Payment for Home Health Services and Hospice Care to Non-VA Providers, 26250-26251 [2013-10694]

Download as PDF 26250 Federal Register / Vol. 78, No. 87 / Monday, May 6, 2013 / Rules and Regulations the Montlake Bridge and University Bridge to remain in the closed position and need not open for maritime traffic from 7:30 a.m. on May 19, 2013 to 9:30 a.m. on May 19, 2013. The bridge shall operate in accordance to 33 CFR 117.1051 at all other times. Waterway usage on the Lake Washington Ship Canal ranges from commercial tug and barge to small pleasure craft. Mariners will be notified and kept informed of the bridge’s operational status via the Coast Guard Notice to Mariners publication and Broadcast Notice to Mariners as appropriate. The draw span will be required to open, if needed, for vessels engaged in emergency response operations during this closure period. In accordance with 33 CFR 117.35(e), the drawbridges must return to its regular operating schedule immediately at the end of the designated time period. This deviation from the operating regulations is authorized under 33 CFR 117.35. Dated: April 22, 2013. Randall D. Overton, Bridge Administrator, Thirteenth Coast Guard District. [FR Doc. 2013–10455 Filed 5–3–13; 8:45 am] BILLING CODE 9110–04–P DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 17 RIN 2900–AN98 Payment for Home Health Services and Hospice Care to Non-VA Providers Department of Veterans Affairs. Final rule. AGENCY: ACTION: The Department of Veterans Affairs (VA) amends its regulations concerning the billing methodology for non-VA providers of home health services and hospice care. Because the newly applicable methodology cannot supersede rates for which VA has specifically contracted, this rulemaking will only affect home health and hospice care providers who do not have existing negotiated contracts with VA. This rule also rescinds internal guidance documents that could be interpreted as conflicting with this final rule. DATES: Effective Date: This final rule is effective November 15, 2013. FOR FURTHER INFORMATION CONTACT: Lisa Brown, Chief, Policy Management Department, Health Administration Center, Veterans Health Administration, Department of Veterans Affairs, 3773 Cherry Creek Drive North, East Tower, pmangrum on DSK3VPTVN1PROD with RULES SUMMARY: VerDate Mar<15>2010 15:01 May 03, 2013 Jkt 229001 Ste. 485, Denver, CO 80209, (303) 331– 7829. (This is not a toll-free number.) SUPPLEMENTARY INFORMATION: In a document published in the Federal Register on November 21, 2011 (76 FR 71920), VA proposed to amend its regulations concerning the billing methodology for non-VA providers of home health services and hospice care. The proposed rulemaking indicated it would make the VA regulation governing payments for certain non-VA health care, 38 CFR 17.56, applicable to non-VA home health services and hospice care. Section 17.56 provides, among other things, that Medicare fee schedule or prospective payment system amounts will be paid to certain non-VA providers, unless VA negotiates other payment amounts with such providers. See 38 CFR 17.56(a)(2)(i). Interested persons were invited to submit comments to the proposed rule on or before December 21, 2011. We received one comment, which supported the proposed rule because it would standardize VA’s payment methodology for non-VA home health and hospice care. The comment indicated, however, that the projected loss in revenue for home care and hospice providers due to the application of § 17.56 rates may affect the level of care provided to veterans. We make no changes to the rule based on this comment. We are not aware of any evidence that supports an inference that, because of potentially lower payments, home care and hospice providers will offer a lower level of care to veterans than these providers have offered to veterans in the past. We are also not aware of evidence that suggests that home care and hospice providers offer a substandard level of care to any patient for which the provider receives the applicable Medicare rate, which is the rate that will now apply to veterans under this rule. Additionally, as stated in the proposed rule, we estimate that each home health care and hospice provider that does not separately negotiate a payment rate with VA may lose up to $1,346.28 annually, which is not a significant amount when compared to the average annual revenue for home health and hospice agencies of $4.7 million (as indicated by data from the Medicare Payment Advisory Commission as well as the Census Bureau). Lastly, to the extent any affected provider makes significantly less than $4.7 million of annual revenue on average, we also reiterate from the proposed rule that affected providers may benefit from any ‘‘phase-in’’ of the § 17.56 rates as contemplated by Medicare rates themselves, as set forth PO 00000 Frm 00018 Fmt 4700 Sfmt 4700 in § 17.56(a)(2)(i), which requires that VA pay ‘‘[t]he applicable Medicare fee schedule or prospective payment system amount (‘Medicare Rate’) for the period in which the service was provided.’’ 38 CFR 17.56(a)(2)(i). Based on the rationale set forth in the proposed rule and in this document, VA is adopting the provisions of the proposed rule as a final rule with no changes. Effect of Rulemaking Title 38 of the Code of Federal Regulations, as revised by this rulemaking, represents VA’s implementation of its legal authority on this subject. Other than future amendments to this regulation or governing statutes, no contrary guidance or procedures are authorized. All existing or subsequent VA guidance must be read to conform with this rulemaking if possible or, if not possible, such guidance is superseded by this rulemaking. Paperwork Reduction Act This final rule contains no collections of information under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501– 3521). Regulatory Flexibility Act The Secretary hereby certifies that this final rule will not have a significant economic impact on a substantial number of small entities as they are defined in the Regulatory Flexibility Act, 5 U.S.C. 601–612. About 8,400 providers without negotiated contracts offer home health care or hospice care to veterans at rates that are equivalent to, or not significantly higher than, those offered by this final rule. VA costs of purchased skilled home care were compared to Medicare Home Health Prospective Payment System (HH–PPS) reimbursement for a 60-day period. The average VA reimbursement level per veteran for a 60-day period was $2,537.40 in fiscal year (FY) 2010. The average Medicare reimbursement level for skilled home care per beneficiary was $2,312.94 in FY 2010. This difference amounts to providers receiving $3.74 less per day from VA for a 60-day episode of care. On average, each provider cares for six veterans at VA expense. The potential annual revenue loss will be approximately $1,346.28 per provider, an insignificant amount of revenue for these providers. Therefore, pursuant to 5 U.S.C. 605(b), this rulemaking is exempt from the initial and final regulatory flexibility analysis requirements of sections 603 and 604. E:\FR\FM\06MYR1.SGM 06MYR1 Federal Register / Vol. 78, No. 87 / Monday, May 6, 2013 / Rules and Regulations Executive Orders 12866 and 13563 Executive Orders 12866 and 13563 direct agencies to assess the costs and benefits of available regulatory alternatives and, when regulation is necessary, to select regulatory approaches that maximize net benefits (including potential economic, environmental, public health and safety effects, and other advantages; distributive impacts; and equity). Executive Order 13563 (Improving Regulation and Regulatory Review) emphasizes the importance of quantifying both costs and benefits, reducing costs, harmonizing rules, and promoting flexibility. Executive Order 12866 (Regulatory Planning and Review) defines a ‘‘significant regulatory action,’’ which requires review by the Office of Management and Budget (OMB), as ‘‘any regulatory action that is likely to result in a rule that may: (1) Have an annual effect on the economy of $100 million or more or adversely affect in a material way the economy, a sector of the economy, productivity, competition, jobs, the environment, public health or safety, or State, local, or tribal governments or communities; (2) Create a serious inconsistency or otherwise interfere with an action taken or planned by another agency; (3) Materially alter the budgetary impact of entitlements, grants, user fees, or loan programs or the rights and obligations of recipients thereof; or (4) Raise novel legal or policy issues arising out of legal mandates, the President’s priorities, or the principles set forth in this Executive Order.’’ The economic, interagency, budgetary, legal, and policy implications of this regulatory action have been examined and it has been determined not to be a significant regulatory action under Executive Order 12866. pmangrum on DSK3VPTVN1PROD with RULES Unfunded Mandates The Unfunded Mandates Reform Act of 1995 requires, at 2 U.S.C. 1532, that agencies prepare an assessment of anticipated costs and benefits before issuing any rule that may result in expenditure by State, local, and tribal governments, in the aggregate, or by the private sector, of $100 million or more (adjusted annually for inflation) in any one year. This final rule will have no such effect on State, local, and tribal governments, or the private sector. Catalog of Federal Domestic Assistance The Catalog of Federal Domestic Assistance numbers and titles for the programs affected by this document are 64.009, Veterans Medical Care Benefits VerDate Mar<15>2010 15:01 May 03, 2013 Jkt 229001 and 64.010, Veterans Nursing Home Care. 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. Jose D. Riojas, Interim Chief of Staff, Department of Veterans Affairs, approved this document on April 30, 2013 for publication. List of Subjects in 38 CFR Part 17 Administrative practice and procedure, Alcohol abuse, Alcoholism, Claims, Day care, Dental health, Drug abuse, Foreign relations, Government contracts, Grant programs-health, Government programs-veterans, Health care, Health facilities, Health professions, Health records, Homeless, Medical and dental schools, Medical devices, Medical research, Mental health programs, Nursing homes, Veterans. Dated: May 1, 2013. Robert C. McFetridge, Director of Regulation Policy and Management, Office of General Counsel, Department of Veterans Affairs. For the reasons stated in the preamble, the Department of Veterans Affairs amends 38 CFR part 17 as follows: PART 17—MEDICAL 1. The authority citation for part 17 continues to read as follows: ■ Authority: 38 U.S.C. 501, and as noted in specific sections. § 17.56 [Amended] 2. Amend § 17.56(a) introductory text by removing ‘‘and except for noncontractual payments for home health services and hospice care’’. ■ [FR Doc. 2013–10694 Filed 5–3–13; 8:45 am] BILLING CODE 8320–01–P ENVIRONMENTAL PROTECTION AGENCY 40 CFR Part 52 [EPA–R06–OAR–2011–0494; FRL–9808–2] Approval and Promulgation of Air Quality Implementation Plans; Texas; Revisions to Control of Air Pollution from Nitrogen Compounds from Stationary Sources Environmental Protection Agency (EPA). AGENCY: PO 00000 Frm 00019 Fmt 4700 Sfmt 4700 ACTION: 26251 Direct final rule. The EPA is taking direct final action to approve revisions to the Texas State Implementation Plan (SIP), 30 TAC, Chapter 117 Control of Air Pollution from Nitrogen Compounds. These revisions concern two separate actions. First, we are approving revisions to Texas SIP, Chapter 117 emissions specifications for lean burn engines fired on landfill or other biogas at minor sources of Nitrogen Oxides (NOx). Second, we are approving revisions to Texas SIP, Chapter 117 to include low temperature drying and curing ovens used in wet-laid nonwoven fiber mat manufacturing operations when nitrogen containing resins or other additives are used. These two actions affect NOx sources operating in the Dallas Fort-Worth (DFW) 1997 8-hour ozone nonattainment area. The EPA is approving these two actions pursuant to section 110 of the Federal Clean Air Act (CAA, Act). DATES: This direct final rule will be effective July 5, 2013 without further notice unless EPA receives adverse comments by June 5, 2013. If adverse comments are received, EPA will publish a timely withdrawal of the direct final rule in the Federal Register informing the public that the rule will not take effect. ADDRESSES: Submit your comments, identified by Docket No EPA–R06– OAR–2011–0494, by one of the following methods: • Federal e-Rulemaking Portal: https://www.regulations.gov. • Follow the online instructions for submitting comments. • EPA Region 6 ‘‘Contact Us’’ Web site: https://epa.gov/region6/ r6coment.htm. Please click on ‘‘6PD (Multimedia)’’ and select ‘‘Air’’ before submitting comments. • Email: Mr. Guy Donaldson at donaldson.guy@epa.gov. Please also send a copy by email to the person listed in the FOR FURTHER INFORMATION CONTACT section below. • Fax: Mr. Guy Donaldson, Chief, Air Planning Section (6PD–L), at fax number 214–665–7263. • Mail: Mr. Guy Donaldson, Chief, Air Planning Section (6PD–L), Environmental Protection Agency, 1445 Ross Avenue, Suite 1200, Dallas, Texas 75202–2733. • Hand or Courier Delivery: Mr. Guy Donaldson, Chief, Air Planning Section (6PD–L), Environmental Protection Agency, 1445 Ross Avenue, Suite 1200, Dallas, Texas 75202–2733. Such deliveries are accepted only between the hours of 8 a.m. and 4 p.m. weekdays, SUMMARY: E:\FR\FM\06MYR1.SGM 06MYR1

Agencies

[Federal Register Volume 78, Number 87 (Monday, May 6, 2013)]
[Rules and Regulations]
[Pages 26250-26251]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2013-10694]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 17

RIN 2900-AN98


Payment for Home Health Services and Hospice Care to Non-VA 
Providers

AGENCY: Department of Veterans Affairs.

ACTION: Final rule.

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

SUMMARY: The Department of Veterans Affairs (VA) amends its regulations 
concerning the billing methodology for non-VA providers of home health 
services and hospice care. Because the newly applicable methodology 
cannot supersede rates for which VA has specifically contracted, this 
rulemaking will only affect home health and hospice care providers who 
do not have existing negotiated contracts with VA. This rule also 
rescinds internal guidance documents that could be interpreted as 
conflicting with this final rule.

DATES: Effective Date: This final rule is effective November 15, 2013.

FOR FURTHER INFORMATION CONTACT: Lisa Brown, Chief, Policy Management 
Department, Health Administration Center, Veterans Health 
Administration, Department of Veterans Affairs, 3773 Cherry Creek Drive 
North, East Tower, Ste. 485, Denver, CO 80209, (303) 331-7829. (This is 
not a toll-free number.)

SUPPLEMENTARY INFORMATION: In a document published in the Federal 
Register on November 21, 2011 (76 FR 71920), VA proposed to amend its 
regulations concerning the billing methodology for non-VA providers of 
home health services and hospice care.
    The proposed rulemaking indicated it would make the VA regulation 
governing payments for certain non-VA health care, 38 CFR 17.56, 
applicable to non-VA home health services and hospice care. Section 
17.56 provides, among other things, that Medicare fee schedule or 
prospective payment system amounts will be paid to certain non-VA 
providers, unless VA negotiates other payment amounts with such 
providers. See 38 CFR 17.56(a)(2)(i). Interested persons were invited 
to submit comments to the proposed rule on or before December 21, 2011. 
We received one comment, which supported the proposed rule because it 
would standardize VA's payment methodology for non-VA home health and 
hospice care. The comment indicated, however, that the projected loss 
in revenue for home care and hospice providers due to the application 
of Sec.  17.56 rates may affect the level of care provided to veterans.
    We make no changes to the rule based on this comment. We are not 
aware of any evidence that supports an inference that, because of 
potentially lower payments, home care and hospice providers will offer 
a lower level of care to veterans than these providers have offered to 
veterans in the past. We are also not aware of evidence that suggests 
that home care and hospice providers offer a substandard level of care 
to any patient for which the provider receives the applicable Medicare 
rate, which is the rate that will now apply to veterans under this 
rule. Additionally, as stated in the proposed rule, we estimate that 
each home health care and hospice provider that does not separately 
negotiate a payment rate with VA may lose up to $1,346.28 annually, 
which is not a significant amount when compared to the average annual 
revenue for home health and hospice agencies of $4.7 million (as 
indicated by data from the Medicare Payment Advisory Commission as well 
as the Census Bureau). Lastly, to the extent any affected provider 
makes significantly less than $4.7 million of annual revenue on 
average, we also reiterate from the proposed rule that affected 
providers may benefit from any ``phase-in'' of the Sec.  17.56 rates as 
contemplated by Medicare rates themselves, as set forth in Sec.  
17.56(a)(2)(i), which requires that VA pay ``[t]he applicable Medicare 
fee schedule or prospective payment system amount (`Medicare Rate') for 
the period in which the service was provided.'' 38 CFR 17.56(a)(2)(i).
    Based on the rationale set forth in the proposed rule and in this 
document, VA is adopting the provisions of the proposed rule as a final 
rule with no changes.

Effect of Rulemaking

    Title 38 of the Code of Federal Regulations, as revised by this 
rulemaking, represents VA's implementation of its legal authority on 
this subject. Other than future amendments to this regulation or 
governing statutes, no contrary guidance or procedures are authorized. 
All existing or subsequent VA guidance must be read to conform with 
this rulemaking if possible or, if not possible, such guidance is 
superseded by this rulemaking.

Paperwork Reduction Act

    This final rule contains no collections of information under the 
Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3521).

Regulatory Flexibility Act

    The Secretary hereby certifies that this final rule will not have a 
significant economic impact on a substantial number of small entities 
as they are defined in the Regulatory Flexibility Act, 5 U.S.C. 601-
612. About 8,400 providers without negotiated contracts offer home 
health care or hospice care to veterans at rates that are equivalent 
to, or not significantly higher than, those offered by this final rule. 
VA costs of purchased skilled home care were compared to Medicare Home 
Health Prospective Payment System (HH-PPS) reimbursement for a 60-day 
period. The average VA reimbursement level per veteran for a 60-day 
period was $2,537.40 in fiscal year (FY) 2010. The average Medicare 
reimbursement level for skilled home care per beneficiary was $2,312.94 
in FY 2010. This difference amounts to providers receiving $3.74 less 
per day from VA for a 60-day episode of care. On average, each provider 
cares for six veterans at VA expense. The potential annual revenue loss 
will be approximately $1,346.28 per provider, an insignificant amount 
of revenue for these providers. Therefore, pursuant to 5 U.S.C. 605(b), 
this rulemaking is exempt from the initial and final regulatory 
flexibility analysis requirements of sections 603 and 604.

[[Page 26251]]

Executive Orders 12866 and 13563

    Executive Orders 12866 and 13563 direct agencies to assess the 
costs and benefits of available regulatory alternatives and, when 
regulation is necessary, to select regulatory approaches that maximize 
net benefits (including potential economic, environmental, public 
health and safety effects, and other advantages; distributive impacts; 
and equity). Executive Order 13563 (Improving Regulation and Regulatory 
Review) emphasizes the importance of quantifying both costs and 
benefits, reducing costs, harmonizing rules, and promoting flexibility. 
Executive Order 12866 (Regulatory Planning and Review) defines a 
``significant regulatory action,'' which requires review by the Office 
of Management and Budget (OMB), as ``any regulatory action that is 
likely to result in a rule that may: (1) Have an annual effect on the 
economy of $100 million or more or adversely affect in a material way 
the economy, a sector of the economy, productivity, competition, jobs, 
the environment, public health or safety, or State, local, or tribal 
governments or communities; (2) Create a serious inconsistency or 
otherwise interfere with an action taken or planned by another agency; 
(3) Materially alter the budgetary impact of entitlements, grants, user 
fees, or loan programs or the rights and obligations of recipients 
thereof; or (4) Raise novel legal or policy issues arising out of legal 
mandates, the President's priorities, or the principles set forth in 
this Executive Order.''
    The economic, interagency, budgetary, legal, and policy 
implications of this regulatory action have been examined and it has 
been determined not to be a significant regulatory action under 
Executive Order 12866.

Unfunded Mandates

    The Unfunded Mandates Reform Act of 1995 requires, at 2 U.S.C. 
1532, that agencies prepare an assessment of anticipated costs and 
benefits before issuing any rule that may result in expenditure by 
State, local, and tribal governments, in the aggregate, or by the 
private sector, of $100 million or more (adjusted annually for 
inflation) in any one year. This final rule will have no such effect on 
State, local, and tribal governments, or the private sector.

Catalog of Federal Domestic Assistance

    The Catalog of Federal Domestic Assistance numbers and titles for 
the programs affected by this document are 64.009, Veterans Medical 
Care Benefits and 64.010, Veterans Nursing Home Care.

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. Jose D. 
Riojas, Interim Chief of Staff, Department of Veterans Affairs, 
approved this document on April 30, 2013 for publication.

List of Subjects in 38 CFR Part 17

    Administrative practice and procedure, Alcohol abuse, Alcoholism, 
Claims, Day care, Dental health, Drug abuse, Foreign relations, 
Government contracts, Grant programs-health, Government programs-
veterans, Health care, Health facilities, Health professions, Health 
records, Homeless, Medical and dental schools, Medical devices, Medical 
research, Mental health programs, Nursing homes, Veterans.

    Dated: May 1, 2013.
Robert C. McFetridge,
Director of Regulation Policy and Management, Office of General 
Counsel, Department of Veterans Affairs.
    For the reasons stated in the preamble, the Department of Veterans 
Affairs amends 38 CFR part 17 as follows:

PART 17--MEDICAL

0
1. The authority citation for part 17 continues to read as follows:

    Authority: 38 U.S.C. 501, and as noted in specific sections.


Sec.  17.56  [Amended]

0
2. Amend Sec.  17.56(a) introductory text by removing ``and except for 
non-contractual payments for home health services and hospice care''.
[FR Doc. 2013-10694 Filed 5-3-13; 8:45 am]
BILLING CODE 8320-01-P
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