Pages 75499-75501]
From the Federal Register Online via the Government Printing 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.

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

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

[[Page 75500]]

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 https://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 https://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 https://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 https://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 https://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

[[Page 75501]]

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 https://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 
https://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
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